Functional status 1 year after severe childhood traumatic brain injury predicts 7-year outcome: results of the TGE study - 02/01/22

Doi : 10.1016/j.rehab.2021.101627

Sara Neumane, MD-PhD ^a,^b,^c, Hugo Câmara-Costa, PhD ^d,^e, Leila Francillette, MSc ^d, Hanna Toure, MD ^a, Dominique Brugel, MD ^a, Anne Laurent-Vannier, MD ^a, Philippe Meyer, MD ^f,^g, Laurence Watier, PhD ^h, Georges Dellatolas, MD-PhD ^e, Mathilde Chevignard, MD-PhD ^a,^d,^e,^⁎
^a Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals, Saint Maurice, France
^b Université de Paris, NeuroDiderot, Inserm, Paris, France
^c Université Paris-Saclay, NeuroSpin-UNIACT, CEA, Gif-sur-Yvette, France
^d Sorbonne Université, Laboratoire d'Imagerie Biomédicale, LIB, CNRS, INSERM, F-75006, Paris, France
^e Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCRe), Paris, France
^f Pediatric Anesthesiology Department, Hôpital Necker Enfants Malades, Paris, France
^g Paris Descartes University, Faculty of Medicine, Paris, France
^h Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France

^⁎Corresponding author: Dr. Mathilde Chevignard, Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals, 14, rue du Val d'Osne, 94410 Saint Maurice, France, Tel: (00)33 1 43 96 63 40, Fax: (00)33 1 43 96 65 47.Rehabilitation Department for Children with Acquired Neurological InjurySaint Maurice Hospitals14, rue du Val d'OsneSaint Maurice94410France

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Highlights

•	Childhood severe traumatic brain injury (TBI) has a long-term impact on morbidity and functional deficits.
•	About 50% of childhood severe TBI survivors exhibit substantial disability at 7 years after severe TBI.
•	Socio-behavioural and cognitive deficits are the most common long-lasting sequelae.
•	Long-term outcome is poorly predicted by early clinical factors / injury severity.
•	Functional impairments at 1 year after TBI strongly predicts disability at 7 years.

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Abstract

Background

Childhood severe traumatic brain injury (TBI) is a leading cause of long-lasting acquired disability, but predicting long-term functional outcome remains difficult.

Objectives

This study aimed to 1) describe the functional outcome at 1 and 7 years post-TBI; 2) determine the initial and concurrent factors associated with long-term outcome; and 3) evaluate the predictive value of functional status, overall disability level and intellectual ability measured at 1 year post-injury to determine 7-year clinically meaningful outcomes.

Methods

Among the children (<16 years) consecutively included over 3 years in the Traumatisme Grave de l'Enfant (TGE) prospective longitudinal cohort study after accidental severe TBI, we studied the outcomes of 39 survivors at 1 and 7 years post-injury. Overall outcome included disability level (Glasgow Outcome Scale), functional status (Pediatric Injury Functional Outcome Scale), intellectual ability (Wechsler scales), executive functions (Behavior Rating Inventory of Executive Functions), behaviour (Child Behavior Checklist) as well as neurological impairments and academic status.

Results

Mean (SD) age of the 39 survivors at injury was 7.6 (4.6) years, and long-term evaluation was conducted at a mean of 7.8 years post-injury (range 5.9–9.3); 36% of participants were adults (≥18 years old). Most of the neurological impairments remained stable beyond 1 year after TBI, whereas overall disability level improved significantly from 1 to 7 years but remained highly variable, with almost half of participants presenting significant disability levels (moderate: 26%, or severe: 21%). Almost half of participants had significant cognitive, behaviour and/or academic difficulties at 7 years post-TBI. On multivariate regression analysis, functional impairment at 1 year was the best predictor of severe disability at 7 years (F_(3,31)=13.18, p<0.001, sensitivity=100%, specificity=78%).

Conclusions

Our results confirm the significant long-term impact of childhood severe TBI. All children with TBI should benefit from systematic follow-up, especially those with persistent functional deficits at 1 year post-injury, because the severity of functional impairment at 1 year seems the best predictor of long-term significant disability up to 7 years post-TBI.

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Keywords : severe traumatic brain injury, child, functional outcome, disability, longitudinal cohort study, long-term follow-up