Assessment of Post‐traumatic Amnesia in Young Children

Abstract

SUMMARY To assess the duration of post‐traumatic amnesia (PTA) in children, a new procedure is described, derived from a method described previously for adults. The procedure was tested on 70 healthy children between 3·5 and 10 years of age, then applied in a longitudinal prospective study of 54 children with brain damage resulting from closed head‐injury. The procedure consistently measured PTA in children of various ages. The duration of PTA was found to be as good a prognostic indicator for the occurrence of long‐term residual sequelae as is duration of coma. RÉSUMÉ Evaluation de l'amnésie post‐traumatique du jeune enfant L'article décrit une nouvelle méthode, dérivée d'une méthode décrite antérieurement chez l'adulte, pour évaluer la durée de l'amnésie post‐traumatique (PTA) chez l'enfant. Le procédé fut expérimenté chez 70 enfants en bonne santéâgés de trois ans et demi à dix ans et appliquéà une étude prospective longitudinale de 54 enfants ayant présenté un traumatisme céphalique récent. Le procédé mesura de façon réguliére la PTA des enfants à des âges variés. La durée de la PTA se révéla un aussi bon indicateur du risque de séquelles résiduelles a long terme que la durée du coma. ZUSAMMENFASSUNG Beurteilung der posttraumatischen Amnesie bei Kleinkindern Es wird eine neue Methode zur Beurteilung der Dauer einer posttraumatischen Amnesie (PTA) bei Kindern vorgestellt, die von einer früher beschriebenen Methode für Erwachsene abgeleitet wurde. Diese Methode wurde bei 70 gesunden Kindern zwischen 3½ und 10 Jahren getesfet und dann in einer prospektiven Langzeitstudie bei 54 Kindern mit einem Schädelhirntrauma angewendet. Mit der Methode wurde die PTA bei Kindern unterschiedlichen Alters gemessen. Die Dauer der PTA stellte sich als ebenso guter prognostischer Indikator für das Auftreten von Spätfolgen heraus wie die Dauer des Komas. RESUMEN Evaluación de la amnesia post‐traumática en niños pequeños Se describe un nuevo método para evaluar la duración de la amnesia post‐traumática (APT), derivada de un método descrito previamente para los adultos. La técnica se ensayó en 70 niños sanos entre 3½ y 10 años de edad, y luego se aplicó a un ensayo prospectivo longitudinal en 54 niños con daño cerebral originado por un traumatismo cerebral cerrado. La técnica consistia en medir la APT en niños de diferentes edades: se observó que la duración de la APT era un indicador pronóstico con respecto a la aparición de secuelas a largo plazo tan bueno, como lo es la duración del coma.

Time to follow commands remains the most useful injury severity variable for predicting WeeFIM® scores 1 year after paediatric TBI

“…These findings replicate the earlier work of Ruijs et al [21], who reported that TFC + PTA did not add value beyond TFC for examining short- and long-term outcomes after paediatric TBI. These results also support earlier work by Suskauer et al [2] demonstrating that TFC alone was a better predictor of functional outcome for children with TBI at both discharge from inpatient rehabilitation and 3-month follow-up.…”

“…Although TFC + PTA has been reported to be the best injury severity indicator for adult long-term follow-up [11, 12, 14, 15, 20], the paediatric literature has been less consistent [8, 18, 19]. Previous paediatric studies have found that TFC was a better predictor of WeeFIM® scores 3 months post-discharge [2] and that TFC demonstrated stronger correlations with outcome (GOS) than TFC + PTA at 3 months, 1 year and 2 years post-injury [21]. It was hypothesized that TFC would remain the best predictor of longer term functional outcome, as measured by WeeFIM® scores at 1 year post-discharge.…”

“…In children, Ruijs et al [21] previously reported that TFC demonstrated stronger correlations with outcome (GOS) than TFC + PTA at 3 months, 1 year and 2 years post-injury. In addition, TFC was felt to be easier to assess than TFC + PTA, thereby further contributing to the utility of TFC alone as a predictor variable.…”

Injury Severity Variables as Predictors of WeeFIM Scores in Pediatric TBI: Time to Follow Commands Is Best

“…Global outcome scales, including GOS and DRS, can be heavily influenced by cognitive function, and TFC+PTA has been shown to predict these outcomes [19,42,43]. TFC+PTA is also more predictive of cognitive outcome, as measured by neuropsychological testing [28].…”

“…TFC+PTA is predictive of global functional outcome, as measured by the GOS, at hospital discharge and at 3, 12, and 24 months post-injury [42, 43]. TFC+PTA has also been shown to predict performance on specific neurobehavioral measures at 3 weeks following normalization of COAT score and at 1 year post-injury [28].…”