Functional Outcome in Pediatric Trauma

De, Wesson; Ji, Williams; Lj, Spence; Rm, Filler; Pf, Armstrong; Rh, Pearl

doi:10.1097/00005373-198905000-00008

Cited by 59 publications

(31 citation statements)

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“…Although TBI is associated with the most disabling sequelae, children with other traumatic injuries also have a high prevalence of functional limitations. 21 Moreover, TBI and persistent physical limitations have been shown to place children at risk for psychosocial morbidity, including behavioral, academic, and family adjust- 22 To our knowledge, the broader outcome domain referred to as health-related quality of life (HRQL) 23 has not been previously examined in children with TBI. Indices of functional outcome, including physical health limitations, adaptive behavior, educational status, and physical and mental health service utilization can be subsumed under this rubric.…”

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Health-Related Quality of Life of Children and Adolescents After Traumatic Brain Injury

et al. 2002

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ABSTRACT. Objective. Relatively little is known about the longer-term impact of traumatic brain injury (TBI) on children's daily functioning, especially the broader outcome domain referred to as health-related quality of life (HRQL). The objective of the present study was to examine the nature and predictors of HRQL outcomes in children with moderate to severe TBI an average of 4 years postinjury.Methods. The study used a concurrent cohort-prospective design involving postinjury assessments of 3 groups of traumatically injured children and their families including 42 with severe TBI, 42 with moderate TBI, and 50 with orthopedic injuries only. Parent and child perceptions of HRQL and child adaptive behavior measures were obtained along with parent descriptions of the child's health problems and use of medical and mental health services. Predictors included indices of injury severity, social factors, and ratings of preinjury child behavior problems and school performance.Results. Based on parent report, adolescents who sustained severe TBI had lower HRQL related to overall psychosocial functioning and in the domains of behavior, mental health, general health, and family impact than adolescents who sustained orthopedic injuries only. Communication skills, daily living skills, and general adaptive functioning also were rated lower in the severe TBI group. In contrast to parent reports, adolescents with severe TBI did not rate their HRQL in most domains differently than did adolescents with orthopedic injuries. There were no group differences in frequency of persistent physical limitations. Sixty-seven percent of families of children with severe TBI used mental health counseling at some point after the injury. Risks for poorer HRQL outcomes were related to family social disadvantage and poorer preinjury child behavioral and academic functioning.Conclusions. Findings underscore the importance of using comprehensive measures of HRQL, along with traditional indicators of functional outcomes, when evaluating the longer-term impact of injuries in children. Identification of predictors suggests the need for close monitoring and intervention of high-risk children. Pediatrics 2002;109(2). URL: http://www. pediatrics.org/cgi/content/full/109/2/e34; traumatic brain injury, health-related quality of life, functional outcomes.ABBREVIATIONS. TBI, traumatic brain injury; HRQL, healthrelated quality of life; CNS, central nervous system; GCS, Glasgow Coma Scale; MISS, Modified Injury Severity Score; SCI, Socioeconomic Composite Index; FAD, Family Assessment Device; FAD-GF, Family Assessment Device General Functioning Scale; CHQ, Child Health Questionnaire; SD, standard deviation; WHO, World Health Organization; CBCL, Child Behavior Checklist; TRF, (Child Behavior Checklist) Teacher's Report Form; OR, odds ratio; CI, 95% confidence interval; SE, standard error. S tudy of the functional status of children with traumatic brain injury (TBI) is justified by both the prevalence of the condition and the multifaceted nature of injury sequel...

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Health-Related Quality of Life of Children and Adolescents After Traumatic Brain Injury

et al. 2002

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“…In addition, they found poor attention with longer duration of impaired consciousness. In another study, 61 82.5% of children 4 years old or older and 92.5% of children 5 to 17 years old were disabled at discharge. Of the 156 children seen at 6 months postdischarge, 84 (53.8%) continued to be disabled.…”

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confidence: 89%

“…The effect of age on impairment is not clear, however, because Wesson et al 61 found that younger children have less residual impairment than older children, but Michaud et al 37 found that school-age children who were injured as preschoolers were 8.8 times more likely to have behavioral disorders at school age than children who were injured in the school-age years. Although Kaufmann et al 23 suggest that time since injury interacts with the age of child, this does not account for the discrepancy.…”

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Effects of Pediatric Head Trauma for Children, Parents, and Families

Youngblut

Singer

Boyer

et al. 2000

Critical Care Nursing Clinics of North America

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SUMMARYSevere pediatric head injury has negative consequences for children of all ages. Even mild and moderate head injury results in residual impairment for school-age children and adolescents. Data are needed on the effects of these less severe insults, especially for preschoolers. Although research on the impact of the child's head injury on the parent-child relationship and family functioning is limited, the experience is likely to be very stressful for the parent and the family. Indeed, family integrity may be at risk. Research is needed that examines the effects of a child's head injury for the parent and the family over time and identifies factors related to these outcomes.Accidental injury is the leading cause of death and acquired disability for children over 1 year of age. Children under 15 years of age account for 22.4% of over 35 million emergency department visits each year that result from injury. 42 Head injuries account for 29% of children's hospitalizations caused by injury. 34 Most pediatric head injuries are caused by accidental falls and motor vehicle accidents for 1-to 9-year olds and sports injuries for 5-to 9-year olds. 28 Continued progress in emergency medical care has led to increased survival of children with traumatic brain injury, but many survivors are at high risk for acute and chronic impairments in functioning. Thus, brain-injured children and their families face significant challenges because of impairment that affects the children's daily lives, their school performance, their future, and frequently, the well-being of family members and the family system. When a preschool child suffers an accidental head injury, families are suddenly faced with fears about the child's survival and current condition and uncertainty about the child's future. Hospitalization in a pediatric intensive care unit (PICU) may exacerbate these fears. 64, 66 Severely brain-injured school-age children and adolescents are often left with significant disabilities. 16 Even school-age children and adolescents with mild traumatic brain injuries experience decreased functional status initially and problems with neurobehavioral abilities, such as attention deficit and memory loss, for at least a year after the injury. 47 The stress associated with adapting to a "new" child with continuing but subtle deficits is likely to have negative effects for the parent's mental health, with potential deterioration of the parent-child and family relationships. The purpose of this article is to review the research on effects of head injury for the injured child, the parents, and the family.Address reprint requests to

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