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

Abstract

After pediatric traumatic brain injury (TBI), early prognosis of expected function is important for optimizing care. The power of several common brain injury severity measures for predicting functional outcome in children with TBI was investigated; the severity variables studied were Glasgow Coma Scale (GCS) score, time to follow commands (TFC), duration of post-traumatic amnesia (PTA), and total duration of impaired consciousness (TFC+PTA). Outcome was assessed using the Functional Independence Measure for Children (WeeFIM) at discharge from inpatient rehabilitation (n = 120) and, in a subset of children, at 3 months following discharge. Correlations and multiple linear regression analyses were conducted using GCS, TFC, PTA, and TFC+PTA to predict age-corrected WeeFIM scores. Models in which TFC and PTA duration were entered as separate variables and as a combined variable (TFC+PTA) were all significantly predictive of WeeFIM scores at discharge; however, TFC accounted for the greatest portion of variance in WeeFIM scores. Among children with moderate to severe TBI who received inpatient rehabilitation, TFC was the best predictor of general functional outcome at discharge and follow-up. Our findings highlight the need for careful and consistent assessment of TFC to assist in predicting functional outcomes as early and accurately as possible.

Analysis of long-term (median 10.5 years) outcomes in children presenting with traumatic brain injury and an initial Glasgow Coma Scale score of 3 or 4

“…6,21,25,28,36,39,43,51,53 Other factors that may be independent predictors of outcome in severe TBI patients include prehospital deterioration, duration of coma, time to "follow commands" duration of amnesia, time to resume oral feeding, and measurement of the efficacy of interventions designed to lower ICP. 17,20,40,45 As most of the published studies evaluated adults, we sought to examine a relatively large cohort of children presenting with a postresuscitation GCS (modified for pediatric patients) score of 3 or 4. We evaluated 67 children treated at a Level 1 trauma center.…”

Emergence to the Conscious State During Inpatient Rehabilitation After Traumatic Brain Injury in Children and Young Adults

“…The prognostic significance of command following at admission is consistent with prior work demonstrating the importance of time to follow commands for predicting outcome among broader groups of children with TBI. 18,19 These data must be interpreted within the context of understanding that individuals with MCS− and MCS+ fall into the broader category of consciousness consistent with MCS, which is associated with more favorable outcome among individuals with DOC. [5][6][7] Further work to examine the prognostic significance of the distinction of MCS− versus MCS+ is needed, although our data suggest that, among children with TBI, there is initial support for the use of command following as a predictor for emergence to CS.…”

Neuropsychological scores and WeeFIM cognitive ratings of children with traumatic brain injury: A brief report

“…Significant impairments in IQ scores, attention and verbal memory compared to controls have been documented in children 2 years post-severe TBI [2]. WeeFIM scores correlated positively with time from injury to rehabilitation admission and length of stay [3], as well as time to follow commands in children post-TBI [4].…”