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

Abstract

Objective To investigate the relationship between injury severity variables, particularly time to follow commands (TFC) and long-term functional outcomes in paediatric traumatic brain injury (TBI). Methods and procedure Participants included 40 children with moderate-to-severe TBI discharged from inpatient rehabilitation. Measures of severity were initial Glasgow Coma Scale score, TFC, duration of Post Traumatic Amnesia (PTA) and total duration of impaired consciousness (TFC + PTA). Functional outcome was measured by age-corrected Functional Independence Measure for Children (WeeFIM®) scores at 1-year after discharge. Results Correlations indicated that injury severity variables (TFC, PTA and TFC + PTA) were all associated with functional outcome. Regression analyses revealed that TFC and TFC + PTA similarly accounted for 49% or 47% of the variance, respectively, in total WeeFIM® score. Thirty-seven of 40 children had good outcome; of the three children with TFC 426 days, two had poor outcome. Conclusion PTA and TFC + PTA do not provide a benefit over TFC alone for prediction of long-term outcome and TFC is identified earlier in the recovery course. TFC remains an important predictor of functional outcome 1-year after discharge from inpatient rehabilitation after paediatric TBI.

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.…”

Functional Independence After Inpatient Rehabilitation for Traumatic Brain Injury Among Minority Children and Adolescents

“…Other investigators have employed DFQs for TBI studies. 8,9 In brief, DFQs provide a quotient score based on age-norm scores, ranging from 14 (lowest possible quotient for a patient who receives a score of 1 in all domains and for whom the age-norm is 7) to more than 100 (a patient who performs at a level that exceeds the age-norm). DFQs are provided by UDSMR ® for all patients who were assessed using the WeeFIM ® instrument.…”

A Narrative Review of Pharmacologic and Non-pharmacologic Interventions for Disorders of Consciousness Following Brain Injury in the Pediatric Population

“…About 15 % of children who experience a TBI will have moderate or severe injuries that include a period of decreased responsiveness [4]. Longer time to recovery from disorders of consciousness is predictive of worse prognosis after TBI [5, 6], and some reports suggest that shortening the period of disordered consciousness may improve outcomes, at least in part by increasing participation in rehabilitation treatment [7, 8]. …”