Injury severity variables as predictors of WeeFIM scores in pediatric TBI: Time to follow commands is best

Issue title: Pediatric Traumatic Brain Injury

Article type: Research Article

Authors: Suskauer, Stacy J.^; | Slomine, Beth S.^; | Inscore, Anjeli B. | Lewelt, Aga J. | Kirk, John W. | Salorio, Cynthia F.^;

Affiliations: Kennedy Krieger Institute, Baltimore, MD, USA | Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA | Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA | VA Maryland Health Care System, Baltimore Medical Center, Baltimore, MD, USA | Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, UT, USA | Department of Physical Medicine and Rehabilitation, The Children's Hospital, Denver, CO, USA

Note: [] Corresponding author: Stacy Suskauer, M.D. Kennedy Krieger Institute, Pediatric Rehabilitation, 707 North Broadway, Baltimore, MD 21205, USA. Tel.: +1 443 923 9440; Fax: +1 443 923 9445; E-mail: suskauer@kennedykrieger.org

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.

Keywords: Traumatic brain injury, children, outcome, coma, post-traumatic amnesia

DOI: 10.3233/PRM-2009-0092

Journal: Journal of Pediatric Rehabilitation Medicine, vol. 2, no. 4, pp. 297-307, 2009