Severity of pediatric traumatic brain injury and neurobehavioral recovery at one year--a cohort study.
As part of an ongoing longitudinal cohort study of children with mild, moderate, and severe traumatic brain injury and their matched controls, the neurobehavioral status of 94 case-control pairs was assessed one year after initial postinjury testing. There was a statistically significant dose-response association of severity with performance in all six domains of neurobehavioral functioning (intelligence, adaptive problem solving, memory, academic performance, motor performance, and psychomotor problem solving) with Spearman correlation coefficients of up to -.35, p < .001. The strongest correlations between severity and outcome were in the domains of intelligence, academic performance, and motor performance. Recovery over the year was also dependent on the severity of brain injury. Because mildly injured cases had negligible initial deficits, recovery was not at issue. However, for moderately and severely injured children, the degree of initial impairment was related to the magnitude of both recovery and residual deficit. Results showed that the use of population normative values to evaluate impairment was misleading. Although the mean scores of all severity groups fell within the normal range of standardized tests, the means for the moderately and severely injured were substantially below those of their matched controls on many tests.
Department of Rehabilitation Medicine, Children's Hospital and Medical Center, Seattle, WA 98105.
K M
KM
Jaffe
G C
GC
Fay
N L
NL
Polissar
K M
KM
Martin
H A
HA
Shurtleff
J M
JM
Rivara
H R
HR
Winn
D000293:Adolescent; D001930:Brain Injuries / Q000503:physiopathology* / Q000523:psychology; D002648:Child; D015331:Cohort Studies; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D007361:Intelligence Tests; D009483:Neuropsychological Tests; D011446:Prospective Studies; D015599:Trauma Severity Indices