Childhood morbidity after severe traumatic brain injury: Increased detection with the Multiattribute Health Status Classification.
OBJECTIVES: Study 1: To determine the interrater agreement on the Multiattribute Health Status Classification (MAHSC) for brain-injured children. Study 2: To determine the outcome of severe childhood traumatic brain injury (TBI) by comparing three measures: MAHSC, Functional Independence Measures (FIM/WeeFIM), and the Glasgow Outcome Scale. Designs: Study 1: Clinic recruitment of parents of patients. Study 2: Surveillance follow-up of an inception cohort. Settings: Study 1: The Brain Injury Clinic, Glenrose Rehabilitation Hospital, Edmonton, Canada. Study 2: Pediatric Intensive Care Unit, University of Alberta Hospital. PATIENTS: Study 1: Two physiatrists and parents of 50 children (5-18 yrs, 54% boys) independently completed the survey. Study 2: From a cohort of 51 patients (3-17 yrs, 69% boys, 6 deaths) consecutively admitted to the pediatric intensive care unit in 1995 and 1996 with severe TBI (Glasgow Coma Score </= 8 within the first 24 hrs postinjury), parents of all survivors (71% boys) completed outcome measures at 6-12 months postinjury. MEASUREMENTS AND MAIN RESULTS: Study 1: The interrater agreement exceeded 70% for attributes of sensation, mobility, cognition, self-care, and general health. Study 2: Of 45 survivors, 34 (76%) had a "good recovery" on the Glasgow Outcome Scale, 16 (36%) had normal scores on the FIM/WeeFIM, and only 8 (18%) had normal attributes on the MAHSC. Correlations of measures were Glasgow Outcome Scale and MAHSC, -.73; Glasgow Outcome Scale and FIM/WeeFIM,.64; and MAHSC and FIM/WeeFIM, -.63. Sensitivity and specificity from acute injury predictors for the Glasgow Outcome Scale were 88% and 91%, respectively; for MAHSC 75% and 70%; and for FIM/WeeFIM 63% and 75%. CONCLUSIONS: The MAHSC has a high interrater reliability after brain injury and is a useful parent-report surveillance tool to audit outcome after severe TBI. It identified problems not addressed by the Glasgow Outcome Scale or FIM/WeeFIM. Most children with severe TBI have adverse outcomes.
Robertson
Charlene M. T.
CM
Departments of Pediatrics and Rehabilitation Medicine (Drs. Robertson, Watt, Murphy, Nagy, McLean, and Pain), Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada; and the Department of Pediatrics (Drs. Robertson, Watt, and Joffe) and Department of Public Health Sciences (Dr. Saunders), University of Alberta, Edmonton, Alberta, Canada.
Watt
Joe M.
JM
Joffe
Ari R.
AR
Murphy
Deirdre B.
DB
Nagy
Julianna M.
JM
McLean
Deirdre E.
DE
Pain
Kerrie S.
KS
Saunders
L. Duncan
LD