Developmental trajectories of infants and toddlers with good initial presentation following moderate or severe traumatic brain injury: a pilot clinical assessment project.
OBJECTIVE
The purpose of this study was to review the feasibility and usefulness of instituting a clinical protocol of scheduled assessments for children after a moderate or severe traumatic brain injury (TBI) sustained before the age of 2 years and showing no immediate deficits at hospital discharge, as well as to explore the early developmental trajectories of these children.


METHODS
Exploratory analytical cohort study.


METHODS
Pediatric Trauma Center Out-patient services.


METHODS
31 children were followed within the clinical protocol of scheduled assessments.


METHODS
The protocol included an immediate post-injury clinical assessment of infants who sustained a TBI and follow-up assessments at the ages of 9 months, 18 months (if injured prior to that age), 30 months, and 42 months. Domains assessed at each scheduled visit included hearing, speech and language, motor performance, personal social abilities, and adaptive behaviors.


RESULTS
Clinicians reported few difficulties with scheduling or administering the assessments, maintaining a 67% participation rate at the end of the follow-up period, thus demonstrating the feasibility of the protocol in this population. Scores on the majority of formal tests showed high variability and 15-20% of children presented with clinically significant motor and/or language delays. By 42 months of age, difficulties with adaptive behavior and personal social abilities were identified in our sample of children when compared to published norms. Qualitative clinical findings from professionals identified between 25-50% of children with potential attentional difficulties throughout the follow-up period.


CONCLUSIONS
Findings from this study demonstrate the feasibility of implementing a clinical protocol of assessment for infants and toddlers who sustain a TBI before the age of 2 years and present with no impairments at the time of discharge from hospital. Developmental problems in this population appear to be easier to identify later in the toddler years as opposed to immediately following the TBI, emphasizing the importance of providing screening for developmental issues in this population prior to school entry.
Montreal Children's Hospital of the McGill University Health Center, Montreal, PQ, Canada.
Geneviève
G
Pomerleau
Anne-Marie
AM
Hurteau
Line
L
Parent
Katrine
K
Doucet
Laurie-Ann
LA
Corbin-Berrigan
Isabelle
I
Gagnon
D000553:Ambulatory Care / Q000379:methods*; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology*; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000209:etiology; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D010045:Outpatients; D010865:Pilot Projects; D012720:Severity of Illness Index