Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Newcastle upon Tyne NE1 4LP, UK.
Arch Dis Child. 2010 Apr;95(4):266-70. doi: 10.1136/adc.2008.147926. Epub 2009 Nov 29.
To describe the range of early recovery patterns seen in children admitted for inpatient rehabilitation after traumatic brain injury and to build simple predictive models of expected recovery.
103 consecutive paediatric admissions to a neurological rehabilitation facility after closed head injury.
Children's recoveries were defined by repeated scores on the WeeFIM (a validated paediatric measure of functional independence) assembled into recovery trajectories. Non-linear mixed effects modelling was used to define 'typical' recoveries and to identify useful simple predictor variables.
WeeFIM recovery curves showed a characteristic sigmoidal form with an initial slow phase followed by a mid-phase of fastest improvement and a late plateau. Final WeeFIM scores ranged from 18 to 125 (median 105, IQR 87-117). The time taken to reach 50% final WeeFIM score ranged from 5 to 145 days (median 27, IQR 17-46). Both final WeeFIM and time to reach 50% final WeeFIM correlated with time to follow commands (TFC), defined as the post-injury day on which a child was first observed to follow two simple commands in a 24 h period.
Simple models predicting outcome trajectory can be built incorporating early rate-of recovery indices (such as TFC) as proxies of injury severity. Such models allow informed discussion with families of likely rates of progress and the CI on these estimates. Models of this nature also potentially allow identification of children making better- or worse-than expected recoveries.
描述创伤性脑损伤后住院康复的儿童早期康复模式范围，并建立预期康复的简单预测模型。
103 名连续接受闭合性颅脑损伤后神经康复设施住院治疗的儿科患者。
通过反复进行 WeeFIM（一种经过验证的儿童功能独立性测量工具）评分，将儿童的康复情况定义为康复轨迹。使用非线性混合效应模型定义“典型”康复，并确定有用的简单预测变量。
WeeFIM 恢复曲线呈特征性的 S 形，初始缓慢阶段后是最快改善的中期阶段，最后是平台期。最终的 WeeFIM 评分范围为 18 至 125（中位数 105，四分位距 87-117）。达到最终 WeeFIM 评分 50%所需的时间范围为 5 至 145 天（中位数 27，四分位距 17-46）。最终的 WeeFIM 和达到最终 WeeFIM 50%所需的时间均与跟随命令的时间（TFC）相关，TFC 定义为受伤后首次观察到儿童在 24 小时内遵循两个简单命令的天数。
可以建立简单的预测模型，纳入早期恢复率指数（如 TFC）作为损伤严重程度的替代指标。此类模型允许与患者家属进行有关进展速度和这些估计值置信区间的知情讨论。这种性质的模型还可以识别出康复情况好于或差于预期的儿童。
