Suskauer Stacy J, Slomine Beth S, Inscore Anjeli B, Lewelt Aga J, Kirk John W, Salorio Cynthia F
Kennedy Krieger Institute, Baltimore, MD, USA.
J Pediatr Rehabil Med. 2009;2(4):297-307.
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.
小儿创伤性脑损伤（TBI）后，预期功能的早期预后对于优化治疗至关重要。研究了几种常见脑损伤严重程度测量指标对小儿TBI功能结局的预测能力；所研究的严重程度变量包括格拉斯哥昏迷量表（GCS）评分、对指令有反应的时间（TFC）、创伤后遗忘症（PTA）持续时间以及意识障碍总持续时间（TFC + PTA）。在住院康复出院时（n = 120），使用儿童功能独立性测量量表（WeeFIM）评估结局，并且在一部分儿童中，在出院后3个月进行评估。使用GCS、TFC、PTA和TFC + PTA进行相关性和多元线性回归分析，以预测年龄校正后的WeeFIM评分。将TFC和PTA持续时间作为单独变量以及作为组合变量（TFC + PTA）输入的模型，均显著预测出院时的WeeFIM评分；然而，TFC在WeeFIM评分的方差中占最大比例。在接受住院康复的中重度TBI儿童中，TFC是出院时和随访时总体功能结局的最佳预测指标。我们的研究结果强调需要对TFC进行仔细且一致的评估，以尽早且准确地预测功能结局。
