Rehabilitation Department for Children with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France; Sorbonne University, Faculty of Medicine, Paris, France.
Université Paris-Saclay, Université Paris-SUD, UVSQ, CESP, INSERM, Paris, France; Sorbonne Université, Laboratoire d'Imagerie Biomédicale, Paris, France.
Ann Phys Rehabil Med. 2021 Jan;64(1):101375. doi: 10.1016/j.rehab.2020.01.008. Epub 2020 Apr 7.
Childhood severe traumatic brain injury (TBI) is a leading cause of long-lasting acquired disability, but little is known about functional outcome.
We aimed to 1) study clinical recovery and functional outcome over 24 months after severe childhood TBI, 2) identify early sociodemographic and severity factors influencing outcome, and 3) examine the clinical utility of the Pediatric Injury Functional Outcome Scale (PIFOS) to assess functional outcome.
Children (0-15 years) consecutively admitted in a trauma centre after accidental severe TBI over 3 years were included in a prospective longitudinal study (Traumatisme Grave de l'Enfant cohort). We measured clinical/neurological recovery, functional status (Pediatric Injury Functional Outcome Scale, [PIFOS]), overall disability (pediatric Glasgow Outcome Scale [GOS-Peds]) as well as intellectual ability (Wechsler scales) and educational outcome (mainstream school vs special education) of survivors at 1, 3, 12 and 24 months post-injury.
For 45 children (aged 3 to 15 years at injury), functional impairments were severe within the first 3 months. Despite the initial rapid clinical recovery and significant improvement over the first year, substantial alterations persisted for most children at 12 months post-TBI, with no significant improvement up to 2 years. Up to 80% of children still had moderate or severe overall disability (GOS-Peds) at 24 months. The severity of functional impairments (PIFOS) at 12 and 24 months was mostly related to socio-emotional, cognitive and physical impairments, and was significantly correlated with clinical/neurological deficits and cognitive (intellectual, executive) and behavioural disorders. Initial TBI severity was the main prognostic factor associated with functional status over the first 2 years post-injury.
Our results confirm the significant impact of severe childhood TBI on short- and medium-term functional outcomes and overall disability. All patients should benefit from systematic follow-up. The PIFOS appeared to be an accurate and reliable tool to assess functional impairment evolution and clinically meaningful outcomes over the first 2 years post-injury.
儿童严重创伤性脑损伤（TBI）是导致长期获得性残疾的主要原因，但对其功能结果知之甚少。
我们旨在：1）研究儿童严重 TBI 后 24 个月的临床恢复和功能结局，2）确定影响结局的早期社会人口统计学和严重程度因素，3）评估儿童创伤功能结局量表（PIFOS）评估功能结局的临床效用。
在 3 年多的时间里，连续在创伤中心收治意外发生的严重 TBI 的儿童（0-15 岁）纳入前瞻性纵向研究（Traumatisme Grave de l'Enfant 队列）。我们测量了幸存者在损伤后 1、3、12 和 24 个月的临床/神经恢复情况、功能状态（儿童创伤功能结局量表[PIFOS]）、总体残疾（儿科格拉斯哥结局量表[GOS-Peds]）以及智力能力（韦氏量表）和教育结果（主流学校与特殊教育）。
对于 45 名（受伤时年龄 3 至 15 岁）儿童，最初 3 个月内功能障碍严重。尽管最初临床恢复迅速，第一年显著改善，但大多数儿童在 TBI 后 12 个月仍存在明显改变，2 年内无明显改善。在 24 个月时，仍有 80%的儿童存在中度或重度总体残疾（GOS-Peds）。12 个月和 24 个月时的功能障碍严重程度（PIFOS）主要与社会情感、认知和身体障碍有关，与临床/神经缺陷以及认知（智力、执行）和行为障碍显著相关。初始 TBI 严重程度是与损伤后前 2 年功能状态相关的主要预后因素。
我们的研究结果证实了儿童严重 TBI 对短期和中期功能结局以及总体残疾的显著影响。所有患者都应受益于系统的随访。PIFOS 似乎是一种准确可靠的工具，可以在损伤后前 2 年评估功能障碍的演变和具有临床意义的结局。
