Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals, Saint Maurice, France; Université de Paris, NeuroDiderot, Inserm, Paris, France; Université Paris-Saclay, NeuroSpin-UNIACT, CEA, Gif-sur-Yvette, France.
Sorbonne Université, Laboratoire d'Imagerie Biomédicale, LIB, CNRS, INSERM, F-75006, Paris, France; Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCRe), Paris, France.
Ann Phys Rehabil Med. 2022 Sep;65(5):101627. doi: 10.1016/j.rehab.2021.101627. Epub 2022 Mar 2.
Childhood severe traumatic brain injury (TBI) is a leading cause of long-lasting acquired disability, but predicting long-term functional outcome remains difficult.
This study aimed to 1) describe the functional outcome at 1 and 7 years post-TBI; 2) determine the initial and concurrent factors associated with long-term outcome; and 3) evaluate the predictive value of functional status, overall disability level and intellectual ability measured at 1 year post-injury to determine 7-year clinically meaningful outcomes.
Among the children (<16 years) consecutively included over 3 years in the Traumatisme Grave de l'Enfant (TGE) prospective longitudinal cohort study after accidental severe TBI, we studied the outcomes of 39 survivors at 1 and 7 years post-injury. Overall outcome included disability level (Glasgow Outcome Scale), functional status (Pediatric Injury Functional Outcome Scale), intellectual ability (Wechsler scales), executive functions (Behavior Rating Inventory of Executive Functions), behavior (Child Behavior Checklist) as well as neurological impairments and academic status.
Mean (SD) age of the 39 survivors at injury was 7.6 (4.6) years, and long-term evaluation was conducted at a mean of 7.8 years post-injury (range 5.9-9.3); 36% of participants were adults (≥18 years old). Most of the neurological impairments remained stable beyond 1 year after TBI, whereas overall disability level improved significantly from 1 to 7 years but remained highly variable, with almost half of participants presenting significant disability levels (moderate: 26%, or severe: 21%). Almost half of participants had significant cognitive, behavior and/or academic difficulties at 7 years post-TBI. On multivariate regression analysis, functional impairment at 1 year was the best predictor of severe disability at 7 years (F=13.18, p < 0.001, sensitivity=100%, specificity=78%).
Our results confirm the significant long-term impact of childhood severe TBI. All children with TBI should benefit from systematic follow-up, especially those with persistent functional deficits at 1 year post-injury, because the severity of functional impairment at 1 year seems the best predictor of long-term significant disability up to 7 years post-TBI.
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，但预测长期功能预后仍然困难。
本研究旨在：1）描述 TBI 后 1 年和 7 年的功能预后；2）确定与长期预后相关的初始和并发因素；3）评估损伤后 1 年测量的功能状态、整体残疾程度和智力能力对确定 7 年临床有意义结局的预测价值。
在连续 3 年纳入的 Traumatisme Grave de l'Enfant（TGE）前瞻性纵向队列研究中的儿童（<16 岁）中，我们研究了 39 名幸存者在受伤后 1 年和 7 年的结局。总体结局包括残疾程度（格拉斯哥结局量表）、功能状态（儿科损伤功能结局量表）、智力能力（韦氏量表）、执行功能（行为评定量表）、行为（儿童行为检查表）以及神经损伤和学业状况。
39 名幸存者在受伤时的平均（SD）年龄为 7.6（4.6）岁，长期评估在受伤后平均 7.8 年进行（范围 5.9-9.3 年）；36%的参与者为成年人（≥18 岁）。大多数神经损伤在 TBI 后 1 年以上仍保持稳定，而整体残疾程度从 1 年到 7 年显著改善，但仍高度可变，近一半的参与者存在显著的残疾水平（中度：26%，或重度：21%）。近一半的参与者在 TBI 后 7 年仍存在认知、行为和/或学业困难。多元回归分析显示，1 年时的功能障碍是 7 年时严重残疾的最佳预测因素（F=13.18，p<0.001，敏感性=100%，特异性=78%）。
我们的结果证实了儿童严重 TBI 的显著长期影响。所有 TBI 患儿都应受益于系统的随访，尤其是那些在受伤后 1 年仍存在持续性功能缺陷的患儿，因为 1 年时的功能障碍严重程度似乎是 TBI 后 7 年长期显著残疾的最佳预测因素。
