Pediatric traumatic brain injury and burn patients in the civil justice system: the prevalence and impact of psychiatric symptomatology.

The goal of this research was to conduct an assessment of psychopathology in plaintiffs following pediatric traumatic brain injury (TBI) and burns and its relationship to awards of total compensatory damages. Childhood TBI (n = 43) and burn (n = 51) plaintiffs were ascertained through a survey of the U.S. civil justice system involving a review of judicial opinions and verdict reporters in cases that had resulted in an award of compensatory damages in all states from 1978 to 1988. Narrative summaries, drawn from these sources with supplemental information from counsel of record, where possible, were prepared. Psychiatric and disability ratings were made from the summaries, blind to award data. Outcome measures were the pattern and prevalence of psychiatric disorders and their correlation with the awards. It was found that psychiatric disorders, which were almost exclusively internalizing disorders (e.g., anxiety), were present in approximately 25 percent of the subjects in each group. Psychiatric symptoms were not related to the award amount. Significantly greater awards in the TBI group were accounted for by greater disability measures. Physical disability and total disability (including physical and quality of life limitations) were significantly and independently correlated with the award. It is concluded that the prevalence of psychiatric disorders in childhood TBI and burn plaintiffs is similar to that found in TBI and burn subjects in clinical studies. Distribution of disorders is atypical in that externalizing disorders (e.g., attention deficit/hyperactivity disorder) were not commonly reported for either class of injuries. Awards are strongly correlated with disability variables reflecting mainly the severity of physical injury. Internalizing psychopathology may be underappreciated in decisions involving magnitude of awards following selected childhood injuries.