Research Reports - Academic outcome, participation and health-related quality of life following childhood severe traumatic brain injury
Ann Phys Rehabil Med. 2016 Sep;59S:e133. doi: 10.1016/j.rehab.2016.07.298.
Chevignard M(1), Francillette L(2), Toure H(3), Brugel D(3), Meyer P(4), Vannier
AL(3), Opatowski M(5), Watier L(6).
OBJECTIVE: Childhood traumatic brain injury (TBI) is the first cause of death and
acquired disability and it represents a major public health issue. Childhood
severe TBI can lead to motor, cognitive, behavioural and social cognition
deficits, which have consequences on academic achievement, social integration,
participation and quality of life. Consequences may only appear after a delay,
when the skills are supposed to be fully developed. The aim of this study was to
prospectively assess academic outcome, health-related quality of life (HRQoL),
amount of ongoing care and participation, following childhood severe traumatic
brain injury (TBI) over 7-8years post-injury, in comparison with a matched
uninjured control group.
MATERIAL/PATIENTS AND METHODS: Sixty-five children, aged 0-15years, consecutively
admitted in a single trauma center over a 3-year period for severe non-inflicted
TBI were included in a prospective longitudinal study. At 7-8years, they were
compared with a matched control group regarding schooling modalities, amount of
ongoing care, and standardized questionnaires of HRQoL (PedsQL, including fatigue
module), and participation (Child and Adolescent Scale of Participation - CASP).
Family socio-economic status (SES) was assessed by parental education level.
RESULTS: After a mean delay of 7.7years, 39 patients participated in the study
(60% of the initial sample; 66% boys; mean coma duration: 6.6days; SD=4.83; mean
age at injury: 7.6years, SD=4.72; mean age at assessment: 15.3years, SD=4.46,
range 7.2-22.2), with no significant differences between participants and
non-participants regarding demographic and severity factors, or initial
intellectual ability). Only 62% of the TBI group was attending mainstream
education (as opposed to 100% of controls). The amount of ongoing rehabilitation
was high (35.3% speech-language therapy, 26.4% occupational therapy; 17.6%
physiotherapy). Self-reported HRQoL was significantly lower in the TBI than in
the control group [71.1; 95% IC 64.8-77.5 versus 83.9; 95% IC 79.3-88.4;
P=0.0026], including the fatigue module [61.1; 95% IC 54.6-67.5 versus 77.4; 95%
IC 71.9-82.8; P=0.0005]. Parent ratings of participation were relatively good but
significantly lower than those of controls [86.4; 95% IC 81.4-91.3 versus 96.3;
95% IC 94.6-98.1; P=0.0002].
DISCUSSION-CONCLUSION: Severe childhood TBI leads to severe and long-standing
impairments, evident several years post-injury, with consequences on school
integration, independence, participation and HRQOL.