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Identifying factors contributing to child and family outcome 30 months after traumatic brain injury in children

¹ University of Melbourne, Melbourne, 3010 Australia
² Murdoch Children’s Research Institute, Melbourne, Australia
³ Alfred Medical Centre, Melbourne, Australia

Correspondence to:
Correspondence to:
Professor V Anderson
Department of Psychology, Royal Children’s Hospital, Flemington Road, Victoria, 3052, Australia; v.anderson{at}vaa.animels.edu.au

Objective: To examine the contributions of injury severity, physical and cognitive disability, child and family function to outcome 30 months after traumatic brain injury (TBI) in children.

Design: A prospective, longitudinal, between group design, comparing function before and after injury across three levels of injury severity.

Subjects: One hundred and fifty children, 3.0–12.11 years old, admitted to hospital with a diagnosis of TBI. The sample was divided according to injury severity: mild (n = 42), moderate (n = 70), severe (n = 38). Children with a history of neurological, developmental, and psychiatric disorders were excluded from participation.

Main outcome measures: Post injury physical function, cognitive ability (incorporating intellect, memory, and attention), behavioural and family functioning, and level of family burden.

Results: A dose–response relation was identified for injury severity and physical and cognitive outcome, with significant recovery documented from acute to six months after TBI. Behavioural functioning was not related to injury severity, and where problems were identified, little recovery was noted over time. Family functioning remained unchanged from preinjury to post injury assessments. The level of family burden was high at both six and 30 months after injury, and was predicted by injury severity, functional impairment, and post injury child behavioural disturbance.

Conclusions: These results suggest ongoing problems for the child and significant family burden 30 months after TBI. The nature and severity of the physical and cognitive problems are closely related to injury severity, with child and family function predicted by psychosocial and premorbid factors.

Abbreviations: CT, computed tomography; FBII, Family Burden of Injury Interview; FFD, Freedom from Distractibility; FFS, Family Functioning Scales; FSIQ, Full Scale IQ; GCS, Glasgow Coma Scale score; GOS, Glasgow Outcome Scale; MRI, magnetic resonance imaging; MTBI, mild traumatic brain injury; ModTBI, moderate traumatic brain injury; PIC, Personality Inventory for Children; PIQ, Performance IQ; RBRI, Rowe Behavioural Rating Inventory; SES, socioeconomic status; SLT, Spatial Learning Test; SRT, Story Recall Test; SS, scaled score/standard score; STBI, severe traumatic brain injury; TBI, traumatic brain injury; VABS, Vineland Adaptive Behavior Scale; VIQ, Verbal IQ; VLT, Visual Learning Test; WISC-III, Wechsler Intelligence Scale for Children-III; WPPSI-R, Wechsler Preschool and Primary Intelligence Scale-Revised

Keywords: traumatic brain injury; childhood; family; predictors