Published online February 1, 2006
PEDIATRICS Vol. 117 No. 2 February 2006, pp. 317-324 (doi:10.1542/10.1542/peds.2005-0979)
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Child Outcomes and Family Characteristics 1 Year After Severe Inflicted or Noninflicted Traumatic Brain Injury

Heather T. Keenan, MDCM, PhDa, Desmond K. Runyan, MD, DrPHb,c and Maryalice Nocera, RN, MSNd

a Department of Pediatrics and Intermountain Injury Research Control Center, University of Utah, Salt Lake City, Utah;
b Department of Social Medicine University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
c Department of Pediatrics University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
d Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

Objective. To assess outcomes 1 year after severe traumatic brain injury (TBI) among young children and to compare outcomes between children with inflicted versus noninflicted injuries.

Study Design. Prospective cohort study.

Methods. All North Carolina-resident children who were hospitalized between January 2000 and December 2001 in any of the state's 9 PICUs and who survived a severe TBI that occurred on or before their second birthday were eligible to participate. Child health status, child use of ancillary medical resources, and family characteristics were determined through maternal caregiver interviews ~1 year after injury. Comparisons were made between family characteristics and child outcomes according to injury type.

Results. Seventy-two interviews of maternal caregivers were completed among 112 survivors (64.3%). Children with inflicted injuries (n = 41) had worse outcomes than did children with noninflicted injuries (n = 31), as measured with the Pediatric Outcome Performance Category and Stein-Jessup Functional Status II (Revised) tools. However, ~50% of children with inflicted injuries had only mild deficits or better. Children with inflicted injuries had a higher use of ancillary medical resources. Families caring for the children did not differ substantively, with a large proportion of single, working, minority mothers.

Conclusions. Children with inflicted TBIs had worse outcomes than did children with other TBIs 1 year after injury. However, outcomes for these children were better than those reported previously. Many families caring for children after severe TBI are socially disadvantaged. Interventions to improve child outcomes may include enhanced family support.

Key Words: traumatic brain injury • child abuse • outcomes • shaken infant syndrome

Abbreviations: CI—confidence interval • CPR—cardiopulmonary resuscitation • DSS—Department of Social Services • FSII(R)—Functional Status II (Revised) • GCS—Glasgow Coma Scale • IQR—interquartile range • POPC—Pediatric Outcome Performance Category • RR—relative risk • TBI—traumatic brain injury

Accepted Jun 15, 2005.


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