Published online December 29, 2008
PEDIATRICS Vol. 123 No. 1 January 2009, pp. 199-206 (doi:10.1542/peds.2008-0607)
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ARTICLE

Family Burden After Traumatic Brain Injury in Children

Mary E. Aitken, MD, MPHa, Melissa L. McCarthy, ScDb, Beth S. Slomine, PhDc,d, Ru Ding, MSb, Dennis R. Durbin, MD, MSCEe, Kenneth M. Jaffe, MDf, Charles N. Paidas, MD, MBAg, Andrea M. Dorsch, PhDh, James R. Christensen, MDi,j, Ellen J. MacKenzie, PhDk and the CHAT Study Group

a Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine, Arkansas Children's Hospital Research Institute, Little Rock, Arkansas
Departments of b Emergency Medicine
d Psychiatry
j Physical Medicine and Rehabilitation and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
c Department of Neuropsychology
i Pediatric Rehabilitation Medicine, Kennedy Krieger Institute, Baltimore, Maryland
e Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
f Departments of Rehabilitation Medicine and Pediatrics
h Division of Rehabilitation Psychology, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle, Washington
g Department of Surgery, University of South Florida, Tampa, Florida
k Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland

OBJECTIVE. Traumatic brain injury has a substantial impact on caregivers. This study describes the burden experienced by caregivers of children with traumatic brain injury and examines the relationship between child functioning and family burden during the first year after injury.

PATIENTS AND METHODS. Children aged 5 to 15 years hospitalized for traumatic brain injury at 4 participating trauma centers were eligible. Caregivers completed baseline and 3- and 12-month telephone interviews measuring the child's health-related quality of life using the Pediatric Quality of Life Inventory. The emotional impact scale of the Child Health Questionnaire was used to identify caregivers with substantial distress, including general worry or interference with family routine. Caregiver perceptions of whether health care needs were met or unmet and days missed from work were also measured.

RESULTS. A total of 330 subjects enrolled; follow-up was conducted with 312 at 3 months and 288 at 12 months. Most subjects were white (68%) and male (69%). Abnormal Pediatric Quality of Life Inventory subscores were related to substantial caregiver burden (either general worry or interference in routine). These abnormalities were reported by >75% of patients at 3 months and persisted to 1 year in some patients. Parental perception of unmet health care needs was strongly related to family burden outcomes, with up to 69% of this subset of parents reporting substantial worry, and nearly one quarter reporting interference with daily routine/concentration 1 year after injury. Child dysfunction predicted parental burden at 3 and 12 months. Burden was greater when health care need was unmet. Abnormalities on the Pediatric Quality of Life Inventory predicted the amount of work missed by parents, especially in the presence of unmet needs.

CONCLUSIONS. Caregivers are more likely to report family burden problems when child functioning is poorer and health care needs are unmet. Improved identification and provision of services is a potentially modifiable factor that may decrease family burden after pediatric traumatic brain injury.

Key Words: traumatic brain injury • health-related quality of life • PedsQL • family burden

Abbreviations: TBI—traumatic brain injury • CHAT—Children's Health After Trauma • AIS—Abbreviated Injury Scale • EIS—emotional impact scale • PedsQL—Pediatric Quality of Life Inventory • NISS—New Injury Severity Score • OR—odds ratio • CI—confidence interval • HRQoL—health-related quality of life

Accepted Apr 23, 2008.


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