FUNCTIONAL OUTCOME IN CHILDREN WITH TRAUMATIC BRAIN INJURY - AGREEMENT BETWEEN CLINICAL JUDGMENT AND THE FUNCTIONAL INDEPENDENCE MEASURE

As improvements in the delivery of trauma care have increased survival from injury, it has become essential to assess the resulting morbidity to plan for medical and psychosocial services, particularly for children whose needs may be wide and long term. This paper focuses on the assessment of disability of 598 children, age 8 to 19 yr, hospitalized for traumatic brain injury with or without injury to other body regions, exclusive of spinal cord injury. The disability was measured at discharge from acute care in nine areas of functional activities and a recovery time assigned by a clinician. For the study, children were divided into three groups: those whose recovery was expected in <7 months (Group A: n = 463), in 7 to 24 months (Group B: n = 66) and in >2 yr (Group C: n = 69). The clinician's expectation of recovery time significantly (P < 0.01) reflected the injury severity as measured by the Glasgow Coma Scale and the injury Severity Score. By the Glasgow Coma Scale, 16.4% were comatose on admission in Group A, 51.5% in Group B and 58% in Group C. The injury Severity Score was significantly different with 25.5% severely injured in Group A, 68.2% in Group B and 84% in Group C. At discharge, 15% in Group A had four or more areas of impairments, 61% in Group B and 84% in Group C. The Functional independence Measure confirmed the clinician's assessment of compromise with significantly (P < 0.01) different average values of 110, 80 and 58 for Groups A, B and C, respectively.