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J Pediatr Intensive Care 2023; 12(01): 055-062
DOI: 10.1055/s-0042-1758475
Original Article

Determinants of Quality of Life after Pediatric Traumatic Brain Injury

Nazan Ulgen Tekerek 
1   Division of Pediatric Intensive Care, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
,
Oguz Dursun 
1   Division of Pediatric Intensive Care, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
,
Selen Karalok 
2   Division of Pediatric Neurology, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
,
Alper Koker 
1   Division of Pediatric Intensive Care, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
,
Ozgur Duman 
2   Division of Pediatric Neurology, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
,
Senay Haspolat 
2   Division of Pediatric Neurology, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
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Abstract

Introduction Pediatric traumatic brain injury (TBI) is a significant cause of death and long-term disability. There is a paucity of data on quality of life in survivors of pediatric TBI. The aim of this study is to determine the factors affecting the quality of life after TBI in children.

Methods Consecutively admitted 104 of 156 patients to the pediatric intensive care unit (PICU) with TBI between 1 month and 18 years were included in the study. Demographics were obtained from electronic records. Injury severity and mortality scores were calculated. The Pediatric Quality of Life Inventory (PedsQL) scale and Glasgow Outcome Scale (GOS) score were evaluated by interview with patient or the caregiving parents. The Rotterdam computed tomography (CT) score was calculated from the radiology images taken within the first 24 hours after admission to the emergency service.

Results Severe TBI, multiple trauma, intracranial hemorrhage from multiple sites, convulsions, high intracranial pressure, emergency operation on admission, and hypotension on admission were associated with low PedsQL values according to results of univariate analysis (p < 0.05). There was a negative correlation between PedsQL and GOS, mechanical ventilation duration, PICU length of stay (LOS), and hospital LOS. In the linear regression model made by considering the univariate analysis results, it was shown that Rotterdam CT score and PICU LOS are independent variables that determine low PedsQL score. PedsQL scores were lower in children ≥ 8 years of age and in those evaluated within the first year after discharge (p = 0.003).

Conclusion In pediatric TBI, Rotterdam CT score and PICU LOS were found as independent variables determining PedsQL score after discharge.

Keywords

children - trauma - outcome - Rotterdam score

Ethical Approval

The study was approved by the local ethics committee (no. KAEK-645).


Consent to Participate

Informed consent was obtained from the participants or their parents.


Supplementary Material



Publication History

Received: 17 May 2022

Accepted: 16 September 2022

Article published online:
11 November 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Dewan MC, Mummareddy N, Wellons III JC, Bonfield CM. Epidemiology of global pediatric traumatic brain injury: qualitative review. World Neurosurg 2016; 91: 497-509.e1
    CrossrefPubMedGoogle Scholar
  • 2 Anderson V, Godfrey C, Rosenfeld JV, Catroppa C. 10 years outcome from childhood traumatic brain injury. Int J Dev Neurosci 2012; 30 (03) 217-224
    CrossrefPubMedGoogle Scholar
  • 3 Babikian T, Asarnow R. Neurocognitive outcomes and recovery after pediatric TBI: meta-analytic review of the literature. Neuropsychology 2009; 23 (03) 283-296
    CrossrefPubMedGoogle Scholar
  • 4 Sariaslan A, Sharp DJ, D'Onofrio BM, Larsson H, Fazel S. Long-term outcomes associated with traumatic brain injury in childhood and adolescence: a nationwide Swedish cohort study of a wide range of medical and social outcomes. PLoS Med 2016; 13 (08) e1002103
    CrossrefPubMedGoogle Scholar
  • 5 McCarthy ML, MacKenzie EJ, Durbin DR. et al; Children's Health After Trauma Study Group. Health-related quality of life during the first year after traumatic brain injury. Arch Pediatr Adolesc Med 2006; 160 (03) 252-260
    CrossrefPubMedGoogle Scholar
  • 6 McCarthy ML, MacKenzie EJ, Durbin DR. et al; CHAT Study Group. The Pediatric Quality of Life Inventory: an evaluation of its reliability and validity for children with traumatic brain injury. Arch Phys Med Rehabil 2005; 86 (10) 1901-1909
    CrossrefPubMedGoogle Scholar
  • 7 Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975; 1 (7905): 480-484
    CrossrefPubMedGoogle Scholar
  • 8 Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med 1996; 24 (05) 743-752
    CrossrefPubMedGoogle Scholar
  • 9 Andruszkow H, Deniz E, Urner J. et al. Physical and psychological long-term outcome after traumatic brain injury in children and adult patients. Health Qual Life Outcomes 2014; 12: 26
    CrossrefPubMedGoogle Scholar
  • 10 Baker SP, O'Neill B, Haddon Jr W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974; 14 (03) 187-196
    CrossrefPubMedGoogle Scholar
  • 11 Liesemer K, Riva-Cambrin J, Bennett KS. et al. Use of Rotterdam CT scores for mortality risk stratification in children with traumatic brain injury. Pediatr Crit Care Med 2014; 15 (06) 554-562
    CrossrefPubMedGoogle Scholar
  • 12 Au AK, Clark RSB. Paediatric traumatic brain injury: prognostic insights and outlooks. Curr Opin Neurol 2017; 30 (06) 565-572
    CrossrefPubMedGoogle Scholar
  • 13 Çakın Memik N, Agaoglu B, Coskun A, Karakaya I. The validity and reliability of pediatric quality of life inventory in 8–12 year old Turkish children. Cocuk Genc Ruh Sagligi Derg 2008; 15 (02) 87-98
    PubMedGoogle Scholar
  • 14 Çakın Memik N, Ağaoğlu B, Coşkun A, Uneri ÖŞ, Karakaya I. The validity and reliability of the Turkish Pediatric Quality of Life Inventory for children 13-18 years old [in Turkish]. Turk Psikiyatr Derg 2007; 18 (04) 353-363
    PubMedGoogle Scholar
  • 15 Varni JW, Seid M, Kurtin PS, Peds QL. PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care 2001; 39 (08) 800-812
    CrossrefPubMedGoogle Scholar
  • 16 Fulkerson DH, White IK, Rees JM. et al. Analysis of long-term (median 10.5 years) outcomes in children presenting with traumatic brain injury and an initial Glasgow Coma Scale score of 3 or 4. J Neurosurg Pediatr 2015; 16 (04) 410-419
    CrossrefPubMedGoogle Scholar
  • 17 Berger-Estilita J, Granja C, Gonçalves H. et al. A new global health outcome score after trauma (GHOST) for disability, cognitive impairment, and health-related quality of life: data from a prospective cross-sectional observational study. Brain Inj 2019; 33 (07) 922-931
    CrossrefPubMedGoogle Scholar
  • 18 Swanson JO, Vavilala MS, Wang J. et al. Association of initial CT findings with quality-of-life outcomes for traumatic brain injury in children. Pediatr Radiol 2012; 42 (08) 974-981
    CrossrefPubMedGoogle Scholar
  • 19 Anderson V, Spencer-Smith M, Wood A. Do children really recover better? Neurobehavioural plasticity after early brain insult. Brain 2011; 134 (Pt 8): 2197-2221
    CrossrefPubMedGoogle Scholar
  • 20 Anderson V, Spencer-Smith M, Leventer R. et al. Childhood brain insult: can age at insult help us predict outcome?. Brain 2009; 132 (Pt 1): 45-56
    CrossrefPubMedGoogle Scholar
  • 21 Crowe LM, Catroppa C, Babl FE, Rosenfeld JV, Anderson V. Timing of traumatic brain injury in childhood and intellectual outcome. J Pediatr Psychol 2012; 37 (07) 745-754
    CrossrefPubMedGoogle Scholar
  • 22 Di Battista A, Soo C, Catroppa C, Anderson V. Quality of life in children and adolescents post-TBI: a systematic review and meta-analysis. J Neurotrauma 2012; 29 (09) 1717-1727
    CrossrefPubMedGoogle Scholar
  • 23 Gabbe BJ, Simpson PM, Sutherland AM. et al. Functional and health-related quality of life outcomes after pediatric trauma. J Trauma 2011; 70 (06) 1532-1538
    PubMedGoogle Scholar
  • 24 Jones KM, Prah P, Starkey N. et al; BIONIC Study Group. Longitudinal patterns of behavior, cognition, and quality of life after mild traumatic brain injury in children: BIONIC study findings. Brain Inj 2019; 33 (07) 884-893
    CrossrefPubMedGoogle Scholar
  • 25 Ryan NP, Noone K, Godfrey C, Botchway EN, Catroppa C, Anderson V. Young adults' perspectives on health-related quality of life after paediatric traumatic brain injury: a prospective cohort study. Ann Phys Rehabil Med 2019; 62 (05) 342-350
    CrossrefPubMedGoogle Scholar
  • 26 Topjian AA, Raymond TT, Atkins D. et al; Pediatric Basic and Advanced Life Support Collaborators. Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2020; 142 (16_suppl_2): S469-S523
    CrossrefPubMedGoogle Scholar