Injury Severity Variables as Predictors of WeeFIM Scores in Pediatric TBI: Time to Follow Commands Is Best

Article Outline

• Disclosures
• Objective
• Design
• Setting
• Participants
• Interventions
• Main Outcome Measures
• Results
• Conclusions
• Copyright

Keywords: Rehabilitation, Pediatrics, Brain injuries, Rehabilitation outcome

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Disclosures 

S. J. Suskauer, None.

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Objective 

To compare the utility of several common measures of brain injury severity, including time to follow commands (TFC), duration of posttraumatic amnesia (PTA), and total duration of impaired consciousness (TFC+PTA), in predicting functional outcome in children with traumatic brain injury (TBI).

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Design 

Retrospective analysis of clinical data obtained over 10 years.

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Setting 

Academically-affiliated pediatric inpatient brain injury rehabilitation program.

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Participants 

121 children with moderate to severe TBI.

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Interventions 

Standard of care.

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Main Outcome Measures 

Time to follow commands (TFC) was defined as time from brain injury until the child was able to follow commands twice within a 24-hour period. Posttraumatic amnesia (PTA) was defined as the time from TFC until a child obtained 2 consecutive scores within 2 standard deviations of the age-based mean on the Children's Orientation and Amnesia Test (COAT). Total duration of impaired consciousness was defined as TFC plus PTA. Functional outcome was assessed at discharge from inpatient rehabilitation and, in a subset of children, at 3 months and 1 year following discharge, using the Functional Independence Measure for Children (WeeFIM), a gross measure of self-care, mobility, and cognitive functioning.

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Results 

Correlations and multiple linear regression analyses were conducted using GCS, TFC, PTA, and TFC+PTA to predict age-corrected WeeFIM scores at discharge and follow-up, while controlling for initial severity of injury. Models in which TFC and PTA duration were entered as separate variables and as a combined variable (TFC+PTA) were all significantly predictive of WeeFIM scores at discharge (P < .001). Comparison of R-squared values for each separate model revealed that TFC accounted for the greatest portion of variance in WeeFIM scores.

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Conclusions 

Among children with moderate to severe TBI who receive care in an inpatient rehabilitation setting, TFC was the best predictor of general functional outcome at discharge and follow-up. Our findings highlight the need for careful and consistent assessment of TFC to assist in predicting functional outcomes as early and accurately as possible.