Factors Influencing Pediatric Recovery from Traumatic Brain Injury

Abstract

Purpose: Many factors are linked to prolonged recovery from traumatic brain injury (TBI) in the pediatric population. This study investigated risk factors to aid anticipatory guidance and treatment strategies. Methods: A retrospective chart review was conducted utilizing 133 patients admitted to a pediatric trauma service at a Level 1 Pediatric Trauma Center. Results: No significant difference in recovery time was found based on acute injury severity as graded by initial Glasgow Coma Score (GCS) (GCS of 3-12 median recovery of 34 days vs GCS 13-15 median recovery of 34 days (p = 0.393)) and presence of intracranial hemorrhage (ICH) (ICH median recovery of 34 days vs no ICH median recovery of 30 days (p = 0.506)). Patients with post-concussive sleep disturbances (median recovery of 53.5 days (p = 0.002)) and comorbid mood disorders (anxiety and/or depression median recovery of 143 days (p = 0.009), ADHD median recovery of 45 days (p = 0.012) showed an increased median recovery length. The median recovery time severe of moderate initial injury (GCS of 3-12 median recovery of 34 days (p = 0.00244)) and mild initial injury (GCS 13-15 median recovery of 34 days (p<0.001)) was longer as compared to outpatient studies (17 days). Conclusions: This study verified that GCS and ICH upon admission are not correlated with recovery, whereas sleep disturbances and comorbid mood disorders are strong prognostic factors for prolonged recovery. A longer median recovery time, compared to outpatient studies, suggests that patients admitted to a pediatric trauma service are at risk for prolonged recovery.