OP36 – 2640: King's Outcome Scale for Childhood Head Injury (KOSCHI) – Prospective and retrospective comparison of outcome, and level of agreement, within the neuro-rehabilitation cohort at Southampton Children's hospital

Abstract

There is a need for standardised outcome assessment for survivors of paediatric traumatic brain injury (TBI). KOSCHI is associated with markers of injury severity. Inter-rater reliability is lacking comparing prospective (P) versus retrospective (R) categorisation. Objective To determine the inter-rater reliability between (P) and (R) KOSCHI scores at discharge. To utilise KOSCHI to evaluate outcome of Southampton (SCH) neuro-rehabilitation TBI cohort. Methods (P) scores were recorded on discharge of all patients 2–18 years with moderate/severe head injury requiring neurological rehabilitation (2005–2014) by specialist physiotherapists. A doctor identified all patients admitted with TBI aged 0–18 and retrospectively scored KOSCHI at discharge using casenotes (blind to (P) cohort). Once collated the agreement between (P) and (R) KOSCHI scores was calculated using Cohen's kappa coefficient (κ). Results 153 patients admitted: 10 died. Sixty-one (45 male, mean age 11 years (range 2–17 years) required neuro-rehabilitation; 15 classified as moderate (GCS 9–12), 46 as severe (GCS ≤8) TBI. κ scores between (P) and (R) showed moderate agreement (κ=0.41), with the agreement improving (moderate κ=0.5) when not utilising the sub-categories. (P) demonstrated the majority are discharged with “moderate disability” (28% KOSCHI 4a, 16% 4b). 32% have “good recovery” (11% documented complete recovery 5b). Poor outcomes less common: KOSCHI 2 “vegetative” (N=1), KOSCHI 3a (N=2), KOSCHI 3b (N=10, 16%). Of those ≤ 3b; the category 2 patient transferred locally to establish continuing care, 4 to another rehabilitation centre, 1 re-admitted for further rehabilitation. 13/61 completed their rehabilitation at Bursledon House (stand-alone rehabilitation unit within SCH). (R) also categorizes the majority of patients with moderate disability (21% 4a, 24% 4b). Conclusion To improve reliability and allow for changes to scores post discharge secondary to further rehabilitation or identification of emerging difficulties, KOSCHI scores should be completed at an agreed time frame post injury and completed prospectively.