Traumatic Brain Injury In Children Research Articles

Neuromonitoring in Children with Traumatic Brain Injury.

Traumatic brain injury remains a major cause of mortality and morbidity in children across the world. Current management based on international guidelines focuses on a fixed therapeutic target of less than 20mm Hg for managing intracranial pressure and 40-50mm Hg for cerebral perfusion pressure across the pediatric age group. To improve outcome from this complex disease, it is essential to understand the pathophysiological mechanisms responsible for disease evolution by using different monitoring tools. In this narrative review, we discuss the neuromonitoring tools available for use to help guide management of severe traumatic brain injury in children and some of the techniques that can in future help with individualizing treatment targets based on advanced cerebral physiology monitoring.

Application of the International classification of functioning, disability and health in medical rehabilitation of children with severe traumatic brain injury

BACKGROUND: The problem of rehabilitation of patients with severe traumatic brain injury has been and remains very important and relevant for both adults and children. Patients with severe traumatic brain injury often develop severe physical, mental, emotional and cognitive impairments, which are often difficult to correct and require long-term treatment, including rehabilitation, relying solely on the body's potential, which is accompanied by a heavy financial burden for the patient, his family, and society in general. The introduction of new diagnostic methods, the improvement of resuscitation measures, the use of modern methods of neurosurgical intervention and timely rehabilitation can increase the proportion of children who survived after severe traumatic brain injury and their quality of life.
 AIM: to evaluate the effectiveness of medical rehabilitation of children with severe traumatic brain injury with the participation of a multidisciplinary rehabilitation team and relatives of patients.
 MATERIALS AND METHODS: The study included 50 children with severe traumatic brain injury. Two groups were distinguished by the randomization method: the main group 25 patients (50%) and the control group, which included 25 patients (50%). The follow-up period was 1 year after the onset of severe traumatic brain injury. In the main group, an individual plan for early rehabilitation was drawn up on the 2nd day after a severe traumatic brain injury in intensive care. At the first stage of rehabilitation, which is carried out in the intensive care unit and the neurosurgery department, an individual medical rehabilitation plan was developed for the children of the main group, depending on somatic indicators and the severity of the condition, and a rehabilitation diagnosis based on the International classification of functioning, disability and health was established. In the control group, after transfer from the intensive care unit to the specialized neurosurgical department, patients received basic rehabilitation therapy: articular gymnastics, paraffin therapy, and psychological support.
 RESULTS: In the main group, more effective changes were noted in domains associated with impaired structure and function of the nervous system, which led to improved activity and participation, self-service. In patients of the control group, there were no significant changes in the state of functions, activity and participation.
 CONCLUSION: The early start of complex medical rehabilitation of children with severe traumatic brain injury reduces disability and accelerates the process of the patient's socialization, which is more clearly demonstrated by the International classification of functioning, disability and health approach. The use of International classification of functioning, disability and health for with severe traumatic brain injury in children in medical rehabilitation departments is a good tool for setting rehabilitation goals, choosing rehabilitation measures and assessing the effectiveness of rehabilitation.

Glycans as Potential Diagnostic Markers of Traumatic Brain Injury in Children.

Diagnosing mild traumatic brain injury (TBI) in the acute setting is challenging due to the nonspecific and often transient or delayed symptoms. Further, the criteria for acute head imaging are frequently not fulfilled, which may lead to a missed diagnosis. A rapid test to diagnose TBI using body fluids would be highly useful. Urine and saliva samples were collected from 28 pediatric patients (mean [SD] age, eight years two months [four years three months]) with acute, clinically diagnosed mild TBI and 30 healthy volunteers at Satasairaala Hospital, Pori, Finland, over 11 months. The mean (SD) time from trauma to first sampling was 3 h 56 min (1 h 14 min). Samples were analyzed to determine the number of lectin-binding glycan molecules, indicating nerve tissue damage. The relative levels of several lectin-bound glycans were measured by fluorescence. Compared with healthy controls, the TBI group showed significant increases (p < 0.05, Wilcoxon rank-sum two-sided test) in nine glycans in the saliva, one glycan in the urine, and a significant decrease in seven glycans in the urine. These findings of potentially diagnostic glycans in body fluids after TBI warrant further research and may enable the development of a rapid body fluid-based point-of-care test to identify pediatric patients with TBI after a head injury.

Family experiences of supporting a relative with agitation during early recovery after traumatic brain injury

ABSTRACT During the early recovery period after traumatic brain injury (TBI), referred to as post-traumatic amnesia (PTA), approximately 44% of individuals may exhibit agitated behaviours. Agitation can impede recovery and poses a significant management challenge for healthcare services. As families provide significant support for their injured relatives during this time, this study aimed to explore the family’s experience during PTA to better understand their role in agitation management. There were 20 qualitative semi-structured interviews conducted with 24 family members of patients exhibiting agitation during early TBI recovery (75% female, aged 30–71 years), predominantly parents (n = 12), spouses (n = 7) and children (n = 3). The interviews explored the family’s experience of supporting their relative exhibiting agitation during PTA. The interviews were analyzed using reflexive thematic analysis, which revealed three key themes: family contributions to patient care, expectations of the health care service and supporting families to support patients. This study emphasized the significant role of families in managing agitation during early TBI recovery and highlighted that families who are well-informed and well-supported have the potential to minimize their relative’s agitation during PTA, which may reduce the burden on healthcare staff and promote patient recovery.

Exploring the Caregiver-Reported Impact of the COVID-19 Pandemic on Children with Traumatic Brain Injury.

The COVID-19 pandemic is expected to have a persistent, negative, and disproportionate impact on children with disabilities. Children with traumatic brain injury (TBI) may be expected to experience a disproportionate impact given the deficits often associated with childhood TBI (e.g., family functioning, fatigue, executive functioning, quality of life). This study aimed to explore the impact of the COVID-19 pandemic on children with TBI and their families, compared to typically developing (TD) children and their families. Thirty caregivers (TBI = 15; TD = 15) completed a series of electronic survey measures. Overall, caregivers reported no negative impact of the COVID-19 pandemic on their family's or child's functioning and association with demographic factors and domains of functioning showed no clear patterns. The findings of this exploratory study support continued longitudinal investigation with larger sample sizes of the provision of supports for all families and children in light of the COVID-19 pandemic. Additional research is needed to understand the effectiveness of targeted services for students with TBI in domains of functioning that are significantly poorer than TD children (e.g., quality of life, executive functioning, fatigue).

A-13 Concussion history is related to performance on executive functioning tasks in youth

Abstract Purpose Pediatric traumatic brain injuries (TBIs) are among the most common acquired disabilities in youth. They occur when the brain is rapidly developing and therefore many impact the child into adulthood and can impact executive functioning (EF) skills that are vital to everyday tasks, like maintaining attention, organizing, and inhibiting behaviors. It is important to understand the impact of childhood TBIs to learn how to best intervene. Methods 11,224 children aged 9-10 years old (mean age=9.91, 49.4% male) at baseline completed an extensive battery of interviews and neuropsychological tasks through the Adolescent Brain Cognitive Development (ABCD) study. Based on parent reports on the Ohio State TBI screening measure, children were classified into No/Unlikely TBI, Possible Mild, Mild, Moderate, and Severe TBI. 153 children met criteria for possible mild TBI or higher. They also completed an array of neurocognitive measures, including Matrix Reasoning and several NIH Toolbox executive functioning tasks. Results There were small significant correlations between TBI status and a language task (Picture Vocab, r=.03, p=.002), attention task (Flanker, r=.02, p=.04), set shifting (Dimensional Change Card Sort, r=.02, p=.04), and with the crystallized cognition (r=.03, p=.005) and cognition composite (r=.03, p=.005) scores. Trend-level correlations were found for an oral reading task and fluid cognition composite score. However, when children with no TBI history were removed, no correlations held. Conclusions A history of even a mild TBI may be related to impaired functioning across several domains of executive functioning skills in youth.

Repetitive mild traumatic brain injuries in children of abuse

Repetitive mild traumatic brain injuries in children of abuse

Incidence of acute neurosurgery for traumatic brain injury in children—a nationwide analysis from 1998 to 2018

BackgroundMost of moderate and severe pTBIs are managed conservatively, but in some cases neurosurgical interventions are needed. The incidence rates of acute pTBI neurosurgery vary considerably between countries and operation types. Our goal was to assess the incidence of acute pTBI neurosurgery in Finland.MethodsWe conducted a retrospective Finnish register-based cohort study from 1998 to 2018. We included all patients that were 0 to 17 years of age at the time of the TBI. The incidence rates of patients with pTBI undergoing neurosurgery and the rates for specific operation types were calculated per 100,000 person-years. We compared the annual incidences with incidence rate ratios (IRR) with 95% confidence intervals (CI). We stratified patients to three age categories: (i) 0 to 3 years of age, (ii) 4 to 12 years of age, and (iii) 13 to 17 years of age.ResultsThe total number of neurosurgeries for acute pTBI during the study period was 386, and the cumulative incidence was 1.67 operations per 100,000 person-years. The cumulative incidence during the 21-year follow-up was highest at the age of 16 (IRR 4.78, CI 3.68 to 6.11). Boys had a 2.42-time higher cumulative incidence (IRR 2.35, CI 1.27 to 3.99) than girls (IRR 0.97, CI 0.35 to 2.20). The most common neurosurgery was an evacuation of an intracranial hemorrhage (n = 171; 44.3%).ConclusionThe incidence of neurosurgeries for pTBIs has been stable from 1998 to 2018. The incidence was highest at the age of 16, and boys had higher incidence than girls.

Outcome of traumatic brain injury and its associated factors among pediatrics patients treated in Amhara national regional state comprehensive specialized hospitals, Ethiopia 2022.

Background Traumatic brain injury in pediatrics is one of the commonest causes of morbidity, disability and mortality worldwide. In low- and middle-income countries Study showed that death of pediatrics from traumatic brain injury was 7.3%. However, there is limited data towards the outcome of traumatic brain injury and its associated factors in Ethiopia. Objective To assess the outcome of traumatic brain injury and associated factors among pediatrics patients in Amhara National Regional State Comprehensive Specialized Hospitals, Ethiopia. Methods An institution based retrospective cross-sectional study was conducted among 423 pediatrics patients from January 1, 2019 to December 30, 2021, and data extraction period was from May 16 to June15, 2022. Systematic random sampling technique was employed to select the study participants. Data were collected from patient charts and registry books by using a data extraction tool. Data were entered into the Epi-info version 7 and analysis was done by SPSS Version 25. Both Bi-variable and multi-variable analyses were employed to identify factors associated with outcome of traumatic brain injury. Result From 423 sampled study participant charts 404 of them had complete information with response rate of 95.5% and included in the final analysis. The overall unfavorable outcome of traumatic brain injury at discharge was found that 12.13% (95% CI: 9.1% - 15.7 %). Sever traumatic brain injury (AOR: 5.11(CI :1.8-14.48), moderate traumatic brain injury (AOR:2.44(CI:1.07-5.58), Hyperglycemia (AOR: 3.01 (CI:1.1-8.04), sign of increased intracranial pressure (AOR:7.4(CI:3.5-15.26), and medical comorbidity (AOR: 2.65(CI:1.19-5.91) were predicted of unfavorable outcome of traumatic brain injury pediatrics patient. Conclusion and recommendations twelve present of traumatic brain injury results unfavorable outcome. Sever and moderate form of traumatic brain injury, hyperglycemia, signs of increased intracranial pressure, and medical comorbidity were factors associated with unfavorable outcome of traumatic brain injury in children. Therefore, it is preferable to improve accesses to acute and post-acute care services to lower the unfavorable outcome of traumatic brain injury in children.

Factors related to adverse long-term outcomes after mild traumatic brain injury in children: a scoping review

ObjectiveTo identify demographic, premorbid and injury-related factors, or biomarkers associated with long-term (≥3 months) adverse outcomes in children after mild traumatic brain injury (mTBI).DesignScoping review of literature.PatientsChildren and adolescents with...

Educational and employment outcomes associated with childhood traumatic brain injury in Scotland: A population-based record-linkage cohort study.

Traumatic brain injury (TBI) is a leading cause of death and disability among young children and adolescents and the effects can be lifelong and wide-reaching. Although there have been numerous studies to evaluate the impact of childhood head injury on educational outcomes, few large-scale studies have been conducted, and previous research has been limited by issues of attrition, methodological inconsistencies, and selection bias. We aim to compare the educational and employment outcomes of Scottish schoolchildren previously hospitalised for TBI with their peers. A retrospective, record-linkage population cohort study was conducted using linkage of health and education administrative records. The cohort comprised all 766,244 singleton children born in Scotland and aged between 4 and 18 years who attended Scottish schools at some point between 2009 and 2013. Outcomes included special educational need (SEN), examination attainment, school absence and exclusion, and unemployment. The mean length of follow up from first head injury varied by outcome measure; 9.44 years for assessment of SEN and 9.53, 12.70, and 13.74 years for absenteeism and exclusion, attainment, and unemployment, respectively. Logistic regression models and generalised estimating equation (GEE) models were run unadjusted and then adjusted for sociodemographic and maternity confounders. Of the 766,244 children in the cohort, 4,788 (0.6%) had a history of hospitalisation for TBI. The mean age at first head injury admission was 3.73 years (median = 1.77 years). Following adjustment for potential confounders, previous TBI was associated with SEN (OR 1.28, CI 1.18 to 1.39, p < 0.001), absenteeism (IRR 1.09, CI 1.06 to 1.12, p < 0.001), exclusion (IRR 1.33, CI 1.15 to 1.55, p < 0.001), and low attainment (OR 1.30, CI 1.11 to 1.51, p < 0.001). The average age on leaving school was 17.14 (median = 17.37) years among children with a TBI and 17.19 (median = 17.43) among peers. Among children previously admitted for a TBI, 336 (12.2%) left school before age 16 years compared with 21,941 (10.2%) of those not admitted for TBI. There was no significant association with unemployment 6 months after leaving school (OR 1.03, CI 0.92 to 1.16, p = 0.61). Excluding hospitalisations coded as concussion strengthened the associations. We were not able to investigate age at injury for all outcomes. For TBI occurring before school age, it was impossible to be certain that SEN had not predated the TBI. Therefore, potential reverse causation was a limitation for this outcome. Childhood TBI, sufficiently severe to warrant hospitalisation, was associated with a range of adverse educational outcomes. These findings reinforce the importance of preventing TBI where possible. Where not possible, children with a history of TBI should be supported to minimise the adverse impacts on their education.

Development and validation of a Bayesian network predicting neurosurgical intervention after injury in children and adolescents.

Timely surgical decompression improves functional outcomes and survival among children with traumatic brain injury and increased intracranial pressure. Previous scoring systems for identifying the need for surgical decompression after traumatic brain injury in children and adults have had several barriers to use. These barriers include the inability to generate a score with missing data, a requirement for radiographic imaging that may not be immediately available, and limited accuracy. To address these limitations, we developed a Bayesian network to predict the probability of neurosurgical intervention among injured children and adolescents (aged 1-18 years) using physical examination findings and injury characteristics observable at hospital arrival. We obtained patient, injury, transportation, resuscitation, and procedure characteristics from the 2017 to 2019 Trauma Quality Improvement Project database. We trained and validated a Bayesian network to predict the probability of a neurosurgical intervention, defined as undergoing a craniotomy, craniectomy, or intracranial pressure monitor placement. We evaluated model performance using the area under the receiver operating characteristic and calibration curves. We evaluated the percentage of contribution of each input for predicting neurosurgical intervention using relative mutual information (RMI). The final model included four predictor variables, including the Glasgow Coma Scale score (RMI, 31.9%), pupillary response (RMI, 11.6%), mechanism of injury (RMI, 5.8%), and presence of prehospital cardiopulmonary resuscitation (RMI, 0.8%). The model achieved an area under the receiver operating characteristic curve of 0.90 (95% confidence interval [CI], 0.89-0.91) and had a calibration slope of 0.77 (95% CI, 0.29-1.26) with a y intercept of 0.05 (95% CI, -0.14 to 0.25). We developed a Bayesian network that predicts neurosurgical intervention for all injured children using four factors immediately available on arrival. Compared with a binary threshold model, this probabilistic model may allow clinicians to stratify management strategies based on risk. Prognostic and Epidemiological; Level III.

Neuroimaging for mild traumatic brain injury in children: cross-sectional study using national claims data.

Current guidelines recommend healthcare professionals avoid routine use of neuroimaging for diagnosing mild traumatic brain injury (mTBI). This study aimed to examine current use of CT and MRI among children and young adult patients with mTBI and factors that increase likelihood of neuroimaging in this population. Data were analyzed using the 2019 MarketScan commercial claims and encounters database for the commercially insured population for both inpatient and outpatient claims. Descriptive statistics and logistic regression models for patients ≤24years of age who received an ICD-10-CM code indicative of a possible mTBI were analyzed. Neuroimaging was performed in 16.9% (CT; 95% CI=16.7-17.1) and 0.9% (MRI; 95% CI=0.8-0.9) of mTBI outpatient visits (including emergency department visits) among children (≤18years old). Neuroimaging was performed in a higher percentage of outpatient visits for patients 19-24years old (CT=47.1% [95% CI=46.5-47.6] and MRI=1.7% [95% CI=1.5-1.8]), and children aged 15-18years old (CT=20.9% [95% CI=20.5-21.2] and MRI=1.4% [95% CI=1.3-1.5]). Outpatient visits for males were 1.22 (95% CI=1.10-1.25) times more likely to include CT compared to females, while there were no differences by sex for MRI or among inpatient stays. Urban residents, as compared to rural, were less likely to get CT in outpatient settings (adjusted odds ratio [aOR]=0.55, 95% CI=0.53-0.57). Rural residents demonstrated a larger proportion of inpatient admissions that had a CT. Despite recommendations to avoid routine use of neuroimaging for mTBI, neuroimaging remained common practice in 2019.

A Scoping Review of Auditory Dysfunction After Childhood Traumatic Brain Injury.

The purpose of this scoping review was to gain an understanding of the evidence available on auditory dysfunction after childhood traumatic brain injury (TBI) and identify limitations, clinical implications, and future directions for speech-language pathology and audiology practice and research. This scoping review of the literature followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A total of eight articles met inclusion for this scoping review. All studies were observational studies (n = 4 with controls, n = 4 without controls). Age at injury, injury severity, time postinjury, and age at time of study varied across the included studies. Three major topics related to childhood TBI were addressed among the included studies: (a) prevalence of auditory dysfunction (n = 5), (b) functional outcomes and biological markers related to auditory processing (n = 2), and (c) clinical presentation of auditory dysfunction (n = 2). This review highlights the particular lack of experimental evidence related to risk and protective factors and assessment and management strategies related to auditory dysfunction after childhood TBI. There is a major need for more research and research of higher rigor to be conducted with individuals who experienced a childhood TBI to support audiologists' and speech-language pathologists' evidence-based decision making to improve long-term functional outcomes for children with TBI.

Executive functioning as mediator of the association between traumatic brain injury and prison bullying

ABSTRACT Objective This study examined whether executive functioning (EF) mediated the relationship between childhood traumatic brain injury (TBI) and engaging in bullying in prison (BP) Participants A sample of male adults in custody in Uruguay (N = 236), drawn from five prisons. Methods Inmates filled out self-report questionnaires examining TBI (Head Injury Questionnaire), EF (Behavior Rating Inventory of Executive Function Adult, BRIEF-A) and bullying in prison (Direct and Indirect Prisoner Behavior Checklist – revised, SCALED, DIPC-SCALED-r). Results Findings showed that TBI was associated with prison bullying after controlling for age, level of education, socioeconomic status, and civil status. The mediation analysis indicated that the relationship between TBI and bullying was fully mediated via executive impairment, especially through the behavioral regulation component (mainly inhibition and emotional control). Conclusion These findings suggested that compensating for EF difficulties in adult inmates with brain injuries might help to decrease the bullying in prison.

The Underlying Mechanisms in the Association Between Traumatic Brain Injury in Childhood and Conduct Disorder Symptoms in Late Adolescence

The present study examined i) the direct association between traumatic brain injury (TBI) in childhood and conduct disorder symptoms in adolescence, ii) whether this effect is mediated by impulsivity and/or callous unemotional traits (CU traits), and iii) whether these indirect effects are moderated by childhood family adversity and adolescent substance use. Utilising data from the Avon Longitudinal Study of Parents and Children (ALSPAC), participants with head injury information up to 12 years (4.5 years, 5.4 years, 6.5 years, 8.6 years, 11.7 years) were identified and categorised into a TBI (n = 409), orthopaedic injury (n = 1469) or non-injury group (n = 5685). Psychosocial factors such as impulsivity at 13 years, CU traits at 13 years, childhood family adversity (between birth to 4 years) and substance use at 14 years were collated for moderated mediation analyses. Conduct disorder symptoms were assessed at 16 years of age. TBI and conduct disorder symptoms were positively associated, and this association was mediated by impulsivity but not CU traits. The indirect effects were higher in magnitude for individuals with higher levels of childhood family adversity. Adolescent substance use was not found to moderate the indirect effects between TBI and conduct disorder symptoms. These results were specific to TBI individuals, and not in participants with orthopaedic injury and no reported injuries. Targeting impulsivity and early family adversity may alleviate the risk of conduct disorder symptoms following TBI in childhood. These findings have important implications for informing neuro-rehabilitative and preventative measures in clinical and community settings.

Paediatric Head Injury: Concordance between CT Findings and GCS Scores- A Retrospective Study in a Tertiary Care Hospital

Introduction: Computed Tomography (CT) remains the mainstay in the detection of traumatic brain injuries in children just as in the adult population. However, unnecessary and inadvertent use of CT in minor and less significant head injuries exposes children to harmful ionising radiation and subsequently increases the lifetime cancer risk. So, there is a need to use CT judiciously in cases of minor head injuries. The Glasgow Coma Score (GCS) can provide a comprehensive framework for proper stratification of neural impairment and head injury severity. Aim: To assess the concordance between CT scan findings and GCS scores in paediatric patients with acute Traumatic Brain Injury (TBI). Materials and Methods: This was a retrospective study of paediatric head injury cases who were referred to the Department of Radiodiagnosis, Mysore Medical College, Karnataka, India. from January 2021 to December 2021. The head CT of 110 patients was reviewed. Demographic details, mode of accident, CT findings, and GCS scores were collected from hospital records. Descriptive statistics were used and results were expressed in terms of frequency and percentages. Results: Out of 110 patients (mean age: 9.17±3.02 years) reviewed, males were 78 (71%) and females were 32 (29%). Road traffic accident was found to be the most common cause, i.e., in 71 patients (64.5%). The most common CT scan finding was fracture as seen in 12 cases. Out of 110 patients, 94 had mild injury according to GCS scores, 12 had a moderate head injury and four had a severe head injury. As the GCS scores decreased, the percentage of positive findings on CT increased. Conclusion: Percentage of positive CT findings was higher in the moderate and severe head injury category, where the role of CT scans in acute settings becomes valuable.

An epidemiologic study of traumatic brain injury in children, middle-aged patients, and elderly presenting to the emergency department

An epidemiologic study of traumatic brain injury in children, middle-aged patients, and elderly presenting to the emergency department

Conceptual framework of the recovery of self-awareness following a severe traumatic brain injury in childhood

ABSTRACT Introduction Self-awareness following a TBI in childhood is an under-represented area of research in the pediatric literature. The issue is well described in the adult literature but the theories and practice recommendations in this body of literature are not easily transferable to pediatric neurorehabilitation. Children and young people sustain a TBI at a time when the brain is yet to fully develop. This paper outlines a conceptual framework that incorporates and adapts knowledge from the adult and pediatric literature of self-awareness. Methods The content and the structure of the framework is constructed from clinical experience, existing literature and the findings from an empirical study. Findings A conceptual framework is presented with 3 key components: self-awareness knowledge, self-awareness in context, self-awareness for the future. The components are explained and the relationship between the concepts is highlighted. Conclusion The framework provides a common language for clinicians and academics to explore the concepts that impact self-awareness during recovery. The framework captures the dynamic developmental and recovery trajectory of self-awareness following a TBI in childhood.

Fatigue After Daily Activities for Children with Traumatic Brain Injury and Typically-Developing Peers

<h3>Research Objectives</h3> Fatigue is one of the most persistent symptoms after acquired brain injury, but few studies have investigated the impact of daily activities (e.g., academic, social) on fatigue in children with traumatic brain injury (TBI). The primary aim of this study was to compare subjective parent- and self-reports of fatigue across daily activities between children with TBI and typically developing (TD) children. <h3>Design</h3> Cross sectional survey completed at two time points (i.e., after a school day; after a weekend day) within 30 days <h3>Setting</h3> self-administered, electronic survey in home/preferred setting. <h3>Participants</h3> 30 participants (15 children with TBI and 15 TD children) ages 8-14 years old. Participants in the TBI group experienced moderate-severe TBIs at 4.69 years (SD = 1.53) and were 5.37 years (SD = 1.53) post-injury at the time of survey participation. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> demographics and injury questionnaire; Pediatric Quality of Life Multi-Dimensional Fatigue Scale (PedsQL MFS). <h3>Results</h3> Participants in the TBI group were parent- and self-reported to have significantly greater levels of fatigue in all domains (i.e., sleep/rest, physical, cognitive, total) compared to TD participants (p < .001), after both a school day and a weekend day. Yet, all participants (i.e., TD and TBI groups) were parent- and self-reported to have similar levels of fatigue in all domains (p > .05) after a school day compared to after a weekend day. <h3>Conclusions</h3> The findings of this study support the chronic nature of fatigue after childhood TBI. Comparing fatigue between children with TBI and TD children and across daily activities highlights opportunities for rehabilitation professionals to refine their supports and services o improve the academic and social participation of children with TBI. <h3>Author(s) Disclosures</h3> Jessica Salley Riccardi has no financial or non-financial relationships to disclose.