Neuropsychological outcome, magnetic resonance imaging findings, and health-related quality of life of pediatric victims of traumatic brain injury: a prospective study.

Abstract

Objective: The authors aimed to evaluate the neuropsychological outcome of pediatric victims of traumatic brain injury (TBI) and its association with trauma severity and MRI findings, and to investigate health-related quality of life (HRQOL) of patients and their families after trauma.

Methods: This was a prospective cohort study of pediatric patients (≤ 16 years) who sustained TBI and were admitted to the emergency department of a tertiary care university hospital in Brazil from June 2018 to December 2019. Trauma severity was determined by Glasgow Coma Scale (GCS), neurological outcome by King's Outcome Scale for Childhood Head Injury (KOSCHI), neuropsychological outcome by the Wechsler Intelligence Scale for Children-Fourth Edition, and HRQOL by the Pediatric Quality of Life Inventory 4.0. Patients also underwent MRI examinations. Neurological outcome was assessed twice at a median of 6 months and 13 months after trauma. Neuropsychological and HRQOL assessment and MRI were performed at a median of 13 months after trauma.

Results: Thirty-seven patients were included. According to the neurological outcome categorized by KOSCHI, 25 (67.6%) patients made a good recovery and 12 (32.4%) had a disability. The neurological status did not change between the two assessments. Patients in the disability group had lower GCS scores (median 11 vs 15, p = 0.0006) and lower median values of full-scale intelligence quotient (67 vs 86, p = 0.0002), perceptual reasoning index (75 vs 92, p = 0.03), verbal comprehension index (72 vs 84, p = 0.02), working memory index (74 vs 88, p = 0.003), and processing speed index (68 vs 86, p = 0.01). The presence of MRI alterations was associated with TBI severity (median GCS score 7 vs 15, p < 0.0001). Mean, axial, and radial diffusivity were higher, and fractional anisotropy was lower in patients with TBI compared with controls. HRQOL was worse in the disability group.

Conclusions: Pediatric patients sustaining TBI with a KOSCHI outcome classified as having a disability had poorer neuropsychological testing performance and worse HRQOL compared with patients with a good recovery. MRI metrics abnormalities suggest diffuse white matter disruption associated with pediatric TBI.