Similar overall disability but different mortality and motor impairment profiles in children compared to adults 7–8 years after severe TBI

Background

Age at injury influences functional outcomes after severe traumatic brain injury (TBI), but its role remains underexplored in studies that simultaneously include children, adolescents, and adults.

Objectives

To investigate the effect of age at injury on mortality and overall disability 7 to 8 years post-severe TBI across diverse age groups.

Methods

Two prospective longitudinal cohorts assessed overall functional outcomes in 39 children/adolescents [Traumatisme Grave de l'Enfant (TGE) cohort, mean age at injury M(SD) = 7.5 years (4.6), range 0.3 to 14.7] and 86 adults [PariS-TBI cohort, M(SD) = 34.1 years (13.7), range 15.4 to 74.8], who sustained severe TBI [Glasgow Coma Scale (GCS) ≤8]. Both studies collected data on baseline demographics (age, gender, education level), initial injury severity (GCS, Injury Severity Score [ISS], length of coma), and mortality rates. Follow-up assessments included clinician-rated overall disability [Glasgow Outcome Scale-Extended (GOS-E)], clinical/neurological recovery, and self-/proxy-reported questionnaires assessing school/work situation, anxiety/depression, and caregivers’ perceived burden.

Results

Adults evidenced significantly higher mortality rates, longer lengths of coma, and more frequent persistent motor deficits than children/adolescents. Children/adolescents exhibited increased rates of good recovery (GOS-E) 7 to 8 years post-injury compared to adults (P = 0.03). In multivariate linear regression analyses, GOS-E was associated with GCS score and pre-injury education in the total sample and adults. In both age groups, overall post-injury disability was associated with the presence of school/work adaptations and motor deficits, increased anxiety/depression, and higher caregiver burden.

Conclusion

These findings reveal distinct age-specific patterns of recovery and disability after severe TBI among children, adolescents, and adults, highlighting the need for tailored assessments and interventions for each group. Furthermore, they underline the necessity of prolonged follow-up in children and adolescents to evaluate their transition to independent living and professional integration. Future research should confirm these results and identify modifiable factors that promote recovery and minimize long-term disability.