Poor Quality of Life for Children with Mild Traumatic Brain Injury

December 17, 2013

I recently co-authored a study that identified certain groups of children with poor quality of life outcomes after suffering a mild traumatic brain injury (mTBI). Children from low-income families, with Medicaid insurance, with less educated parents, or of Hispanic ethnicity were more likely to have poor outcomes at follow-up when compared to other children.

This study is part of CIRP's Post-injury Care and Recovery (PICAR) line of research that focuses on improving acute care and outcomes after injury. For this analysis, we partnered with colleagues from the the University of Washington as part of a larger study of children with TBI. We focused on the 329 children under age 18 treated for an isolated mTBI (almost all concussion) and with no other injuries, and found that 11.2 percent functioned poorly three months after the mTBI and 12.9 percent functioned poorly 12 months after the mTBI as measured by the Pediatric Quality of Life index (PedsQL).

Although previous research¹ ² has shown that ethnic minorities and socioeconomically disadvantaged patients are more likely to die or have long-term disability following more severe traumatic brain injury, our research has also identified similar disparities in outcomes for children with isolated mTBI. While our study could not determine the reason for these differences, future research should explore potential disparities in acute and follow-up care, as well the need for additional post-injury support and services in these populations. 

Our study also draws attention to the Abbreviated Injury Scale (AIS),a standardized scale of injury severity published by the Association for the Advancement of Automotive Medicine (AAAM). The AIS, originally designed as a ‘threat to life’ scale, categorizes injuries and assigns severities ranging from 1 (‘minor’) to 6 (‘maximal, currently untreatable’). AIS 2 or greater injuries are typically considered ‘clinically important’. The most current version of the AIS (AIS 2005/2008 update) identifies concussion with loss of consciousness as an AIS 2+ injury and without loss of consciousness as an AIS 1. In our study, 10 percent of the children with poor outcomes at three months following injury and 11 percent of the children with poor outcomes at 12 months following injury had an AIS 1 concussion. Given these findings, it is clear that not all children with mTBI and no loss of consciousness will have favorable outcomes. Therefore this severity score for these seemingly ‘mild’ injuries may need to be reconsidered.
 

¹ Hakmeh W, Barker J, Szpunar SM, et al. Effect of race and insurance on outcome of pediatric trauma. Acad Emerg Med. 2010;17:809-12

² Haider AH, Efron DT, Haut ER, et al. Black children experience worse clinical and functional outcomes after traumatic brain injury: an analysis of the National Pediatric Trauma Registry. J Trauma. 2007;62:1259-62; discussion 62-3.