Citation

Keenan HT, Clark AE, Holubkov R, Cox CS, Patel RP, Moore KR, Ewing-Cobbs L. J. Neurotrauma 2020; ePub(ePub): ePub.

Affiliation

Texas, United States; Linda.ewing-cobbs@uth.tmc.edu.

Copyright

(Copyright © 2020, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2019.6874

PMID

32103698

Abstract

Heterogeneity of injury severity among children with traumatic brain injury (TBI) classified by the Glasgow Coma Scale (GCS) makes comparisons across research cohorts, enrollment in clinical trials, and clinical predictions of outcomes difficult. The present study uses latent class analysis (LCA) to distinguish severity subgroups from a prospective cohort of 433 children aged 2.5 to 15 years with TBI who were recruited from two level 1 pediatric trauma centers. Indicator variables available within 48 hours post-injury including ED GCS, hospital motor GCS, Abbreviated Injury Score (AIS), Rotterdam Score, hypotension in the ED, and prehospital loss of consciousness, intubation, seizures and sedation were evaluated to define subgroups. To understand whether latent class subgroups were predictive of clinically meaningful outcomes, the Pediatric Injury Functional Outcome Scale (PIFOS) at 6 and 12 months, and the Behavior Rating Inventory of Executive Function at 12 months, were compared across subgroups. Then, outcomes were examined by GCS (primary) and AIS (secondary) classification alone to assess whether LCA provided improved outcome prediction. LCA identified four distinct increasing severity subgroups (1 to 4). Unlike GCS classification, mean outcome differences on PIFOS at 6 months showed decreasing function across classes. PIFOS differences relative to the lowest latent class (LC1) were: LC2 2.27 (0.83, 3.72); LC3 3.99 (1.88, 6.10); LC4 11.2 (7.04, 15.4). Differences in 12-month outcomes were seen between the most and least severely injured groups. Differences in outcomes in relation to AIS were restricted to the most and less severely injured at both timepoints. This study distinguished four latent classes that are clinically meaningful, distinguish a more homogenous severe injury group, and separate children by six-month functional outcomes better than GCS, alone. Systematic reporting of these variables would allow comparisons across research cohorts, potentially improve clinical predictions and increase sensitivity to treatment effects in clinical trials.

Language: en

Keywords

ASSESSMENT TOOLS; OUTCOME MEASURES; PEDIATRIC BRAIN INJURY