Disability from Pediatric Trauma Brain Injury

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Population based studies have estimated the incidence of TBI but have not provided population-based estimates of subsequent disability. This population-based information is important for the appropriate planning and delivery of services to children disabled by TBI. Objectives: (1) Determine the incidence of mild, moderate, and severe TBI in children and adolescents 0-18 years of age; (2) Determine the disability from different severities of TBI in children of different age groups; (3) Determine how this disability changes over time after injury; (4) Identify risk and protective factors for disability from TBI. Study Design: In this project, we will conduct a population-based surveillance of children and adolescents with TBI. From this surveillance, we will identify a sample of pediatric patients with TBI who will be recruited and enrolled in the study. This sample will be stratified by severity and age to allow adequate numbers of individuals at each severity level and each age group for study. Initial and base line measurements will be obtained, and patients will be followed over time to determine outcomes from TBI. Setting: Subjects will be identified in Emergency Departments, Hospitals and Medical Examiners in King County, Washington, and Philadelphia County, Pennsylvania. Participants: 1000 patients 0-18 years of age with mild, moderate or severe TBI. Outcome Measures: We will examine patient and family disability pre-injury and at 3, 12, 24, and 36 months post-TBl. This will include quality of life, social, emotional, behavioral and academic disability in patients and family functioning and parenting stress. Implications: This study will address many of these unanswered questions surrounding pediatric TBI. It will provide population-based rates of the incidence and disability fromTBI, including mild, moderate and severe based on medical record and interview data. It will follow patients and their families for three years after injury, examining the degree to which recovery plateaus in the months following TBI. It will examine factors which interact with the injury to produce disability, be they positive or negative influences on outcomes. The study team represents an interdisciplinary group of very experienced investigators to carry out a rigorous study to provide information to inform future research, care and policy.