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Health-Related Quality of Life During the First Year After Traumatic Brain Injury
Melissa L. McCarthy, ScD;
Ellen J. MacKenzie, PhD;
Dennis R. Durbin, MD, MS;
Mary E. Aitken, MD, MPH;
Kenneth M. Jaffe, MD;
Charles N. Paidas, MD;
Beth S. Slomine, PhD;
Andrea M. Dorsch, PhD;
James R. Christensen, MD;
Ru Ding, MS; for the Children's Health After Trauma Study Group
Arch Pediatr Adolesc Med. 2006;160:252-260.
Objectives To document health-related quality of life (HRQOL) of children with traumatic brain injury (TBI) and to examine the relationship between TBI severity and HRQOL during the first year after injury.
Design Prospective cohort study.
Setting Four pediatric level I trauma centers.
Patients Children with TBI (n = 330).
Main Exposure Traumatic brain injury.
Main Outcome Measures A primary caregiver completed telephone interviews at baseline, 3 months, and 12 months to measure the child's HRQOL using the Pediatric Quality of Life Inventory. The HRQOL outcomes were modeled as a function of injury, patient characteristics, and family characteristics using longitudinal, multivariable regression.
Results A considerable proportion of children had impaired HRQOL at 3 months (42% of children) and 12 months (40% of children) after injury. Multiple dimensions of HRQOL were negatively affected among children with moderate or severe TBI (decrease of 3.7 to 17.6) (P<.05) and did not improve significantly over time. Concomitant lower extremity fractures and spinal injuries resulted in large declines in overall HRQOL, particularly at 3 months after injury (decrease of 12.9 and 8.1, respectively) (P<.05). The HRQOL scores were also reduced by preexisting psychosocial conditions (decrease of 2.9 to 12.3), impaired family functioning (decrease of 5.1 to 6.8), having Medicaid coverage or being uninsured (decrease of 3.1 to 5.5), and single-parent households (decrease of 3.2 to 3.4) (P<.05).
Conclusions Moderate or severe TBI resulted in measurable declines in children's HRQOL after injury. Injury-related factors impacted HRQOL more compared with patient and family characteristics during the first year after injury.
Author Affiliations: Departments of Emergency Medicine (Dr McCarthy and Ms Ding), Surgery (Dr Paidas), Psychiatry (Dr Slomine), Physical Medicine and Rehabilitation (Dr Christensen), and Pediatrics (Dr Christensen), School of Medicine, and Center for Injury Research and Policy, Bloomberg School of Public Health (Dr MacKenzie), Johns Hopkins University, Baltimore, Md; Department of Pediatrics, School of Medicine, University of Pennsylvania, Philadelphia (Dr Durbin); Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock (Dr Aitken); Departments of Rehabilitation Medicine (Dr Jaffe) and Pediatrics (Dr Jaffe) and Division of Rehabilitation Psychology (Dr Dorsch), Children's Hospital and Regional Medical Center, School of Medicine, University of Washington, Seattle; and Departments of Neuropsychology (Dr Slomine) and Pediatric Rehabilitation Medicine (Dr Christensen), Kennedy Krieger Institute, Baltimore.
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