L.L. Lawes2, M.N. Kelly2, G.T. Sibley5, L. Elliot1, S. Schultz1, A. Tilton1, J. Volk4, D.C. Yu1,3, J.A. Zagory1,2 1Children’s Hospital New Orleans, New Orleans, LOUISIANA, USA 2Louisiana State University Health Sciences Center, New Orleans, LA, USA 3Tulane University School Of Medicine, New Orleans, LA, USA 4Louisiana State University Health Sciences Center, Department Of Neurosurgery, New Orleans, LA, USA 5Louisiana State University Health Sciences Center, Division Of Physical Medicine And Rehabilitation, New Orleans, LA, USA
Introduction: Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality in the United States, but little is known about long-term neurorecovery. In this study, we investigated the duration of post-TBI coma on outcomes.
Methods: We performed a retrospective review of pediatric and adolescent trauma patients (< 18 years old) admitted to an accredited pediatric inpatient rehabilitation (IPR) unit after TBI between January 1, 2018, and December 31, 2023. Outcomes include Pediatric Functional Independence Measure (WeeFIM) scores measured at IPR admission and discharge.
Results: 122 patients were included. When comparing patients who had duration of coma <7 (short, N=63) versus >7 days (long, N=59), we found patients with long duration were less likely to be male, sustained blunt injury, had lower Glascow Coma Scale at admission, have longer hospital (38.2±29.3 vs 15.5±11 days, p<0.0001) and IPR length of stay (LOS, 47.7±26 vs 27.4±20 days, p<0.0001), need a wheelchair (66 vs 28.6%, p=0.0001), and require botulism for spasticity (42 vs 23.8%, p=0.03). WeeFIM scores across all domains (self-care, mobility, and cognition) were significantly worse for patients with longer duration of coma at both IPR admission and discharge (all p<0.01), and these patients were less likely to attain school/community reintegration (75 vs 93%, p=0.01) (Table). When analyzed for initial GCS, the findings were not reproduced.
Conclusion: Duration of coma greater than 7 days after TBI predicts worse outcomes for pediatric and adolescent patients.