Development of a novel method to predict disability after head trauma in children

Abstract

Background/purpose: Although analysis of functional independence measures (FIM) at discharge are useful for assessing extent of disability in head-injured children, there is no reliable method to predict the severity of disability at the time of admission. The authors developed a novel method to predict severe disability after head trauma on admission.

Methods: Head-injured patients, 2 to 16 years old, with FIM recorded at discharge (n = 3,491) were identified in our state trauma database for the period from 1993 through 1996. Patients categorized as completely dependent by one or more of the FIM (Feeding, Locomotion, Expression, Transfer Mobility, Social Interaction) were classified as disabled. Probability of disability (P(D)) was estimated based on regression weights for Glasgow Coma Scale (GCS), Injury Severity Score (ISS), age, and number of anatomic regions injured. Observed to expected disability rates were compared using a test data set of 2,553 patients entered in the database between 1997 through 1999.

Results: There was no statistically significant difference between observed and expected disability across all P(D) intervals, which suggests that the P(D) accurately predicted disability.

Conclusions: P(D) offers a novel and reliable method for early prediction of likelihood of disability in children who sustain head trauma. Routine use of the P(D) may lead to earlier intervention to improve long-term results in head-injured children.