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. 2023 Jun 7;12(12):3895.
doi: 10.3390/jcm12123895.

A Multidimensional Approach to Assessing Factors Impacting Health-Related Quality of Life after Pediatric Traumatic Brain Injury

Nicole von Steinbuechel  1 , Ugne Krenz  1 , Fabian Bockhop  1 , Inga K Koerte  2 , Dagmar Timmermann  1 , Katrin Cunitz  1 , Marina Zeldovich  1 , Nada Andelic  3   4 , Philine Rojczyk  2 , Michaela Veronika Bonfert  5 , Steffen Berweck  6 , Matthias Kieslich  7 , Knut Brockmann  8 , Maike Roediger  9 , Michael Lendt  10 , Anna Buchheim  11 , Holger Muehlan  12 , Ivana Holloway  1 , Laiene Olabarrieta-Landa  13   14
Affiliations

A Multidimensional Approach to Assessing Factors Impacting Health-Related Quality of Life after Pediatric Traumatic Brain Injury

Nicole von Steinbuechel et al. J Clin Med. .

Abstract

In the field of pediatric traumatic brain injury (TBI), relationships between pre-injury and injury-related characteristics and post-TBI outcomes (functional recovery, post-concussion depression, anxiety) and their impact on disease-specific health-related quality of life (HRQoL) are under-investigated. Here, a multidimensional conceptual model was tested using a structural equation model (SEM). The final SEM evaluates the associations between these four latent variables. We retrospectively investigated 152 children (8-12 years) and 148 adolescents (13-17 years) after TBI at the recruiting clinics or online. The final SEM displayed a fair goodness-of-fit (SRMR = 0.09, RMSEA = 0.08 with 90% CI [0.068, 0.085], GFI = 0.87, CFI = 0.83), explaining 39% of the variance across the four latent variables and 45% of the variance in HRQoL in particular. The relationships between pre-injury and post-injury outcomes and between post-injury outcomes and TBI-specific HRQoL were moderately strong. Especially, pre-injury characteristics (children's age, sensory, cognitive, or physical impairments, neurological and chronic diseases, and parental education) may aggravate post-injury outcomes, which in turn may influence TBI-specific HRQoL negatively. Thus, the SEM comprises potential risk factors for developing negative post-injury outcomes, impacting TBI-specific HRQoL. Our findings may assist healthcare providers and parents in the management, therapy, rehabilitation, and care of pediatric individuals after TBI.

Keywords: adolescent; anxiety; child; depression; health-related quality of life; post-concussion symptoms; traumatic brain injury.

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Conflict of interest statement

The authors declare no conflict of interest. The sponsors had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision of publishing the results.

Figures

Figure 1
Figure 1
Multidimensional conceptual model for testing factors impacting TBI-specific HRQoL.
Figure 2
Figure 2
Flow chart of study participants and number of imputed items in the SEM building. Note. FIML = Full Information Maximum Likelihood; Sociodemographic and injury-related characteristics of the two pediatric TBI age groups are listed separately and overall in Table 1 as well as significant group differences. Missing data points can be found in Table 1, Table 2 and Table 3.
Figure 3
Figure 3
Final empirical SEM path diagram showing the final parameter estimates and their statistical significance. Note. Significant estimates are flagged with an asterisk (** p < 0.01). The pathway from Post-injury outcome to TBI-specific HRQoL in green: higher scores in GAD-7, PHQ-9, and PCSI are negatively associated with TBI-specific HRQoL (lower QOLIBRI-KID/ADO scores).
See this image and copyright information in PMC

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