DEVELOPMENTAL PATHWAY OF COGNITIVE RECOVERY FROM PAEDIATRIC ACQUIRED BRAIN INJURY (ABI)

Objectives: ABI is the leading cause of paediatric death & long-term disability in western countries with consequences in multiple domains. Recovery from ABI is a developmental process. Severity of injury is accepted as the best predictor of outcome after ABI. Current research on prognosis generally fails to: identify children at an early & uniform point in course of recovery; provide uniform follow up across the spectrum of injury severity & include measures of pre-morbid functioning. Designed a long term prospective inception cohort study for school-aged children. As time progresses from injury, is there a widening gap between performance and expected age appropriate function, particularly in cognition and behaviour.

Methods: Medical & demographic variables were collected on 299 eligible children admitted to McMaster Children's Hospital. On admission pre-morbid cognitive & functional status collected via questionaries & review of all Ontario School Records. Functional and clinical outcome data collected on 183 participants at 8, 12 and 20/24 months post injury, via many published scales. Areas sampled included: academic performance; school function; child health; participation & enjoyment; environmental factors; family assessment; impact on family; and process of care. Results: The medical and pre-morbid variables which best predicted cognitive outcome at the times sampled were determined via hierarchical linear modelling. Pattern(s) of cognitive recovery overtime indicate more difficulties than previously reported, especially in the milder groups. Conclusion: The influence of pre-morbid behavioural and cognitive factors on the cognitive outcome and recovery pathways is found even after mild ABI. There is significant impact and interplay amongst pre-morbid status, recovery and severity of injury. Cognitive changes are clearly reflected in changes in academic performance. Use of the GCS to categorize injury severity is not sufficient to categorize outcome beyond one month health status.