Behavioural Outcome at One and Six Months after Severe/moderate and Mild Traumatic Brain Injury (TBI) in Childhood; Relationship to Pre-injury Behaviour
Introduction: TBI is a major cause of paediatric hospital admissions. Disturbed behaviour is well recognised in TBI children, but it is uncertain if this is due to injury or reflects pre-morbid functioning.
Aims: (1) To define behavioural outcome in TBI children compared to controls (2) to relate pre injury behaviour in TBI children to behaviour in controls and to behaviour post TBI.
Methods: Longitudinal prospective study of a cohort of children admitted to hospital for TBI compared to non-injured controls matched for age, sex and socio-economic status. The Glasgow Coma Score (GCS) on admission was used to classify TBI into severe (GCS 3-8), moderate (GCS 9-12) and mild (GCS 13-15) categories. Pre and post injury behaviour was assessed using parent report form of the Child Behaviour Checklist (CBCL). Statistical analysis was by 2-way repeated measures ANOVA and one-way ANOVA with Scheffe’s multiple comparison measures.
Results: 86 TBI children and 47 controls were recruited. Mean age of TBI children was 11.0 y (SD 3.8); mean age of controls 11.1 y (SD 3.8). For post injury behaviour, there were significant differences at 1 and 6 months between severe/moderate and mild TBI children and controls for all aspects of the CBCL i.e. Externalising Index, Internalising Index, Social Competence and Total Problem Score (p<0.001 for all comparisons). For pre injury behaviour, there were significant differences between TBI groups and control children for CBCL Externalising Index (p=0.01) but not for Internalising Index (p=0.30), Social Competence (p=0.51) or Total Problem Score (p=0.08). Comparison of pre and post injury behaviour up to six months in TBI children showed no significant changes in CBCL Externalising Index (p=0.35) but significant changes in Internalising Index (p=0.01), Social Competence (p<0.001) and Total Problem Score (p=0.003); in the latter analysis the two TBI groups did not differ significantly.
Conclusion: There are significant differences between TBI children and controls for a range of behaviours. Group differences in externalising behaviours appear to reflect pre-morbid behavioural status, but this is not the case for internalising behaviours or social competence, which appear due to TBI.