Severe acquired brain injury aetiologies, early clinical factors, and rehabilitation outcomes: a retrospective study on pediatric patients in rehabilitation

ABSTRACT

Objective: Studies on pediatric severe acquired brain injury (sABI) outcomes focused mostly on single etiologies, not clarifying the independent role of clinical factors, and scantly explored inter-dependence between variables. We assessed associations of clinical factors at admission with essential outcomes, controlling for inter-dependence and sABI etiology.

Methods: We reviewed the clinical records of 280 patients with traumatic and 292 with non-traumatic sABI, discharged from intensive care to pediatric neurological rehabilitation. We analyzed the distribution of clinical factors based on sABI etiology; conducted a factor analysis of variables; built multivariate models evaluating the associations of variables with death, persistent vegetative states, duration of coma, GOS outcome, length of stay.

Results: We described the study sample. Factor analysis of inter-dependence between GCS, time before rehabilitation, dysautonomia, device use, produced the indicators “injury severity” and “neurological dysfunction”, independent from sABI etiology, age, sex, and admittance GOS. Multivariate analyzes showed that: coma duration, GOS outcome, and length of stay, which may depend on rehabilitation courses, were directly associated with injury severity, neurological dysfunction, and patients’ age; death and persistent vegetative states were also associated with etiology.

Conclusion: Future studies should analyze larger cohorts and investigate mechanisms linking specific etiologies and patients’ age with outcomes.

KEYWORDS:

• Brain injury
• Pediatrics
• rehabilitation
• risk factors
• outcomes

Acknowledgments

This work was supported by the Regional Center of Pharmacovigilance of Lombardy (to EC), the Italian Medicines Agency, Agenzia Italiana del Farmaco (AIFA, to EC) and by the Italian Ministry of Health (Ricerca Corrente 2019, to MP and SS) which is gratefully acknowledged. The funding public institutions had no role in any part of the work.

Declaration of interest statement

The authors report no conflicts of interest.

Additional information

Funding

This work was supported by the Agenzia Italiana del Farmaco, Ministero della Salute [-]; Regione Lombardia.