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Relationship of Two Measures of Injury Severity to Pediatric Psychological Outcome 1-3 Years after Acute Head Injury

Objective:To compare the strength of relationship of the Glasgow Coma Scale (GCS) versus the ASCOT probability of survival (Ps), a multidimensional trauma severity index, with a comprehensive range of core areas of psychological functioning assumed to influence quality of life in pediatric head injury survivors. Design:Correlational relationships between the GCS versus the Ps and standardized outcome measures in six psychological domains were compared. Ordering effects of level of severity on outcome were studied through analyses of variance for the GCS versus the Ps. Setting:A pediatric level I trauma center. Patients:Eighty-six children with mild to severe traumatic brain injury retrospectively recruited from consecutive head injury admissions for a 30-month period. Measures:Wechsler Intelligence Scale for Children-Revised, Trail Making Test, Tactual Performance Test, Fuld Object Memory Evaluation, Finger Tapping, Grooved Pegboard, Beery Developmental Test of Visual-Motor Integration, Detroit Oral Directions, Woodcock-Johnson Tests of Achievement, Vineland Adaptive Behavior Scales, Achenbach Child Behavior Checklist, Harter Self-Perception Scales. Results:Significant correlations were found between each of the severity indices (GCS and Ps) and the IQ and neuropsychological variables. Both Ps and GCS were able to distinguish the severe injury group from lesser injury. Ps yielded a stronger pattern of correlations and a clearer step-wise separation of the three injury severity levels on neuropsychological variables. Only the GCS was related to adaptive behavior. Neither severity index showed strong correlational patterns with behavioral or self-perception psychological domains. Conclusions:Multidimensional trauma severity measures such as the Ps merit further study as tools for prediction of longterm neuropsychological outcome following pediatric head injury, especially in the case of children with moderate head injuries. Findings must be considered preliminary due to sample limitations but do emphasize the greater degree of independence of psychosocial, as compared to neurocognitive, outcome relative to initial Injury severity.