Similar overall disability but different mortality and motor impairment profiles in children compared to adults 7-8 years after severe TBI - 26/02/25

Doi : 10.1016/j.rehab.2025.101961

Hugo CÂmara-Costa, PhD ^1,^2,^3,^⁎ , Philippe AZOUVI, MD, PhD ^4,⁵, Claire Jourdan, MD, PhD ⁶, Hanna Toure, MD ¹, Anne Laurent-Vannier, MD ¹, Philippe Meyer, MD ⁷, Eléonore Bayen, MD, PhD ^2,⁸, Alexis Ruet, MD, PhD ⁹, Claire Vallat-Azouvi, MD, PhD ^10,¹¹, Georges Dellatolas, MD, PhD ³, Mathilde Chevignard, MD, PhD ^1,^2,³
¹ Rehabilitation Department for Children with Acquired Brain Injury, Saint Maurice Hospitals, Hôpitaux Paris Est Val-de-Marne (site Saint Maurice), 12/14 rue du Val d'Osne, 94410 Saint Maurice, France
² Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale (LIB), F-75006, Hôpital de la Pitié Salpétrière, 47 boulevard de l'Hôpital, 75013 Paris, France
³ Sorbonne Université, GRC 24 Handicap Moteur Cognitif et Réadaptation (HaMCRe), AP-HP, F-75013, Hôpital de la Pitié Salpétrière, 47 boulevard de l'Hôpital, 75013 Paris, France
⁴ AP-HP, GH Paris Saclay, Hôpital Raymond Poincaré, Service de Médecine Physique et de Réadaptation, 104 boulevard Raymond-Poincaré, 92380 Garches, France
⁵ Université Paris-Saclay, UVSQ, Inserm, CESP, Hôpital Paul Brousse Bâtiment, 15-16 avenue Paul Vaillant Couturier, 94807 Villejuif, France.
⁶ Physical Medicine and Rehabilitation Department, Lapeyronie Hospital, CHRU, 371 avenue du Doyen Gaston Giraud, 34090 Montpellier, France
⁷ Assistance Publique des Hôpitaux de Paris (APHP) Centre - Université de Paris, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75743 Paris, France
⁸ Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière, Service De Médecine Physique Et Réadaptation, Hôpital de la Pitié Salpétrière, 47 boulevard de l'Hôpital, 75013 Paris, France
⁹ Physical Medicine and Rehabilitation Department, CHU Caen, INSERM U1077, Avenue de la Côte de Nacre, 14033 Caen, France
¹⁰ Laboratoire DysCo, Paris 8 University, Saint Denis, France
¹¹ Pôle Médico-Social Adulte - Parcours Cérébrolésés et Polyhandicap - UGECAM IDF, Hôpital Raymond Poincaré, 104 boulevard Raymond-Poincaré, 92380 Garches, France

^⁎Corresponding author: Hugo Câmara Costa, Rehabilitation Department for Children with Acquired Neurological Injury, Hôpitaux Paris Est Val-de-Marne (site Saint-Maurice), 12/14 rue du Val d'Osne, 94410 Saint Maurice, France; and Sorbonne Université, Laboratoire d'Imagerie Biomédicale (LIB), Service de Médecine Physique et Réadaptation, Hôpital de la Pitié Salpétrière, 47 boulevard de l'Hôpital, 75013 Paris, FranceRehabilitation Department for Children with Acquired Neurological InjuryHôpitaux Paris Est Val-de-Marne (site Saint-Maurice)Laboratoire d'Imagerie Biomédicale (LIB)Service de Médecine Physique et RéadaptationHôpital de la Pitié Salpétrière12/14 rue du Val d'OsneSaint Maurice94410France

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Highlights

•	Adverse outcomes 7-8 years after severe traumatic brain injury (sTBI) depend on age
•	Adults post-sTBI face higher mortality, longer coma, and persistent motor deficits
•	Children/adolescents post-sTBI exhibit more Good Recoveries than adults
•	Predictors of post-sTBI disability vary between children/adolescents and adults
•	Severe TBI causes lasting, multifaceted issues in children/adolescents and adults

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Abstract

Background

Age at injury influences functional outcomes after severe traumatic brain injury (TBI), but its role remains underexplored in studies that simultaneously include children, adolescents, and adults.

Objectives

To investigate the effect of age at injury on mortality and overall disability 7 to 8 years post-severe TBI across diverse age groups.

Methods

Two prospective longitudinal cohorts assessed overall functional outcomes in 39 children/adolescents [Traumatisme Grave de l'Enfant (TGE) cohort, mean age at injury M(SD)=7.5 years (4.6), range 0.3 to 14.7] and 86 adults [PariS-TBI cohort, M(SD)=34.1 years (13.7), range 15.4 to 74.8], who sustained severe TBI [Glasgow Coma Scale (GCS) ≤8]. Both studies collected data on baseline demographics (age, gender, education level), initial injury severity (GCS, Injury Severity Score [ISS], length of coma), and mortality rates. Follow-up assessments included clinician-rated overall disability [Glasgow Outcome Scale-Extended (GOS-E)], clinical/neurological recovery, and self-/proxy-reported questionnaires assessing school/work situation, anxiety/depression, and caregivers’ perceived burden.

Results

Adults evidenced significantly higher mortality rates, longer lengths of coma, and more frequent persistent motor deficits than children/adolescents. Children/adolescents exhibited increased rates of good recovery (GOS-E) 7 to 8 years post-injury compared to adults (P = 0.03). In multivariate linear regression analyses, GOS-E was associated with GCS score and pre-injury education in the total sample and adults. In both age groups, overall post-injury disability was associated with the presence of school/work adaptations and motor deficits, increased anxiety/depression, and higher caregiver burden.

Conclusion

These findings reveal distinct age-specific patterns of recovery and disability after severe TBI among children, adolescents, and adults, highlighting the need for tailored assessments and interventions for each group. Furthermore, they underline the necessity of prolonged follow-up in children and adolescents to evaluate their transition to independent living and professional integration. Future research should confirm these results and identify modifiable factors that promote recovery and minimize long-term disability.

Le texte complet de cet article est disponible en PDF.

Keywords : Severe traumatic brain injury, children/adolescents, adults, prospective longitudinal study, long-term outcome, disability