Abstract
Objectives
To (1) describe characteristics of children with anoxic or hypoxic brain injuries
(AnHBI) who presented to an inpatient rehabilitation unit, (2) explore functional
outcomes of children with AnHBI at discharge, and (3) examine differences between
children with AnHBI associated with cardiac arrest (CA) vs those with respiratory
arrest (RA) only.
Design
Retrospective cohort study.
Setting
Pediatric inpatient rehabilitation hospital in the Northeast United States.
Participants
A total of 46 children and adolescents ages 11 months to 18 years admitted to an inpatient
rehabilitation brain injury unit (1994-2018) for a first inpatient admission after
AnHBI.
Interventions
Not applicable.
Main Outcome Measures
Pediatric Cerebral Performance Category Scale (PCPC), Pediatric Overall Performance
Category, and Functional Independence Measure for Children developmental functional
quotients (WeeFIM DFQs) total and subscale scores.
Results
Most children had no disability before injury (PCPC=normal, n=37/46) and displayed
significant functional impairments at admission to inpatient rehabilitation (PCPC=normal/mild,
n=1/46). WeeFIM and PCPC scores improved significantly during inpatient rehabilitation
(WeeFIM DFQ Total, P=.003; PCPC, P<.001), although many children continued to demonstrate significant impairments at
discharge (PCPC=normal/mild, n=5/46). Functioning was better for the RA-only group
relative to the CA group at admission (WeeFIM DFQ Total, P=.006) and discharge (WeeFIM DFQ Total, P<.001). Ongoing gains in functioning were noted 3 months after discharge compared
with discharge (WeeFIM DFQ Cognitive, P=.008).
Conclusions
In this group of children with AnHBI who received inpatient rehabilitation, functional
status improves significantly between rehabilitation admission and discharge. By discharge,
many children continued to display significant impairments, a minority of children
had favorable neurologic outcomes, and children with CA have worse outcomes than those
with RA-only. Given the small sample size, future research should examine functional
recovery during inpatient rehabilitation in a larger, multisite cohort and include
longer-term follow-up to examine recovery patterns over time.
Keywords
List of abbreviations:
ABI (acquired brain injury), AnHBI (anoxic/hypoxic brain injury), CA (cardiac arrest), DFQ (developmental functional quotient), ICD (International Classification of Diseases), LOS (length of stay), PCPC (Pediatric Cerebral Performance Category), POPC (Pediatric Overall Performance Category), RA (respiratory arrest), TBI (traumatic brain injury), TTA (time to admission), WeeFIM (Functional Independence Measure for Children)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Acquired brain injury.Pediatric rehabilitation: principles and practice. Springer Publishing Company, New York2020: 294-318
- Outcome of severe anoxic/ischemic brain injury in children.Pediatr Neurol. 1994; 10: 207-212
- Social function changes in children and adolescents with acquired brain injury during inpatient rehabilitation.Pediatr Rehabil. 2001; 4: 177-185
- Self-care recovery of children with brain injury.Phys Occup Ther Pediatr. 2002; 21: 7-27
- Gross Motor Function Measure-66 trajectories in children recovering after severe acquired brain injury.Dev Med Child Neurol. 2015; 57: 241-247
- Children sustaining a severe acquired brain lesion before age 3 years: a follow-up study at 1 year from insult.Brain Inj. 2019; 33: 160-167
- Assessing the outcome of pediatric intensive care.J Pediatr. 1992; 121: 68-74
- Relationship of Pediatric Overall Performance Category and Pediatric Cerebral Performance Category scores at pediatric intensive care unit discharge with outcome measures collected at hospital discharge and 1- and 6-month follow-up assessments.Crit Care Med. 2000; 28: 2616-2620
- Recommended guidelines for uniform reporting of pediatric advanced life support: the Pediatric Utstein Style: a statement for Healthcare Professionals from a Task Force of the American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council.Resuscitation. 1995; 30: 95-115
- P-COSCA (Pediatric Core Outcome Set for Cardiac Arrest) in children: an advisory statement from the International Liaison Committee on Resuscitation.Circulation. 2020; 142: e246-e261
- WeeFIM: normative sample of an instrument for tracking functional independence in children.Clin Pediatr (Phila). 1994; 33: 431-438
- The Functional Independence Measure for Children (WeeFIM): conceptual basis and pilot use in children with developmental disabilities.Clin Pediatr (Phila). 1994; 33: 421-430
- Interrater agreement and stability of the functional independence measure for children (weefimTM): use in children with developmental disabilities.Arch Phys Med Rehabil. 1997; 78: 1309-1315
- Concurrent validity of the Functional Independence Measure for Children (WeeFIM(TM)) and the Pediatric Evaluation of Disabilities Inventory in children with developmental disabilities and acquired brain injuries.Phys Occup Ther Pediatr. 2002; 21: 91-101
- Examining acute rehabilitation outcomes for children with total functional dependence after traumatic brain injury: a pilot study.J Head Trauma Rehabil. 2013; 28: 361-370
- Time to follow commands remains the most useful injury severity variable for predicting WeeFIM® scores 1 year after paediatric TBI.Brain Inj. 2013; 27: 1056-1062
- Injury severity variables as predictors of WeeFIM scores in pediatric TBI: time to follow commands is best.J Pediatr Rehabil Med. 2009; 2: 297-307
- In-hospital versus out-of-hospital pediatric cardiac arrest: a multicenter cohort study.Crit Care Med. 2009; 37: 2259-2267
- Relationships between three and twelve month outcomes in children enrolled in the therapeutic hypothermia after pediatric cardiac arrest trials.Resuscitation. 2019; 139: 329-336
- Factors associated with poor outcome in pediatric near-hanging injuries.J Emerg Med. 2019; 57: 21-28
- Pediatric Emergency Care Applied Research Network. In-hospital versus out-of-hospital pediatric cardiac arrest: a multicenter cohort study.Crit Care Med. 2009; 37: 2259-2267
- Rehabilitation in children with disorder of consciousness.Curr Phys Med Rehabil Rep. 2019; 7: 94-103
Article info
Publication history
Published online: February 07, 2023
Accepted:
January 23,
2023
Received in revised form:
October 26,
2022
Received:
August 29,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Disclosures: none.
Identification
Copyright
© 2023 by the American Congress of Rehabilitation Medicine.
