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Background: Identification of children after traumatic brain injury (TBI) likely to have functional deficits at trauma center discharge will facilitate care., Methods: Two logistic regression models were derived from data on 4,439 children after TBI 7 to 14 years old enrolled in the National Pediatric Trauma Registry between 1994 and 2001 to predict physical and cognitive disabilities., Results: Children with open or multiple fractures or closed fractures or injured by motor vehicles were 8.2, 3.5, or 2.5 times more likely, respectively, than those without those circumstances to have discharge physical disabilities. Likelihood of cognitive impairment was increased by factors of 3.2 and 5.8 in children obtunded or comatose on arrival. Preexisting cognitive deficits, injury severity, and intubation predicted physical and cognitive disabilities. The C statistic was 0.862 for the motor model and 0.860 for the cognitive model., Conclusion: Predicting the likelihood of morbidity after acute management of childhood TBI can provide information pertinent to providing effective care.

Using data from the National Pediatric Trauma Registry, this study examined the characteristics of bicycle-related head injury, factors related to the presence of head injury, and different outcomes of head injury up to the time of discharge. Of the 2,333 patients ages 0 to 14 years who were admitted to trauma centers because of bicycle-related injury during 1989 through 1992, more than one-half (54%) sustained head injury, predominantly concussions and skull fractures. With adjustment for age, sex, and motor vehicle involvement, children who had pre-existing mental disorders, who did not wear a helmet at the time of injury, or who were injured on roads had a significantly increased likelihood of sustaining head injuries. Patients with a head injury were four times as likely as patients with no head injury to be treated in intensive care units, and were almost twice as likely to develop complications. Head injury was associated with an increased risk of inhospital fatality and high prevalence rates of communication and behavior impairments at discharge. Although it is urgent to increase helmet use substantially by child bicyclists, special attention should be paid to high-risk groups, such as children with mental disorders and children who are likely to ride in traffic.

The ability of the Pediatric Trauma Score (P.T.S.) to predict injury severity and mortality was evaluated by analysis of its relationship with the Injury Severity Score (I.S.S.) of 615 children entered into the National Pediatric Trauma Registry (N.P.T.R.). Mean age was 8.2 years and mortality was 3.5%. Mean I.S.S. of survivors was 8.1 in comparison to 59.7 for nonsurvivors. Linear regression coefficient determined from analysis of these variables produced a slope of -3.7 with a statistically significant correlation of P.T.S. to I.S.S. (p less than 0.001; r2 = 0.89). Analysis of the mortality for each cohort of patients with the same P.T.S. identified three categories of mortality potential. Children whose P.T.S. was greater than 8 had a 0% mortality. Children whose P.T.S. was between 0 and 8 had an increasing mortality related to their decreasing P.T.S. (r2 = 0.86), and children whose P.T.S. was below 0 had 100% mortality. This study documents the direct linear relationship between P.T.S. and injury severity, and confirms the P.T.S. as an effective predictor of both severity of injury and potential for mortality.