Long-term psychosocial outcome after severe traumatic brain injury in childhood

Introduction. In addition to long-term neurological impairment, severe traumatic brain injury (TBI) in childhood is frequently associated with negative psychosocial consequences. In contrast to Anglo-American countries only few data concerning the long-term psychosocial development are available in Germany. Material and methods. Follow-up investigations of 49 former patients (aged 0-17 years) were carried out an average of 6 years after severe TBI and subsequent inpatient rehabilitation. Behavioral problems and psychological distress (assessed by CBCL, SCL-90-R scale) and academic as well as occupational status were related to functional outcome (KOSCHI scale) at discharge. Results. The frequency of behavioral problems in children and adolescents was significantly increased. In the subgroup of children without premorbid psychiatric diagnosis 29% showed clinically significant behavioral problems at follow-up with highest scores on the CBCL scale "attention problems" and "social problems". The KOSCHI scores obtained 3 months after TBI were significantly related to behavioral problems and special educational needs at follow-up. With respect to patients who had reached adulthood, 19% scored in the clinical range and primarily complained about cognitive impairment. The KOSCHI scores of the adults were not related to psychological distress but to integration into the job market. Conclusion. Early assessment of the functional status after TBI supports risk estimation of long-term psychosocial impairment.