Dissertation/Thesis Abstract

Early outcomes from mild traumatic brain injury from child and proxy perspectives
by Pieper, Pamela, Ph.D., Barry University School of Nursing, 2009, 180; 3388093
Abstract (Summary)

Background. Approximately 70-90% of traumatic brain injuries are mild, with a worldwide incidence greater than 600 per 100,000 people. Previous studies of health-related quality of life (HRQoL) after a mild traumatic brain injury (mTBI) have not included child perspectives or children discharged from the Emergency Department.

Purpose. This study evaluates, from perspectives of children and their proxies, whether children who have sustained an mTBI return to pre-injury levels of HRQoL by 1-month post-injury and whether their HRQoL is different from that of mild non-brain injured or uninjured children at either time point. It also compares child/proxy dyad ratings of the child’s HRQoL.

Theoretical Framework. Haas’ model of the middle range theory HRQoL is the foundation for this research. It includes subjective and objective indicators and physical, psychological, social, and role dimensions. HRQoL was operationalized using the PedsQL™ 4.0 Generic Core Scales and Cognitive Functioning Scale.

Methods. A nonexperimental, prospective longitudinal descriptive design was used to evaluate the HRQoL of mTBI, mild non-brain injured, and uninjured children ages 5-17, from child and proxy perspectives. Pre-injury interviews were conducted in person; 1-month interviews were conducted via telephone. Injured child/proxy dyads were met in the Emergency Department within hours of injury; only those with a maximum hospitalization of 24 hours were included in the study. Uninjured children were age- and gender-matched with mTBI children. Data were analyzed using the paired t-test, Wilcoxon matched pairs signed-rank test, ANOVA, Kruskal-Wallis, and regression.

Results. Children sustaining an mTBI and uninjured children had similar ratings of HRQoL at baseline and at 1-month, whereas mild non-brain injured children and their proxies both rated 1-month post-injury physical HRQoL statistically significantly lower than pre-injury levels. Child HRQoL ratings were statistically significantly lower than proxy ratings on all but the PedsQL™ Cognitive Functioning Scale at both time points.

Conclusions. These mTBI children did not experience differences between pre-injury and 1-month post-injury HRQoL. Further evaluation is indicated in cases where disparities are noted. Clinical significance of child/proxy HRQoL rating incongruence is limited as a result of small to medium effect sizes.

Indexing (document details)
Advisor: Bear, Mary
School: Barry University School of Nursing
School Location: United States -- Florida
Source: DAI-B 70/12, Dissertation Abstracts International
Subjects: Nursing, Cognitive psychology
Publication Number: 3388093
ISBN: 9781109526035
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