Endocrine Abstracts

Objectives: To determine long-term functional outcome following traumatic brain injury (TBI) in childhood.

Patients: Longitudinal study of 49 participants with TBI (21 mild, 28 moderate/severe TBI) and 16 healthy controls matched for age, gender and socioeconomic status. Age at TBI (median (range)) 11.8 (1–16) years; 17 were prepubertal, 16 peripubertal, 16 postpubertal. Age at study 19.7 (10–26) years, time post TBI 8.6 (5.8–10.8) years. All subjects had clinical review, auxology and pubertal assessment. Quality of life was assessed with the Paediatric Quality of Life Inventory (PedsQL 4.0) and the Health Utilities Index (HUI), fatigue with the Chalder fatigue questionnaire. 24/28 of the moderate/severe TBI group agreed to GH stimulation testing (ITT) (6 peripubertal, 18 postpubertal).

Results: None of the participants had clinical problems with growth, puberty or thyroid status or were on anti-convulsants. The overall HRQL scores using the HUI3 multi-attribute utility function were significantly lower (P=0.05) in participants with moderate/severe TBI (0.82) than in mild TBI (0.91) or in the control group (0.95). Single-attribute utility function analysis showed significant differences (P=0.006) in cognition scores between groups (moderate/severe 0.86, mild 0.92 and control 1). PedsQL results did not reach significance but overall and psychosocial health summary scores were lower in the moderate/severe than mild and control group (80±16 vs 81±19 vs 87±7 and 76±18 vs 78±23 vs 87±7 respectively). Physical health summary scores did not differ between groups. Fatigue scores were higher in the TBI vs control group (14/34 vs 0/9 reaching the bimodal score >4, P=0.02). 6/24 had suboptimal GH and one had a suboptimal cortisol response but GH status did not correlate with fatigue or poor HRQL.

Conclusions: Evidence of poor HRQL, cognition difficulties and fatigue are identifiable 8–10 years post TBI. Their aetiology is not explained by GH status in standard provocation tests and requires further investigation.