Clinical Factors Associated With Functional Recovery in Pediatric Traumatic Brain Injury

Document Type

Article

Publication Date

4-19-2026

Publication Title

Journal of Surgical Research

Abstract

Introduction: Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality in the United States, but little is known about long-term neurorecovery. We investigated the association between coma duration, ischemic injury, and seizure activity on post-TBI functional outcomes among pediatric patients admitted to inpatient rehabilitation (IPR). Methods: A retrospective review of pediatric and adolescent trauma patients ( < 18 y) admitted to an accredited pediatric IPR unit after TBI was performed. Patients were classified into short ( ≤ 7 d) and long ( > 7 d) coma duration. Outcomes were measured through the pediatric Functional Independence Measure scores measured at IPR admission and discharge, comparing subdomains of self-care, mobility, and cognition. Results: A total of 111 patients met the inclusion criteria, with 57% experiencing short coma and 43% long coma. Most injuries were blunt with intracranial hemorrhage. Ischemic injury occurred in 23% and post-traumatic seizures in 31% of patients. Ischemic injury was associated with lower cognitive Functional Independence Measure scores at both admission (8.46 ± 6.03 versus 11.95 ± 7.83, P = 0.0195) and discharge (13.46 ± 9.73 versus 18.76 ± 8.92, P = 0.0054). Long coma was independently associated with lower self-care (relative rate: 0.80; 95% confidence interval: 0.66-0.96) and mobility outcomes (relative rate: 0.82; 95% confidence interval: 0.68-0.98). Conclusions: Coma duration, injury mechanism, ischemic injury, and seizure activity emerged as factors associated with functional recovery after TBI. Long coma duration was associated with increased hospital and rehabilitation resource utilization and lower likelihood of return to baseline function. Patients with ischemic injury demonstrated lower cognitive recovery scores, consistent with prior literature. Early recognition of these factors can guide therapy, family counseling, and discharge planning. These findings highlight the importance of targeted and individualized rehabilitation strategies for pediatric TBI patients.

First Page

381

Last Page

389

PubMed ID

42001804

Volume

322

Rights

© 2026 Elsevier Inc.

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