Survival
In the last two decades, morbidity and mortality associated with pediatric TBI has been on the decline, with children younger than 4 years of age and adolescents
10.3
Modified Glasgow Outcome Scale
Cognitive Status
O-Normal
1- Verbal communication, needs help in academic setting
2- Limited language, can express needs and wants, significant adaptation of academic setting
3- No language, responds to voices
4- Persistent vegetative state
Motor Status
O-Normal
1- Near-normal ambulation, needs supervision for ADLs
2- Ambulates with assistive devices and/or needs adaptive equipment for ADLs
3- Needs assistance for ambulation or ADLs
4- Nonambulatory, assistance for transfers, dependent for ADLs
5- No purposeful movement greater than 15 years of age having higher mortality rates.
Infants still had the highest overall mortality (235). This improved mortality rate in children and adolescents may be due to improvements in medical care and surgical treatment. Potoka et al. (236) reported that for children who sustain severe TBI, mortality was significantly lower if the child was treated at a pediatric trauma center or at an adult trauma center with qualifications to treat children. The mortality of patients who sustained a TBI was higher if the child was treated at a level 2 adult trauma center instead. More than two-thirds of deaths from brain injury occur at the scene or en route to the hospital in a population in which both adults and children were studied (237), but children with acquired brain injury who survive the initial injury generally live for many years. The pediatric literature evaluating mortality after TBI suggests that death from profound brain injury is only seen in children who remained in vegetative states longer than 90 days after anoxic or traumatic injury (238). These findings stand in contrast to adults who have sustained an acquired brain injury. The adult literature notes that approximately 50% of adults in vegetative states die within one year of their injury, whereas in the pediatric population, one-half of the children still in vegetative states one year after injury were still living seven to eight years later (238,239).