G183(P) Brain injury in children and young people: a holistic, multidisciplinary approach leads to refocused expectations and hence equitable outcomes. (May 2019)

• Record Type: Journal Article
• Authors: Bali, A; Mundada, V
• Is Part Of: Archives of disease in childhood. Volume 104:(2019)Supplement 2
• Page Start: A74
• Page End: A74
• Publication Date: 2019-05
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2019-rcpch.178
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: Traumatic (TBI) and acquired causes of brain injury (ABI) are associated with poor outcomes in children and young people (including quality of life, emotion, behaviour, cognition and participation). Evidence shows outcomes depend on severity of injury; equally, adult data suggests cultural factors may affect patient/family experience. Our hospital, a major trauma centre, serves a culturally diverse population. Our inpatient service includes weekly meetings of a multi-disciplinary team, with goal-directed therapies based on assessed needs. This evaluation assessed if there was any difference in perceived brain injury outcomes, based on ethnicity, severity and type of injury; our hypothesis was no difference, based on the equitable nature of our service. Methods: Patients attending Paediatric Neurology follow-up outpatient appointments between January 2015 and May 2016, at least 1 month after a diagnosis of ABI/TBI, were included. Parents/caregivers completed a validated questionnaire (Child and Family Follow-up Survey – CFFS), with demographic/clinical details also collected. Comparative statistics were performed, comparing ABI/TBI (Student's t-test), ethnicity and mild/moderate/severe injury (ANOVA). Results: Nineteen children were included, with no significant differences in demographics. There was a statistically significant difference in parental rating of physical health with ABI versus TBI (poorer in ABI group, p=0.009). However, this did not translate to statistical differences in function, participation, impact or service experience. There was no statistical difference in any domain when grouping by ethnicity/injury severity. Case studies showed families especially valued continuity of care (e.g. support coordinator), advice/signposting (e.g. financial), and tailored support grading children back into daily activities (e.g. school). Conclusion: This evaluation suggests our service offers uniform provision following brain injury, independent of ethnicity, injury type or severity. The latter finding, contrary to previous studies, may be explained in large part by patient/family adaptation post-injury, including refocused expectations. It is our belief that the holistic service design, providing appropriate individualised interventions, also facilitates this adjustment, leading to equitable outcomes. This study had limitations in numbers and length; further specific work is needed to interrogate this potentially important finding.