Individualized Prognostic Prediction of the Long-Term Functional Trajectory in Pediatric Acquired Brain Injury

• Main Authors: Erika Molteni, Marta Bianca Maria Ranzini, Elena Beretta, Marc Modat, Sandra Strazzer
• Format: Article
• Language: English
• Published: MDPI AG 2021-07-01
• Series: Journal of Personalized Medicine
• Subjects: single-subject recovery prediction; trajectory prediction; Functional Independence Measure for children (WeeFIM); acquired brain injury (ABI); mixed models; structural equation modelling (SEM)
• Online Access: https://www.mdpi.com/2075-4426/11/7/675

In pediatric acquired brain injury, heterogeneity of functional response to specific rehabilitation treatments is a key confound to medical decisions and outcome prediction. We aimed to identify patient subgroups sharing comparable trajectories, and to implement a method for the early prediction of the long-term recovery course from clinical condition at first discharge. 600 consecutive patients with acquired brain injury (7.4 years ± 5.2; 367 males; median GCS = 6) entered a standardized rehabilitation program. Functional Independent Measure scores were measured yearly, until year 7. We classified the functional trajectories in clusters, through a latent class model. We performed single-subject prediction of trajectory membership in cases unseen during model fitting. Four trajectory types were identified (post.prob. > 0.95): high-start fast (<i>N</i> = 92), low-start fast (<i>N</i> = 168), slow (<i>N</i> = 130) and non-responders (<i>N</i> = 210). Fast responders were older (chigh = 1.8; clow = 1.1) than non-responders and suffered shorter coma (chigh = −14.7; clow = −4.3). High-start fast-responders had shorter length of stay (c = −1.6), and slow responders had lower incidence of epilepsy (c = −1.4), than non-responders (<i>p</i> < 0.001). Single-subject trajectory could be predicted with high accuracy at first discharge (accuracy = 0.80). In conclusion, we stratified patients based on the evolution of their response to a specific treatment program. Data at first discharge predicted the response over 7 years. This method enables early detection of the slow responders, who show poor post-acute functional gains, but achieve recovery comparable to fast responders by year 7. Further external validation in other rehabilitation programs is warranted.