Assessment of Post Traumatic Amnesia in Children Aged 4-7 Years

Abstract

Post traumatic amnesia (PTA) is a period of cerebral malfunction following brain injury during which a person is confused and unable to establish continuous memories. Only few scales have been particularly developed to assess PTA in children under 8 year of age, however these pediatric scales have notable shortcomings and do not cover the entire 4-7 year old age range. The current study aimed to review the available pediatric PTA scales, and establish a PTA scale suitable for children aged 4-7 years. Firstly, a systematic literature review identified five PTA scales that have been used with children aged 4-7 years, but revealed that information about psychometric properties of these scales was often incomplete and very limited. Secondly, the developmental validity of a 10-item PTA scale developed by the Brain Injury Rehabilitation Team at Sydney Children’s Hospital (SCH) was examined in a sample of 52 typically developing children aged 4-7 years. This study identified a set of five items that are developmentally appropriate for the targeted age range. Thirdly, this 5-item PTA scale was evaluated in a retrospective study, using a clinical sample of 35 children consecutively admitted to SCH with traumatic brain injury (TBI). The 5-item scale was found to have good concurrent and predictive validity; correlating with initial Glasgow Coma Scale (GCS) scores, and being the strongest predictor of gross functional outcome compared to other indicators of TBI severity (initial GCS and clinical estimates of PTA duration) at discharge and outpatient follow-ups (approximately 6 and 20 weeks post discharge). Finally, suggestions were made regarding further improvements of this 5-item scale; proposing a 9-item PTA scale that has the potential to fulfill the clinical gap in the assessment of PTA in children aged 4-7 years.