Heterogeneity of injury severity among children with traumatic brain injury (TBI) classified by the Glasgow Coma Scale (GCS) makes comparisons across research cohorts, enrollment in clinical trials, and clinical predictions of outcomes difficult. The present study uses latent class analysis (LCA) to distinguish severity subgroups from a prospective cohort of 433 children 2.5–15 years of age with TBI who were recruited from two level 1 pediatric trauma centers. Indicator variables available within 48 h post-injury including emergency department (ED) GCS, hospital motor GCS, Abbreviated Injury Score (AIS), Rotterdam Score, hypotension in the ED, and pre-hospital loss of consciousness, intubation, seizures, and sedation were evaluated to define subgroups. To understand whether latent class subgroups were predictive of clinically meaningful outcomes, the Pediatric Injury Functional Outcome Scale (PIFOS) at 6 and 12 months, and the Behavior Rating Inventory of Executive Function at 12 months, were compared across subgroups. Then, outcomes were examined by GCS (primary) and AIS (secondary) classification alone to assess whether LCA provided improved outcome prediction. LCA identified four distinct increasing severity subgroups (1–4). Unlike GCS classification, mean outcome differences on PIFOS at 6 months showed decreasing function across classes. PIFOS differences relative to the lowest latent class (LC1) were: LC2 2.27 (0.83, 3.72), LC3 3.99 (1.88, 6.10), and LC4 11.2 (7.04, 15.4). Differences in 12 month outcomes were seen between the most and least severely injured groups. Differences in outcomes in relation to AIS were restricted to the most and less severely injured at both time points. This study distinguished four latent classes that are clinically meaningful, distinguished a more homogenous severe injury group, and separated children by 6-month functional outcomes better than GCS alone. Systematic reporting of these variables would allow comparisons across research cohorts, potentially improve clinical predictions, and increase sensitivity to treatment effects in clinical trials.

中文翻译：

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潜在类别分析对小儿创伤性脑损伤的损伤严重程度进行分类。

根据格拉斯哥昏迷量表 (GCS) 分类的创伤性脑损伤 (TBI) 儿童的损伤严重程度存在异质性，这使得研究队列之间的比较、临床试验的招募和结果的临床预测变得困难。本研究使用潜在类别分析 (LCA) 来区分从两个 1 级儿科创伤中心招募的 433 名 2.5-15 岁 TBI 儿童前瞻性队列中的严重程度亚组。受伤后 48 小时内可用的指标变量，包括急诊科 (ED) GCS、医院运动 GCS、简明损伤评分 (AIS)、鹿特丹评分、急诊室低血压以及院前意识丧失、插管、癫痫发作和镇静进行评估以定义亚组。为了了解潜在类别亚组是否可以预测有临床意义的结果，对 6 个月和 12 个月时的儿科损伤功能结果量表 (PIFOS) 以及 12 个月时的执行功能行为评定量表进行了跨亚组的比较。然后，单独通过 GCS（初级）和 AIS（二级）分类检查结果，以评估 LCA 是否提供了改进的结果预测。LCA 确定了四个不同的严重程度逐渐增加的亚组 (1-4)。与 GCS 分类不同，6 个月时 PIFOS 的平均结果差异显示各类别的功能下降。相对于最低潜伏类别 (LC1) 的 PIFOS 差异为：LC2 2.27 (0.83, 3.72)、LC3 3.99 (1.88, 6.10) 和 LC4 11.2 (7.04, 15.4)。受伤最严重和最轻的组之间 12 个月的结果存在差异。与 AIS 相关的结果差异仅限于两个时间点受伤最严重和较轻的情况。这项研究区分了四个具有临床意义的潜在类别，区分了更同质的严重损伤组，并通过 6 个月的功能结果来区分儿童，比单独使用 GCS 更好。这些变量的系统报告将允许跨研究队列进行比较，有可能改善临床预测，并提高临床试验中治疗效果的敏感性。