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Neurocritical Care

, Volume 7, Issue 1, pp 64–75 | Cite as

Child health-related quality of life following neurocritical care for traumatic brain injury: an analysis of preference-weighted outcomes

  • John M. Tilford
  • Mary E. Aitken
  • Allen C. Goodman
  • Debra H. Fiser
  • Jeffrey B. Killingsworth
  • Jerril W. Green
  • P. David Adelson
Original Paper

Abstract

Background

Cost-effectiveness analysis relies on preference-weighted health outcome measures as they form the basis for quality adjusted life years. Studies of preference-weighted outcomes for children following traumatic brain injury are lacking.

Objective

This study seeks to describe the preference-weighted health outcomes of children following a traumatic brain injury at 3- and 6-months following pediatric intensive care unit (ICU) discharge.

Setting/Patients

Children aged 5–17 who required ICU admission and endotracheal intubation or mechanical ventilation.

Main Outcome Measures

The Quality of Well-being (QWB) score was used to describe preference-weighted outcomes. Clinical measures from the intensive care unit stay were used to estimate risk of mortality. Risk of mortality, Glasgow coma scores, patient length of stay in the intensive care unit, and parent-reported items from the Child Health Questionnaire (CHQ) were used to test construct validity.

Methods

Subject data were obtained from nine pediatric intensive care units with consent procedures approved by representative institutional review boards. Medical records containing clinical information from the ICU stay were abstracted by the study coordinating center. Caregivers of children were contacted by telephone for follow-up interviews at 3- and 6-months following ICU discharge. All interviews were conducted by telephone with the primary caregiver of the injured child. Preference score statistics are presented overall and in relation to characteristics of the patient and their ICU admission.

Results

A response rate of 59% was achieved for the 3-month interviews (N = 56) and 67% for the 6-month interviews (N = 65) for caregivers of children aged 5 years and above that consented to participate. Overall, QWB scores averaged 0.508 (95% CI: 0.454–0.562) at the 3-month interview and 0.582 (95% CI: 0.526–0.639) at the 6-month interview. For both interview periods, scores ranged from 0.093 to 1.0 on a 0–1 value scale, where 0 represents death and 1 represents perfect health. Specific acute and chronic health problems from the QWB scale were present more often in patients with higher injury severity. Mortality risk, ICU length of stay, Glasgow Coma Scales, and parental reported summary scores from the CHQ all correlated correctly with the QWB scores.

Conclusions

The findings support the use of the QWB score with parental report to measure preference-weighted health outcomes of children following a traumatic brain injury. Information from the study can be used in economic evaluations of interventions to prevent or treat traumatic brain injuries in children.

Keywords

Utility values Economic evaluation Outcome assessment Quality of life 

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Notes

Acknowledgments

We thank Tammy Binz and Melanie Sabik for excellent research assistance.

References

  1. 1.
    Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-effectiveness in health and medicine. New York, Oxford: Oxford University Press; 1996.Google Scholar
  2. 2.
    Gold MR, Patrick DL, Hadorn DC, MS Kamlet, Torrance GW, Fryback DG, et al. Identifying and valuing outcomes. In: Gold MR, Siegel JE, Russell LB, Weinstein MC, editors. Cost-effectiveness in health and medicine. New York, Oxford: Oxford University Press; 1996. p. 82–134.Google Scholar
  3. 3.
    Neumann PJ, Goldie SJ, Weinstein MC. Preference-based measures in economic evaluation in health care. Annu Rev Public Health 2000;21:587–611.PubMedCrossRefGoogle Scholar
  4. 4.
    Bell C, Chapman RC, Sandberg EA, Stone PW, Neumann PJ. An off-the-shelf help list: a comprehensive catalog of preference weights from published cost-utility analyses. Med Decis Mak 1999;19:519.Google Scholar
  5. 5.
    Dijkers MP. Quality of life after traumatic brain injury: a review of research approaches and findings. Arch Phys Med Rehabil 2004;85(Suppl 2):S21–35.PubMedCrossRefGoogle Scholar
  6. 6.
    Taylor A, Butt W, Rosenfeld J, Shann F, Ditchfield M, Lewis E, et al. A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst 2001;17(3):154–62.PubMedCrossRefGoogle Scholar
  7. 7.
    Torrance GW, Boyle MH, Horwood SP. Application of multi-attribute utility theory to measure social preferences for health states. Oper Res 1982;30(6):1043–69.PubMedCrossRefGoogle Scholar
  8. 8.
    Kumar R, West C, Quirke C, et al. Do children with severe head injury benefit from intensive care? Child’s Nervous Syst 1991;7:299–304.CrossRefGoogle Scholar
  9. 9.
    Ghajar J, Hariri R. Variability of neurotrauma care in hospitals. In: Narayan R, Wilberger J, Povlishock J, editors. Neurotrauma. New York: McGraw Hill, Inc.; 1996.Google Scholar
  10. 10.
    Ghajar J, Hariri R, Narayan R, Iacono L, Firlik K, Patterson R. Survey of critical care management of comatose, head-injured patients in the United States. Crit Care Med 1995;23(3):560–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Tilford JM, Simpson PM, Yeh T, Lensing S, Aitken ME, Green J, et al. Variation in therapy and outcome for pediatric head trauma patients. Crit Care Med 2001;29(5):1056–61.PubMedCrossRefGoogle Scholar
  12. 12.
    Tilford JM, Aitken ME, Anand KJ, Green JW, Goodman AC, Parker JG, et al. Hospitalizations for critically ill children with traumatic brain injuries: a longitudinal analysis. Crit Care Med 2005;33(9):2074–81.PubMedCrossRefGoogle Scholar
  13. 13.
    Landgraf JM, Abetz L. Influences of sociodemographic characteristics on parental reports of children’s physical and psychosocial well-being: early experiences with the child health questionnaire. In: Dratar D, editor. Measuring health-related quality of life in children and adolescents. New Jersey: Lawrence Erlbaum Associates, Publishers; 1998. p. 105–30.Google Scholar
  14. 14.
    Landgraf JM, Abetz L, Ware JE. The CHQ User’s Manual, 1996, 1st ed., editor. Boston: The Health Institute, New England Medical Center; 1996.Google Scholar
  15. 15.
    Fiser D, Long N, Roberson P, Hefley G, Zolten K, Brodie-Fowler M. Relationship of Pediatric Overall Performance Category and Pediatric Cerebral performance Category scores at pediatric intensive care unit discharge with outcome measures collected at hospital dischare and 1- and 6-month follow-up assessments. Crit Care Med 2000;28(7):2616–20.PubMedCrossRefGoogle Scholar
  16. 16.
    Fiser DH. Assessing the outcome of pediatric intensive care. J␣Pediatr 1992;121:68–74.PubMedCrossRefGoogle Scholar
  17. 17.
    Robinson A, Spencer A. Exploring challenges to TTO utilities: valuing states worse than dead. Health Econ 2006; 15(4):393–402.PubMedCrossRefGoogle Scholar
  18. 18.
    Patrick DL, Starks HE, Cain KC, Uhlmann RF, Pearlman RA. Measuring preferences for health states worse than death. Med Decis Making 1994;14(1):9–18.PubMedCrossRefGoogle Scholar
  19. 19.
    Brent RJ. Cost-benefit analysis, health care evaluations. Northhampton MA: Edward Elgar; 2003.Google Scholar
  20. 20.
    Thurman D, Guerrero J. Trends in hospitalization associated with traumatic brain injury. JAMA 1999;282(10):954–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Thakker J, Splaingard M, Zhu J, Babel K, Bresnahan J, Havens P. Survival and functional outcome of children requiring endotracheal intubation during therapy for severe traumatic brain injury. Crit Care Med 1997;25(8):1396–401.PubMedCrossRefGoogle Scholar
  22. 22.
    Kaplan RM, Anderson JP. The general health policy model: an integrated approach. In: Spiker B. editor. Quality of life and pharmeaeconomics in clinical trials. Philadelphia: Lippincott-Raven Publishers; 1996. p. 309–22.Google Scholar
  23. 23.
    Kaplan RM, Anderson JP. A general health policy model: update and Applications. Health Ser Res 1988;23(2):203–35.Google Scholar
  24. 24.
    Pyne JM, Sieber WJ, David K, Kaplan RM, Hyman RM, Keith WD. Use of the quality of well-being self-administered version (QWB-SA) in assessing health-related quality of life in depressed patients. J Affect Disord 2003;76(1–3):237–47.PubMedCrossRefGoogle Scholar
  25. 25.
    Czyzewski DI, Mariotto MJ, Bartholomew LK, LeCompte SH, Sockrider MM. Measurement of quality of well being in a child and adolescent cystic fibrosis population. Med Care 1994;32(9):965–72.PubMedCrossRefGoogle Scholar
  26. 26.
    Frosch DL, Kaplan RM, Ganiats TG, Groessl EJ, Sieber WJ, Weisman MH. Validity of self-administered quality of well-being scale in musculoskeletal disease. Arthritis Rheum 2004;51(1):28–33.PubMedCrossRefGoogle Scholar
  27. 27.
    Groessl EJ, Kaplan RM, Barrett-Connor E, Ganiats TG. Body mass index and quality of well-being in a community of older adults. Am J Prev Med 2004;26(2):126–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Groessl EJ, Kaplan RM, Cronan TA. Quality of well-being in older people with osteoarthritis. Arthritis Rheum 2003;49(1):23–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Kaplan RM, Anderson JP, Wu AW, Mathews WC, Kozin F, Orenstein D. The Quality of Well-being Scale. Applications in AIDS, cystic fibrosis, and arthritis. Med Care 1989;27(3 Suppl):S27–43.PubMedCrossRefGoogle Scholar
  30. 30.
    Heard C, Li V, Heard A. A useful tool for predicting outcome for the pediatric head trauma patient. Crit Care Med 2003;30(6):1403–4.CrossRefGoogle Scholar
  31. 31.
    O’Brien BJ, Spath M, Blackhouse G, Severens JL, Dorian P, Brazier J. A view from the bridge: agreement between the SF-6D utility algorithm and the Health Utilities Index. Health Econ 2003;12(11):975–81.PubMedCrossRefGoogle Scholar
  32. 32.
    Brazier J, Roberts J, Deverill M. The estimation of a preference-based measure of health from the SF-36. J Health Econ 2002;21(2):271–92.PubMedCrossRefGoogle Scholar
  33. 33.
    Killingsworth JB, Tilford JM, Parker JG, Graham JJ, Dick RM, Aitken ME. National hospitalization impact of pediatric all-terrain vehicle injuries. Pediatr 2005;115(3):e316–21.CrossRefGoogle Scholar
  34. 34.
    Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray␣HE, Goldstein B, et al. Guidelines for the acute medical␣management of severe traumatic brain injury in infants,␣children, and adolescents. Chapter 5. Indications for intracranial pressure monitoring in pediatric patients with severe traumatic brain injury. Pediatr Crit Care Med 2003;4(3 Suppl):S19–24.PubMedGoogle Scholar
  35. 35.
    Tilford JM. Cost-effectiveness analysis and emergency medical services for children: issues and applications. Ambul Pediatr 2002;2(4 Suppl):330–6.PubMedCrossRefGoogle Scholar
  36. 36.
    Griebsch I, Coast J, Brown J. Quality-adjusted life-years lack quality in pediatric care: a critical review of published cost-utility studies in child health. Pediatr 2005;115(5):e600–14.CrossRefGoogle Scholar
  37. 37.
    Tilford JM, Aitken ME, Goodman AC, Adelson PD. Is more aggressive treatment of pediatric traumatic brain injury worth it? American Association of Health Economists National Meeting. 2006.Google Scholar
  38. 38.
    Skinner JS, Staiger DO, Fisher ES. Is technological change in medicine always worth it? The case of acute myocardial infarction. Health Aff (Millwood) 2006;25(2):w34–47.CrossRefGoogle Scholar
  39. 39.
    Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ, et al. Management of severe head injury: institutional variations in care and effect on outcome. Crit Care Med 2002;30(8):1870–6.PubMedCrossRefGoogle Scholar
  40. 40.
    Parsons SK, Barlow SE, Levy SL, Supran SE, Kaplan SH. Health-related quality of life in pediatric bone marrow transplant survivors: according to whom? Int J Cancer Suppl 1999;12:46–51.PubMedCrossRefGoogle Scholar
  41. 41.
    Corrigan JD, Harrison-Felix C, Bogner J, Dijkers M, Terrill MS, Whiteneck G. Systematic bias in traumatic brain injury outcome studies because of loss to follow-up. Arch Phys Med Rehabil 2003;84(2):153–60.PubMedCrossRefGoogle Scholar
  42. 42.
    McCullagh S, Feinstein A. Outcome after mild traumatic brain injury: an examination of recruitment bias. J Neurol Neurosurg Psychiatry 2003;74(1):39–43.PubMedCrossRefGoogle Scholar
  43. 43.
    McCarthy ML, MacKenzie EJ, Durbin DR, Aitken ME, Jaffe KM, Paidas CN, et al. Health-related quality of life during the first year after traumatic brain injury. Arch Pediatr Adolesc Med 2006;160(3):252–60.PubMedCrossRefGoogle Scholar
  44. 44.
    McCarthy ML, MacKenzie EJ, Durbin DR, Aitken ME, Jaffe KM, Paidas CN, et al. The Pediatric Quality of Life Inventory: an evaluation of its reliability and validity for children with traumatic brain injury. Arch Phys Med Rehabil 2005;86(10):1901–9.PubMedCrossRefGoogle Scholar
  45. 45.
    Slomine BS, McCarthy ML, Ding R, et al. Health care utilization and needs after pediatric traumatic brain injury. Pediatr 2006; 117(4):e663–74.CrossRefGoogle Scholar
  46. 46.
    Aitken ME, Tilford JM, Barrett KW, Parker JG, Simpson P, Landgraf J, et al. Health status of children after admission for injury. Pediatr 2002;110(2 Pt 1):337–42.CrossRefGoogle Scholar
  47. 47.
    Marra CA, Woolcott JC, Kopec JA, Shojania K, Offer R, Brazier JE, et al. A comparison of generic, indirect utility measures (the HUI2, HUI3, SF-6D, and the EQ-5D) and disease-specific instruments (the RAQoL and the HAQ) in rheumatoid arthritis. Soc Sci Med 2005;60(7):1571–82.PubMedCrossRefGoogle Scholar
  48. 48.
    Brazier J, Roberts J, Tsuchiya A, Busschbach J. A comparison of the EQ-5D and SF-6D across seven patient groups. Health Econ 2004;13(9):873–84.PubMedCrossRefGoogle Scholar
  49. 49.
    Hatoum HT, Brazier JE, Akhras KS. Comparison of the HUI3 with the SF-36 preference based SF-6D in a clinical trial setting. Value Health 2004;7(5):602–9.PubMedCrossRefGoogle Scholar
  50. 50.
    Smith-Olinde L, Grosse SD, Olinde F, Martin PF, Gartman S, Tilford JM. Health state preference scores for children with congenital hearing loss: A comparative analysis. 2006.Google Scholar

Copyright information

© Humana Press Inc. 2007

Authors and Affiliations

  • John M. Tilford
    • 1
  • Mary E. Aitken
    • 1
  • Allen C. Goodman
    • 2
  • Debra H. Fiser
    • 1
  • Jeffrey B. Killingsworth
    • 1
  • Jerril W. Green
    • 1
  • P. David Adelson
    • 3
  1. 1.Department of Pediatrics College of MedicineUniversity of Arkansas for Medical Sciences and Arkansas Children’s HospitalLittle RockUSA
  2. 2.Department of EconomicsWayne State UniversityDetroitUSA
  3. 3.Department of NeurosurgeryUniversity of PittsburghPittsburghUSA

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