Fatigue Following Pediatric Acquired Brain Injury: Interplay With Associated Factors in a Clinical Trial Population Compared to Healthy Controls

Abstract

Objective: The aims of the present study were to compare fatigue levels in children with pediatric acquired brain injury (pABI) with healthy controls (HCs), and examine the interplay of fatigue with associated factors. Method: We used baseline data from a preregistered randomized controlled trial. Seventy-six children aged 10–17 (median 13 years) with pABI in the chronic phase (88% with confirmatory cerebral imaging findings) and executive function (EF) complaints were included, most with moderate disability according to The Glasgow Outcome Scale Extended (GOSE-E) categorization. HCs consisted of 60 children aged 10–17 (median 13 years). All 127 participants completed measures of fatigue and intelligence. pABI participants were also assessed for behavioral problems, health-related quality of life (HRQoL), and EF. Nonparametric statistics were employed, in addition to a network analysis to model the unique associations between parent-reported fatigue and related factors. Results: Parents reported significantly more fatigue in the pABI-group (75% of scores in clinical range; < 70) compared to HCs (11.7% of scores in clinical range). No strong associations were found between fatigue and injury characteristics, but findings indicated more fatigue in the older than younger age-group for pABI participants. Network modeling revealed a central role for HRQoL, behavioral, and EF symptoms in relation to fatigue. Conclusions: Fatigue is reported to be highly prevalent in the chronic phase of pABI. When addressing fatigue, our findings demonstrate the advantage of including multidimensional measures of fatigue and examining associated psychological and cognitive constructs, such as HRQoL, behavioral problems, and EF. Impact Statement Question: What is the prevalence and severity of fatigue in children and adolescents with pediatric brain injuries, and is it related to other factors? Findings: For the majority of children in chronic phase of pABI, parents reported fatigue in the clinical range. Fatigue is associated with health-related quality of life, behavioral problems, and executive function. Importance: Fatigue is a complex symptom that negatively impacts functioning across a range of areas, and needs to be addressed in all phases of brain injury rehabilitation. Next Steps: Longitudinal studies are needed to confirm the directionality of the relationships between factors associated with fatigue.