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      Prevalence of and Risk Factors for Poor Functioning after Isolated Mild Traumatic Brain Injury in Children

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          Abstract

          This study aimed to determine the prevalence and predictors of poor 3 and 12 month quality of life outcomes in a cohort of pediatric patients with isolated mild TBI. We conducted a prospective cohort study of children and adolescents <18 years of age treated for an isolated mild TBI, defined as "no radiographically apparent intracranial injury" or "an isolated skull fracture, and no other clinically significant non-brain injuries." The main outcome measure was the change in quality of life from baseline at 3 and 12 months following injury, as measured by the Pediatric Quality of Life index (PedsQL). Poor functioning was defined as a decrease in total PedsQL score of >15 points between baseline and follow-up scores (at 3 and 12 months). Of the 329 patients who met inclusion criteria, 11.3% (95% CI 8.3-15.3%) at 3 months and 12.9% (95% CI 9.6-17.2%) at 12 months following injury had relatively poor functioning. Significant predictors of poor functioning included less parental education, Hispanic ethnicity (at 3 months following injury, but not at 12 months); low household income (at 3 and 12 months), and Medicaid insurance (at 12 months only). Children and adolescents sustaining a mild TBI who are socioeconomically disadvantaged may require additional intervention to mitigate the effects of mild TBI on their functioning.

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          Reliable change in postconcussive symptoms and its functional consequences among children with mild traumatic brain injury.

          Eloise Kaizar, Jerome Rusin, K Nuss … (2012)
          OBJECTIVE To examine reliable change in postconcussive symptoms and its functional consequences among children with mild traumatic brain injury (TBI) over the first year postinjury as compared with children with orthopedic injuries. DESIGN Prospective, longitudinal cohort. SETTING Emergency departments at 2 children's hospitals. PARTICIPANTS Eight- to 15-year-old children with mild TBI (n = 186) or orthopedic injuries (n = 99). MAIN EXPOSURE Closed-head or orthopedic trauma. MAIN OUTCOME MEASURES Parents rated preinjury symptoms retrospectively shortly after injury and postconcussive symptoms at 2 weeks and 3 and 12 months postinjury. A regression-based approach was used to determine whether each child displayed reliable increases in postconcussive symptoms at each postinjury occasion. Health-related quality of life was assessed at 3 and 12 months postinjury. Information regarding children's educational programming was collected at the initial and 12-month assessments. RESULTS Children with mild TBI were significantly more likely than those with orthopedic injuries to show reliable increases in both cognitive and somatic symptoms. Group differences in the likelihood of reliable increases became less common with time for somatic symptoms but persisted to 12 months postinjury for cognitive symptoms. Among children with mild TBI, reliable increases in symptoms were more common among children with loss of consciousness or abnormalities on neuroimaging. Reliable increases in symptoms were associated with significant declines in health-related quality of life and an increased likelihood of educational intervention. CONCLUSION Many children with mild TBI show reliable increases in postconcussive symptoms that are associated with significant functional impairment in their daily lives.
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            The UCLA longitudinal study of neurocognitive outcomes following mild pediatric traumatic brain injury.

            Robert Asarnow, Richard S. Lewis, Roger Light … (2011)
            Comprehensive reviews of neurocognitive outcomes following mild, uncomplicated traumatic brain injury (TBI) in children have shown minimal effects on neurocognition, especially in methodologically rigorous studies. In this study, we report longitudinal (1, 6, and 12 months post injury) results in four domains of neurocognitive functioning in a large sample of children with mild TBI (n = 124, ages 8-17 at injury) relative to two demographically matched control groups (other injury: n = 94 and non-injury: n = 106). After accounting for age and parental education, significant main effects of group were observed on 7 of the 10 neurocognitive tests. However, these differences were not unique to the TBI sample but were found between both the TBI and other injury groups relative to the non-injured group, suggesting a general injury effect. Effects were primarily within the domains measuring memory, psychomotor processing speed, and language. This is the largest longitudinal study to date of neurocognitive outcomes at discrete time points in pediatric mild TBI. When controlling for pre-injury factors, there is no evidence of long-term neurocognitive impairment in this group relative to another injury control group. The importance of longitudinal analyses and use of appropriate control groups are discussed in the context of evaluating the effects of mild TBI on cognition.
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              Disability 3, 12, and 24 months after traumatic brain injury among children and adolescents.

              Nancy Temkin, Monica Vavilala, Eileen K Jaffe … (2011)
              To examine disability in children and adolescents after traumatic brain injury (TBI) across the spectrum of injury severity. This was a prospective cohort study of children younger than 18 years treated for a TBI (n = 729) or an arm injury (n = 197) between March 1, 2007, and September 30, 2008. The main outcome measures were disability in health-related quality of life, adaptive skills, and participation in social and community activities 3, 12, and 24 months after injury compared with preinjury functioning. The health-related quality of life for children with moderate or severe TBI was lower at all follow-up times compared with baseline, but there was some improvement during the first 2 years after injury. Three months after injury, there was a substantial decrease in the level of activities in which children with moderate and severe TBI were able to participate; these activities improved at 12 and 24 months but were still significantly impaired. Communication and self-care abilities in children with moderate and severe TBI were lower at 3 months than at baseline and did not improve by 24 months. Children who met the definition of mild TBI but had an intracranial hemorrhage had lower quality-of-life scores at 3 months. Children with moderate or severe TBI and children with mild TBI who had intracranial hemorrhage had substantial long-term reduction in their quality of life, participation in activities with others, and ability to communicate and care for themselves.
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                Author and article information

                Journal
                Title: Journal of Neurotrauma
                Abbreviated Title: Journal of Neurotrauma
                Publisher: Mary Ann Liebert Inc
                ISSN (Print): 0897-7151
                ISSN (Electronic): 1557-9042
                Publication date Created: April 15 2014
                Publication date (Print): April 15 2014
                Volume: 31
                Issue: 8
                Pages: 722-727
                Affiliations
                [1 ]Center for Injury Research and Prevention, and the Division of Emergency Medicine, The Children's Hospital of Philadelphia; Department of Pediatrics and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
                [2 ]Department of Epidemiology, University of Washington, Seattle, Washington.
                [3 ]Department of Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington.
                [4 ]Department of Pediatrics, University of Washington, Seattle, Washington.
                [5 ]Department of Biostatistics, University of Washington, Seattle, Washington.
                [6 ]Department of Neurological Surgery, University of Washington, Seattle, Washington.
                [7 ]Department of Rehabilitation Medicine, University of Washington, Seattle, Washington.
                [8 ]Department of Anesthesiology, University of Washington, Seattle, Washington.
                Article
                DOI: 10.1089/neu.2013.3088
                PMC ID: 3967417
                PubMed ID: 24294826
                SO-VID: b634c09b-74dd-4817-96bd-fd31b72d57e1
                Copyright © © 2014
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