Injury versus noninjury factors as predictors of postconcussive symptoms following mild traumatic brain injury in children.

McNally, Kelly; Bangert, Barbara; Dietrich, Ann; Nuss, Kathryn E.; Rusin, Jerome; Wright, Martha; Taylor, H. Gerry; Yeates, Keith Owen

doi:10.1037/a0031370

Cited by 144 publications

(109 citation statements)

References 44 publications

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“…38 A strength of our study is that we enrolled subjects within 6 hours of injury, but our results differed from these previous reports. This suggests that acute symptom report alone is not an accurate reflection of the physiologic and psychological factors that ultimately lead to DSR.…”

Section: Discussioncontrasting

confidence: 55%

Acute Concussion Symptom Severity and Delayed Symptom Resolution

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Children are often evaluated in the emergency department after a concussion. Although prolonged symptoms are associated with higher initial symptom severity when measured 2 to 3 weeks after injury, a similar association with acute symptom severity has not been demonstrated. WHAT THIS STUDY ADDS:Higher acute symptom severity is not associated with development of persistent post-concussion symptoms 1 month after injury, but persistent post-concussive symptoms affect a significant number of children after concussion. Outpatient follow-up is essential to identify children who develop persistent symptoms. abstract BACKGROUND AND OBJECTIVES: Up to 30% of children who have concussion initially evaluated in the emergency department (ED) display delayed symptom resolution (DSR). Greater initial symptom severity may be an easily quantifiable predictor of DSR. We hypothesized that greater symptom severity immediately after injury increases the risk for DSR. METHODS:We conducted a prospective longitudinal cohort study of children 8 to 18 years old presenting to the ED with concussion. Acute symptom severity was assessed using a graded symptom inventory. Presence of DSR was assessed 1 month later. Graded symptom inventory scores were tested for association with DSR by sensitivity analysis. We conducted a similar analysis for post-concussion syndrome (PCS) as defined by the International Statistical Classification of Diseases and Related Health Problems, 10th revision. Potential symptoms characteristic of DSR were explored by using hierarchical cluster analysis. RESULTS:We enrolled 234 subjects; 179 (76%) completed follow-up. Thirtyeight subjects (21%) experienced DSR. Initial symptom severity was not significantly associated with DSR 1 month after concussion. A total of 22 subjects (12%) had PCS. Scores .10 (possible range, 0-28) were associated with an increased risk for PCS (RR, 3.1; 95% confidence interval 1.2-8.0). Three of 6 of the most characteristic symptoms of DSR were also most characteristic of early symptom resolution. However, cognitive symptoms were more characteristic of subjects reporting DSR.CONCLUSIONS: Greater symptom severity measured at ED presentation does not predict DSR but is associated with PCS. Risk stratification therefore depends on how the persistent symptoms are defined. Cognitive symptoms may warrant particular attention in future study. Follow-up is recommended for all patients after ED evaluation of concussion to monitor for DSR. Dr Grubenhoff conceptualized and designed the study, designed the database, oversaw data collection and analysis, drafted the initial manuscript, and reviewed and revised the manuscript; Ms Deakyne performed the primary statistical analysis, assisted with study design and database design, managed study personnel in recruitment and data acquisition, and co-authored, reviewed, and revised the manuscript; Ms Brou assisted with the cluster analysis and drafting and reviewed and revised the manuscript; Dr Bajaj assisted with study design and ...

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Section: Discussioncontrasting

confidence: 55%

Acute Concussion Symptom Severity and Delayed Symptom Resolution

et al. 2014

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“…We were also unable to carry out specific volumetric or other analyses of the neuroimaging findings, which is potentially important to explore in future research because intracranial compromise in these patients tends to be variable, and lesion burden is considerably more complex than a simple present vs. absent dichotomy (Bigler et al, 2013). We also did not have data about family factors such as parental adjustment, which have been shown to affect parent ratings after mild pediatric TBI (McNally et al, 2013). Another limitation is that we only included parental rating scales.…”

Section: Discussionmentioning

confidence: 98%

Parental ratings of daily behavior and child cognitive test performance after pediatric mild traumatic brain injury

Donders

DeWit

2016

Child Neuropsychology

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This study aimed to evaluate the degree to which the Behavior Rating Inventory of Executive Function (BRIEF) and Child Behavior Checklist (CBCL) measure overlapping vs. distinct constructs in pediatric patients with mild traumatic brain injury (TBI), and to examine the demographic and injury correlates of such constructs as well as those of cognitive test performance. A total of 100 parents completed the BRIEF and the CBCL within 1 to 12 months after the injury of their child. Groups were contrasted based on the presence vs. absence of impairment on, respectively, the BRIEF and the CBCL. Exploratory maximum likelihood factor analysis was used to evaluate latent constructs. Correlates of the various factor scores were evaluated through regression analysis and contrasted with those of a test of verbal learning and memory.The results revealed that the BRIEF and the CBCL disagree about the presence vs. absence of impairment in about one quarter of cases. A prior history of attention deficit/hyperactivity disorder (ADHD) was associated with an increased likelihood of impairment on both the BRIEF and the CBCL, whereas prior outpatient psychiatric treatment was associated with the increased likelihood of selective impairment on the CBCL. Latent constructs manifested themselves along cognitive regulation, emotional adjustment and behavioral regulation factors. Whereas premorbid characteristics were the exclusive correlates of these factors, performance on a test of verbal learning and memory was negatively affected by intracranial lesions on neuroimaging.It is concluded that the BRIEF and the CBCL offer complementary and non-redundant information about daily functioning after pediatric mild TBI. The correlates of cognitive test performance and parental behavior ratings after such injuries are different and reflect a divergence between premorbid and injury-related influences.

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“…18 One factor that has been found to increase the risk for persistent symptoms is more severe mTBI, such as injury associated with intracranial pathology on neuroimaging. [19][20][21][22] However, the effect of injury-related factors tends to diminish over time 23 and not all "postconcussive" symptoms are driven by injury-related neurologic factors. Postconcussive symptoms are nonspecific, occurring often in normal samples.…”

Section: Discussionmentioning

confidence: 99%

“…Postconcussive symptoms are nonspecific, occurring often in normal samples. [24][25][26][27][28] Symptoms after pediatric mTBI are also associated with multiple other noninjury factors, including premorbid symptom ratings, 23 premorbid learning and behavioral problems, 29,30 demographic factors, 23 maladaptive coping, 31 comorbid bodily injury and pain, 32 and parental anxiety and family stress. 6,33 Anothernoninjury factor thatlikely helps to account for some postconcussive problems is symptom exaggeration and/ or feigning, which has been neglected almost entirely in the pediatric mTBI literature.…”

Section: Discussionmentioning

confidence: 99%