Persistent postconcussive symptoms in children and adolescents with mild traumatic brain injury receiving initial head computed tomography

Abstract

OBJECTIVEThe aim of this paper was to evaluate the prevalence of postconcussive symptoms and their relation to health-related quality of life (HRQOL) in pediatric and adolescent patients with mild traumatic brain injury (mTBI) who received head CT imaging during initial assessment.METHODSPatients aged between 5 and 21 years with mTBI (Glasgow Coma Scale scores 13–15) and available Rivermead Post Concussion Questionnaire (RPQ) at 6 months of follow-up in the multicenter, prospectively collected CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) study were included. The prevalence of postconcussive symptoms was assessed, and the occurrence of postconcussive syndrome (PSC) based on the ICD-10 criteria, was analyzed. HRQOL was compared in patients with and without PCS using the Quality of Life after Brain Injury (QOLIBRI) questionnaire.RESULTSA total of 196 adolescent or pediatric mTBI patients requiring head CT imaging were included. High-energy trauma was prevalent in more than half of cases (54%), abnormalities on head CT scans were detected in 41%, and admission to the regular ward or intensive care unit was necessary in 78%. Six months postinjury, 36% of included patients had experienced at least one moderate or severe symptom on the RPQ. PCS was present in 13% of adolescents and children when considering symptoms of at least moderate severity, and those patients had significantly lower QOLIBRI total scores, indicating lower HRQOL, compared with young patients without PCS (57 vs 83 points, p < 0.001).CONCLUSIONSAdolescent and pediatric mTBI patients requiring head CT imaging show signs of increased trauma severity. Postconcussive symptoms are present in up to one-third of those patients, and PCS can be diagnosed in 13% 6 months after injury. Moreover, PCS is significantly associated with decreased HRQOL.

Quality of Life after Brain Injury in Children and Adolescents (QOLIBRI-KID/ADO)—The First Disease-Specific Self-Report Questionnaire after Traumatic Brain Injury

“…The Generalized Anxiety Disorder 7 (GAD-7) [32] measures seven symptoms of generalized anxiety according to the DSM-IV [33], rated on a four-point Likert-type scale ranging from 0 to 3 ("Not at all" to "Nearly every day"). The severity is characterized by minimal (1-4), mild (5-9), moderate (10)(11)(12)(13)(14), and severe (15)(16)(17)(18)(19)(20)(21) symptoms.…”

“…The response categories range from 0 to 3 ("Not at all" to "Nearly every day"). Severity corresponds to the following scores: minimal (1-4), mild (5-9), moderate (10)(11)(12)(13)(14), and severe (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) symptoms.…”

“…Based on earlier pediatric studies, we assumed that boys would report higher HRQoL values than girls [17] and that HRQoL would decrease with increasing age [59]. The following clinical characteristics were assumed to be associated with lower HRQoL, as in the respective reference group: moderate to severe TBI [18], lower level of recovery [5], high physical, sensory, and cognitive problems [59], and high post-concussion burden [21]. To investigate symptom burden descriptively, the frequency of symptoms grouped by domain was first examined for the total sample.…”

“…More often, associations have been reported regarding TBI severity (e.g., [15,18]) and posttraumatic stress disorder (e.g., [19]). Mental health issues such as depression (e.g., [20]) and a higher number of post-concussion symptoms (e.g., [21]) have also been linked to lower HRQoL.…”

Neural correlates of cognitive control deficits in pediatric mild traumatic brain injury

“…), which could have been discovered using more visits between SA and EC. Although the pmTBI sample included in the current study is representative of the pmTBI population in the United States, only 7% of the patients receiving CT (50% of the total group) had lesions, which limits extrapolation of our findings to more severely injured pmTBI patients (Riemann et al, 2021). Finally, a general limitation of the BOLD response is that it is an indirect measure of neuronal activity, which is determined by a myriad of factors that altogether make up the neurovascular coupling (Hall et al, 2016).…”