Post-acute white matter microstructure predicts post-acute and chronic post-concussive symptom severity following mild traumatic brain injury in children

Abstract

IntroductionMild traumatic brain injury (TBI) is a global public health concern that affects millions of children annually. Mild TBI tends to result in subtle and diffuse alterations in brain tissue, which challenges accurate clinical detection and prognostication. Diffusion tensor imaging (DTI) holds promise as a diagnostic and prognostic tool, but little research has examined DTI in post-acute mild TBI. The current study compared post-acute white matter microstructure in children with mild TBI versus those with mild orthopedic injury (OI), and examined whether post-acute DTI metrics can predict post-acute and chronic post-concussive symptoms (PCS).Materials and methodsChildren aged 8–16.99 years with mild TBI (n = 132) or OI (n = 69) were recruited at emergency department visits to two children's hospitals, during which parents rated children's pre-injury symptoms retrospectively. Children completed a post-acute (<2 weeks post-injury) assessment, which included a 3T MRI, and 3- and 6-month post-injury assessments. Parents and children rated PCS at each assessment. Mean diffusivity (MD) and fractional anisotropy (FA) were derived from diffusion-weighted MRI using Automatic Fiber Quantification software. Multiple multivariable linear and negative binomial regression models were used to test study aims, with False Discovery Rate (FDR) correction for multiple comparisons.ResultsNo significant group differences were found in any of the 20 white matter tracts after FDR correction. DTI metrics varied by age and sex, and site was a significant covariate. No interactions involving group, age, and sex were significant. DTI metrics in several tracts robustly predicted PCS ratings at 3- and 6-months post-injury, but only corpus callosum genu MD was significantly associated with post-acute PCS after FDR correction. Significant group by DTI metric interactions on chronic PCS ratings indicated that left cingulum hippocampus and thalamic radiation MD was positively associated with 3-month PCS in the OI group, but not in the mild TBI group.ConclusionsPost-acute white matter microstructure did not differ for children with mild TBI versus OI after correcting for multiple comparisons, but was predictive of post-acute and chronic PCS in both injury groups. These findings support the potential prognostic utility of this advanced DTI technique.

Premature white matter microstructure in female children with a history of concussion

“…decreased FA) at chronic timepoints. 5,45,47,48 Unique aspects of the current study may explain the apparent discrepancy. First, the restricted age range of 9-to 10-year-olds is at the lower end of the age ranges included in previous studies which may have increased the sensitivity of the group comparison as it reduced developmental heterogeneity in the sample.…”

“…decreased FA), suggestive of axon injury, 5,47 or no significant differences post-injury. 45,48 However, the long-term (>12 months), sex-specific effects of injury in childhood on brain microstructure have not, to our knowledge, been investigated. This is necessary for informing the impact of concussion on maturation of brain microstructure and associated cognitive performance.…”

Gastrointestinal failure score in children with traumatic brain injury

“…Compared with elderly critically ill patients with cardiovascular disease or diabetes, the children’s organ function was basically normal. (2) Children’s nervous systems are still developing; therefore, the stress response may not be completely elicited, and the abnormal release of brain-gut peptides is weakened [ 19 ]. (3) The gastrointestinal system of children can adapt to changes in the structure and function of neuronal circuits, and mucosal repair and functional reconstruction mechanisms are stronger in children than in adults [ 20 ].…”

Gastrointestinal Failure Score in Children with Traumatic Brain Injury

“…We speculate that 1) the included children did not have primary gastrointestinal injury. Compared with elderly critically ill patients with cardiovascular disease or diabetes, children's organ function is basically normal; 2) children's nervous systems are still developing; therefore, the stress response may not be completely elicited, and the abnormal release of brain-gut peptides is weakened [19]; 3) the gastrointestinal system of children can adapt to changes in the structure and function of neuronal circuits, and mucosal repair and functional reconstruction mechanisms are stronger in children than in adults [20]. Although we de ned FI using objective measurements for greater precision, FI is a subjective variable and a universally used clinical characteristic covering the entire spectrum of gastrointestinal symptoms.…”