The Impact of Traumatic Brain Injury on Neurocognitive Outcomes in Children: a Systematic Review and Meta-Analysis

Abstract

ObjectiveTo assess the burden of paediatric traumatic brain injury (TBI) on neurocognition via a systematic review and meta-analysis.MethodsStudies that compared neurocognitive outcomes of paediatric patients with TBI and controls were searched using Medline, Embase, PsycINFO and Cochrane Central Register of Controlled Trials, between January 1988 and August 2019. We presented a random-effects model, stratified by TBI severity, time of assessment post injury and age.ResultsOf 5919 studies, 41 (patients=3717) and 33 (patients=3118) studies were included for the systematic review and meta-analysis, respectively. Studies mostly measured mild TBI (n=26, patients=2888) at 0–3 months postinjury (n=17, patients=2502). At 0–3 months postinjury, standardised mean differences between TBI and controls for executive function were −0.04 (95% CI −0.14 to 0.07; I2=0.00%), −0.18 (95% CI −0.29 to –0.06; I2=26.1%) and −0.95 (95% CI −1.12 to –0.77; I2=10.1%) for mild, moderate and severe TBI, respectively; a similar effect was demonstrated for learning and memory. Severe TBI had the worst outcomes across all domains and persisted >24 months postinjury. Commonly used domains differed largely from workgroup recommendations. Risk of bias was acceptable for all included studies.ConclusionA dose-dependent relationship between TBI severity and neurocognitive outcomes was evident in executive function and in learning and memory. Cognitive deficits were present for TBIs of all severity but persisted among children with severe TBI. The heterogeneity of neurocognitive scales makes direct comparison between studies difficult. Future research into lesser explored domains and a more detailed assessment of neurocognitive deficits in young children are required to better understand the true burden of paediatric TBI.

A Child Presenting with a Glasgow Coma Scale Score of 13: Mild or Moderate Traumatic Brain Injury? A Narrative Review

“…70 An inverse relationship between TBI severity and outcomes is especially reflected in the neurocognitive domains of executive function, learning, and memory. 71 An analogous difference in neuropsychological recovery has been shown for complicated mTBI GCS <15 compared with children with GCS 15 and normal CT. 51,70 In a systematic review of outcomes after 3, 6, 12, or 24 months following mTBI, 6.8% of studies indicated adverse academic (school and learning) outcomes, 17.8% adverse general neuropsychological outcomes, and 48.9% adverse psychosocial functioning. 72 For children with moderate TBI (GCS 9-12), these figures were 18.2, 45, and 31.8% respectively.…”

Characteristics of Psychiatric Sequela of Cranio-Brain Injury in the Psychiatric Outpatients

“…Следует обратить внимание, что в этой группе была диагностирована черепно-мозговая травма, которая относилась к категории тяжелых, имелись выписки из первичной медицинской документации, связанной с травмой. Зависимость выраженности снижения во всех когнитивных доменах от степени тяжести черепно-мозговой травмы показана во многих исследованиях [12,13]. Предполагается, что некоторые части мозга не подлежат восстановлению или подвергаются прогрессирующему ухудшению, что приводит к долгосрочным или пожизненным повреждениям.…”

Back to School: Academic Functioning and Educational Needs among Youth with Acquired Brain Injury

“…In TBI populations, prior findings have demonstrated a persistent dose-dependent relationship between injury severity and cognitive outcome [ 37 ]. Challenges with memory, attention or working memory, and processing speed tend to remit several months to years after injury, though they remain relatively more pronounced and persistent in those with more severe injuries [ 26 , 37 , 38 ]. Moreover, parents of children with severe TBI continue to perceive executive functioning problems in their children up to three years after their injury [ 39 ].…”

“…In addition to injury severity, age of injury has been shown to moderate long-term sequelae. Recent findings show that executive functioning challenges are often most devastating in children whose TBI was before age 5 years [ 37 ].…”