The UCLA Longitudinal Study of Neurocognitive Outcomes Following Mild Pediatric Traumatic Brain Injury

Abstract

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.

Postconcussive Symptom Exaggeration After Pediatric Mild Traumatic Brain Injury

“…[1][2][3][4][5][6] This finding corresponds with the general conclusions of several critical reviews, [7][8][9] as well as meta-analytic studies with both pediatric and adult samples. [10][11][12][13][14][15][16][17] In contrast, when examining outcomes by using subjectively reported symptoms, a minority of pediatric patients endorse more persistent problems.…”

Canadian pediatric emergency physician knowledge of concussion diagnosis and initial management

“…[6][7][8][9][10] The identification of concussion is critical to deliver appropriate care and support to patients and their families. [11][12][13] Persistent symptoms following concussion can have a devastating impact. 14,15 Consequences of concussion can include school absenteeism, depression, loss of social activities, and lower quality of life.…”

“…17,18 Slowed cognition, decreased attention, and memory impairment may make schoolwork a challenge upon return and require educational interventions. 12,15,19,20 Given the serious short-and long-term effects following mild traumatic brain injury, the application of appropriate initial management practices is essential. [21][22][23][24][25][26] Numerous guidelines for the management of concussion have been released from specialty groups (including sports medicine, neurology, pediatrics, and family medicine) and from large medical associations.…”

An fMRI Study of Auditory Orienting and Inhibition of Return in Pediatric Mild Traumatic Brain Injury

“…In the United States alone, the rate of TBI-related emergency department visits was over 500 per 100,000 for children less than 17 years of age (Faul et al, 2010), and 75% of these injuries were classified as mild in nature (Centers for Disease Control and Prevention, 2003). While the majority of mild TBI (mTBI) patients fully recover within the first several months of injury (Babikian and Asarnow, 2009;Satz et al, 1997), a small subset of patients may experience persistent neurocognitive or psychosocial dysfunction for years (Anderson et al, 2001;Babikian et al, 2011;Catale et al, 2009;Fay et al, 2010;McKinlay et al, 2002McKinlay et al, ,2009McKinlay et al, ,2010Sterr et al, 2006), or even decades (Daneshvar et al, 2011;Hessen et al, 2007;Klonoff et al, 1993). Thus it is critical to identify neuroimaging and behavioral markers sensitive to mTBI to better understand recovery, and to prevent potentially long-term adverse outcomes from repeated mTBI.…”