Prediction of cognitive sequelae based on abnormal computed tomography findings in children following mild traumatic brain injury

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  • 1 Departments of Physical Medicine and Rehabilitation,
  • 7 Radiology, and
  • 9 Neurosurgery, Baylor College of Medicine;
  • 2 Department of Pediatrics, The University of Texas Medical School at Houston;
  • 6 Pediatric Neuroradiology, Texas Children's Hospital, Houston;
  • 4 Center for BrainHealth, The University of Texas at Dallas, Texas;
  • 5 Department of Psychiatry, University of California at San Diego, California; and
  • 3 Program in Neurosciences and Mental Health and
  • 8 Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
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Object

The aim of this study was to determine whether the presence of intracranial pathophysiology on computed tomography (CT) scans obtained within 24 hours of mild traumatic brain injury (MTBI) in children adversely affects neuropsychological outcome during the 1st year postinjury.

Methods

A prospective longitudinal design was used to examine the neuropsychological outcomes in children (ages 5–15 years) who had been treated for MTBI, which was defined as a loss of consciousness for up to 30 minutes and a lowest Glasgow Coma Scale (GCS) score of 13–15. Exclusion criteria included any preinjury neurological disorder. Outcome assessments were performed within 2 weeks and at 3, 6, and 12 months postinjury. Outcomes were compared between patients with MTBI whose postinjury CT scans revealed complications of brain pathophysiology (32 patients, CMTBI group) and those with MTBI but without complications (48 patients, MTBI group).

Results

Significant interactions confirmed that the pattern of recovery over 12 months after injury differed depending on the intracranial pathology, presence and severity of injuries to body regions other than the head, preinjury attention-deficit hyperactivity disorder (ADHD), and socioeconomic status. Children in the CMTBI group had significantly poorer episodic memory, slower cognitive processing, diminished recovery in managing cognitive interference, and poorer performance in calculating and reading than patients in the MTBI group. Among the patients with mild or no extracranial injury, visuomotor speed was slower in those in the CMTBI group; and among patients without preinjury ADHD, working memory was worse in those in the CMTBI group.

Conclusions

Neuropsychological recovery during the 1st year following MTBI is related to the presence of radiographically detectable intracranial pathology. Children with intracranial pathology on acute CT performed more poorly in several cognitive domains when compared with patients whose CT findings were normal or limited to a linear skull fracture. Depending on the presence of preinjury ADHD and concomitant extracranial injury, working memory and visuomotor speed were also diminished in patients whose CT findings revealed complications following MTBI. Computed tomography within 24 hours postinjury appears to be useful for identifying children with an elevated risk for residual neuropsychological changes.

Abbreviations used in this paper: ADHD = attention-deficit hyperactivity disorder; CMTBI = mild traumatic brain injury plus complications from MTBI; CT = computed tomography; CVLT-C = California Verbal Learning Test–Children's Version; EIS = extracranial injury score; GCS = Glasgow Coma Scale; SCWIT = Stroop Color-Word Interference Task; SES = socioeconomic status; SSRT = stop-signal reaction time; WISC-III = Wechsler Intelligence Scale for Children–Third Edition; WJTA = Woodcock-Johnson III Tests of Achievement.

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Contributor Notes

Address correspondence to: Harvey S. Levin, Ph.D., Baylor College of Medicine, 1709 Dryden Road, Suite 725, Houston, Texas 77030. email: hlevin@bcm.edu.
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