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A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)
Published on: February 7, 2025
Medical and cognitive outcome in children with traumatic brain injury
Craig G N Campbell1, Sally M Kuehn, Pauline M P Richards
1Division of Neurology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Canada.
Insights
Pediatric head injury can impair cognitive function. While intelligence and memory scores improve over time, some children experience lasting deficits, with initial injury severity predicting outcomes.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Traumatic Brain Injury Research
Background:
- Head injury is a significant cause of pediatric morbidity and mortality.
- Comprehensive outcome studies are limited, yet cognitive impairments are suspected after moderate to severe head injuries.
Purpose of the Study:
- To investigate the long-term cognitive outcomes in children with moderate to severe head injuries.
- To identify predictors of mortality and cognitive impairment in pediatric traumatic brain injury.
Main Methods:
- Retrospective chart review of 83 pediatric patients (age 1-18) with moderate or severe head injury.
- Analysis of correlations between medical variables (Glasgow Coma Scale, PRISM III score, ICU/hospital stay) and cognitive functioning (intelligence, memory).
Main Results:
- Seventy percent of injuries were severe, with a 13% mortality rate. Lower GCS and higher PRISM III scores predicted mortality.
- Cognitive scores improved over time, with mean intelligence and memory within the average range at 16-38 months post-injury.
- Despite group improvements, a higher-than-norm proportion of children had scores below 1.5 SDs for verbal IQ, performance IQ, and verbal memory. Lower GCS predicted poorer nonverbal intelligence and visual memory.
Conclusions:
- Initial Glasgow Coma Scale score is a key predictor of mortality and cognitive outcomes in pediatric traumatic brain injury.
- Children show temporal improvement in intelligence and memory, but individual outcomes vary significantly.
- While group means normalize, a substantial number of children experience persistent cognitive deficits.
Background:
Head injury is an important cause of morbidity and mortality in pediatrics. Comprehensive studies on outcome are scarce despite significant clinical concern that multiple areas of functioning may be impaired following moderate to severe head injury. The literature suggests that sequelae include not only medical problems but also impairments in cognitive functioning.
Methods:
A retrospective medical and psychology chart review of patients, age 1-18 years, admitted to the Children's Hospital of Eastern Ontario with moderate (Glasgow Coma Scale [GCS] 9-12) or severe head injury (GCS < or = 8) from November 1, 1993 until December 31, 1998 was conducted. Correlations were performed between medical variables (i.e., GCS, Pediatric Risk of Mortality [PRISM] III score, duration of ICU and hospital stay) and measures of intelligence and memory functioning.
Results:
Eighty-three children age 1 to 18 were included. Seventy percent of the children were classified as having a severe head injury. There was a mortality rate of thirteen percent. Younger age at injury, lower GCS, and higher PRISM III scores predicted higher mortality. Medical complications were documented systematically. Forty-four patients underwent at least one cognitive assessment and 17 of these children had intelligence testing at three points in time: baseline (< four months), early recovery (five to 15 months) and follow-up (16 to 38 months). The mean intelligence and memory scores fell within the average range at the latest point in follow-up. For those children who underwent three serial assessments, the mean verbal and performance IQ fell within the low average range at baseline improving significantly to fall within the average range by early recovery. Continued improvements were apparent in verbal memory beyond early recovery, with the mean obtained at follow-up falling within 1 SD of the normative mean. Despite the return to normal ranges for the group means the proportion of scores falling below 1.5 standard deviations from the mean was greater than population norms for verbal IQ, performance IQ and verbal memory. Lower GCS scores and longer duration of stay in ICU or hospital were predictive of lower nonverbal intelligence. Lower GCS was also predictive of lower visual memory scores.
Conclusions:
This study describes a population of Canadian children who suffered moderate or severe traumatic brain injury. Initial GCS was the best predictor of mortality and cognitive outcome. These children demonstrated a temporal improvement in intelligence and memory functioning, with their mean performance on these cognitive measures falling within the average range at 16 to 38 months postinjury, although there was considerable variability in the outcomes between individuals.
