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Severity of pediatric traumatic brain injury and early neurobehavioral outcome: a cohort study
K M Jaffe1, G C Fay, N L Polissar
1Department of Rehabilitation Medicine, University of Washington, Seattle.
Insights
Pediatric traumatic brain injury (TBI) can cause neurobehavioral issues. Even mild TBIs can lead to impairments in intelligence, memory, and academics compared to matched peers.
Area of Science:
- Neuroscience
- Pediatric Medicine
- Psychology
Background:
- Traumatic brain injury (TBI) is a leading cause of disability in children.
- Neurobehavioral effects of pediatric TBI can be challenging to differentiate from pre-existing conditions.
- Early identification of TBI consequences is crucial for intervention.
Purpose of the Study:
- To determine the early neurobehavioral effects of TBI in children.
- To compare children with TBI to individually matched controls to isolate injury effects.
- To assess the impact of TBI severity on cognitive and academic performance.
Main Methods:
- A cohort of 98 children (aged 6-15) with mild, moderate, or severe closed head injuries was studied.
- Controls were individually matched for age, gender, school grade, behavior, and academic performance.
- Intellectual, neuropsychological, and academic assessments were conducted 3 weeks post-orientation.
Main Results:
- No significant differences in premorbid characteristics were found between TBI cases and controls.
- Performance decline correlated with increasing TBI severity across intelligence, memory, motor speed, problem-solving, and academic measures.
- Moderately and severely injured children showed impairments relative to controls, despite normal performance on standardized norms.
Conclusions:
- Pediatric TBI, even when not severe, can lead to significant neurobehavioral impairments.
- These impairments place children with moderate to severe TBI at risk for academic and higher-order cognitive difficulties.
- Early assessment and support are vital for children experiencing TBI to mitigate long-term consequences.
Abstract:
Traumatic brain injury (TBI) is a major cause of pediatric disability. Its neurobehavioral sequelae can often be difficult to distinguish from premorbid problems. To establish the early neurobehavioral consequences of TBI, we compared a cohort of brain injured children with controls, individually matched on premorbid characteristics. Ninety-eight children, aged 6 to 15 years, with mild, moderate, and severe closed head injuries, were consecutively identified on presentation to two regional medical centers. Individually selected controls were matched for age, gender, school grade, behavior, and academic performance. Intellectual, neuropsychologic, and academic assessments were undertaken 3 weeks after full orientation was achieved. No significant case-control differences were found on 20 variables measuring premorbid status. The pattern of decline in performance with increasing severity of brain injury was consistent for measures assessing intelligence, memory, speeded motor performance, adaptive problem solving, and academic performance. Moderately and severely injured patients performed at normal levels in reference to standardized intellectual norms, but they showed impairment when compared with their matched controls. The impairments uncovered in this study place moderately and severely brain injured children at risk for problems in the acquisition of academic skills and higher-order cognitive abilities.