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Prediction of cognitive sequelae based on abnormal computed tomography findings in children following mild traumatic
Harvey S Levin1, Gerri Hanten, Garland Roberson
1Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA. hlevin@bcm.edu
Insights
Children with intracranial pathology on CT scans after mild traumatic brain injury (MTBI) show poorer long-term cognitive outcomes. Early CT scans help identify children at risk for lasting neuropsychological changes.
Area of Science:
- Pediatric Neurology
- Neuropsychology
- Radiology
Background:
- Mild traumatic brain injury (MTBI) is common in children.
- The impact of intracranial pathology on long-term outcomes is not fully understood.
- Early identification of risk factors is crucial for effective intervention.
Purpose of the Study:
- To determine if intracranial pathophysiology on early CT scans affects neuropsychological outcomes in children with MTBI.
- To compare outcomes between children with and without intracranial pathology on CT.
- To identify predictors of poorer recovery in pediatric MTBI.
Main Methods:
- Prospective longitudinal study of children (5-15 years) with MTBI.
- Exclusion of pre-existing neurological disorders.
- Neuropsychological assessments at 2 weeks, 3, 6, and 12 months post-injury.
- Comparison between children with (CMTBI group) and without (MTBI group) intracranial pathology on CT scans.
Main Results:
- Children with intracranial pathology (CMTBI group) exhibited poorer episodic memory, slower cognitive processing, and diminished cognitive interference management.
- The CMTBI group also showed deficits in calculation and reading skills.
- Slower visuomotor speed and worse working memory were observed in subgroups of the CMTBI group, depending on extracranial injury and ADHD status.
Conclusions:
- Intracranial pathology on acute CT scans is associated with impaired neuropsychological recovery in children post-MTBI.
- CT scans within 24 hours are valuable for identifying children at risk for residual cognitive deficits.
- Factors like preinjury ADHD and extracranial injuries can further influence outcomes.
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.
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