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Investigations on Alterations of Hippocampal Circuit Function Following Mild Traumatic Brain Injury
Published on: November 19, 2012
Neurocognitive evaluation of mild traumatic brain injury in the hospitalized pediatric population
Michael L Nance1, Alison Polk-Williams, Michael W Collins
1Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. nance@email.chop.edu
Insights
Inpatient neurocognitive testing is feasible for children with mild traumatic brain injury (MTBI). Most children show neurocognitive deficits upon hospital admission, with significant improvement after discharge, suggesting delayed return-to-activity decisions.
Area of Science:
- Pediatric neurology
- Neurotraumatology
- Clinical neuropsychology
Background:
- Mild traumatic brain injury (MTBI) is prevalent in children.
- Lack of standardized protocols for assessing neurocognitive impairment and guiding return to activities post-MTBI.
Purpose of the Study:
- To evaluate the feasibility of conducting neurocognitive testing during hospitalization for pediatric MTBI.
- To quantify the extent of neurocognitive deficits and symptomatology in these patients.
- To assess neurocognitive recovery following discharge.
Main Methods:
- Prospective enrollment of 11-17 year olds hospitalized with MTBI over two years.
- Utilized Immediate Postconcussion Assessment and Cognitive Testing (IPACT) for inpatient and follow-up assessments.
- Assessed feasibility, neurocognitive impairment, and symptom severity.
Main Results:
- 116 pediatric MTBI patients were enrolled; mean age 14 years, 69.8% male.
- Initial inpatient testing revealed widespread neurocognitive deficits (95.7% with at least one subtest below 25th percentile) and high symptom scores (83.4%).
- Follow-up testing showed significant improvements in all neurocognitive subtests and a decrease in symptom scores (P < 0.05 for all).
Conclusions:
- Inpatient neurocognitive testing is a feasible approach for pediatric MTBI.
- Neurocognitive abnormalities are common upon initial evaluation but improve with outpatient follow-up.
- Return-to-activity recommendations for hospitalized MTBI children should be based on post-discharge assessments.
Objective:
To test the feasibility of inpatient neurocognitive testing and measure the degree of disability in children hospitalized with mild traumatic brain injury (MTBI).
Summary Background Data:
MTBI is common in the pediatric population. A standardized approach to identify neurocognitive impairment and determine optimal time to return to exertional activities (eg, school, sports) is lacking.
Methods:
For a 2-year period, children (age: 11-17 years) hospitalized at a level 1 urban Pediatric Trauma Center with MTBI were prospectively enrolled. Neurocognitive performance was assessed utilizing previously validated computer-based tests (Immediate Postconcussion Assessment and Cognitive Testing) as inpatient and in follow-up clinic after discharge. The feasibility of inpatient testing and the degree neurocognitive impairment and symptomatology were assessed. This study was approved by the IRB and registered with clinicaltrials.gov (NCT00715949).
Results:
For the 2 years of study, 116 subjects were prospectively enrolled and tested. The population had a mean age of 14 years and 69.8% were male. On initial in-hospital testing, the overall population demonstrated considerable neurocognitive deficits (mean values for all 4 subtests below 25th percentile, norm 50%) with at least one subtest score below 25% in 95.7% and an abnormal symptom score in 83.4% of patients. In comparing initial testing to follow-up testing (N = 63), significant improvements were noted for all subtests (verbal memory: 28.0% vs. 37.5%, respectively, norm 50%, P = 0.02; visual memory: 24.9% vs. 38.1%, respectively, norm 50%, P < 0.01; visual motor: 21.8% vs. 31.1%, respectively, norm 50%, P = 0.01; reaction time: 21.8% vs. 30.3%, respectively, norm 50%, P = 0.05), with a decline in the symptom score (26.9 vs. 9.2, respectively, norm 0-8, P < 0.01) as well. Patients not seen in follow-up (N = 53) did not differ demographically from those seen in clinic.
Conclusions:
Inpatient neurocognitive testing was feasible in pediatric MTBI patients. Neurocognitive abnormalities were nearly universally present on initial evaluation with significant improvements demonstrated at the time of outpatient follow-up. Return to activity recommendations are thus best deferred for most hospitalized MTBI children until formal assessment can be performed after discharge.
