Neurosensory Screening and Symptom Provocation in Pediatric Mild Traumatic Brain Injury
Andrew R Mayer1, Christopher J Wertz, Cidney R Robertson-Benta
1The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico (Drs Mayer, Stephenson, Hanlon, and Phillips, Messrs Wertz, Dodd, and Shaff, and Mss Robertson-Benta and Pabbathi Reddy); Departments of Psychiatry and Behavioral Sciences (Dr Mayer), Psychology (Drs Mayer and Campbell), Neurology (Drs Mayer and Phillips), and Emergency Medicine (Mr Oglesbee and Dr Park), University of New Mexico, Albuquerque; Department of Epidemiology and Biostatistics, University of Arizona, Tucson (Dr Bedrick); Center for Injury Research and Prevention, Department of Pediatrics (Drs Master, Grady, and Arbogast), and Division of Orthopedic Surgery (Drs Master and Grady), The Children's Hospital of Philadelphia, Philadelphia; Department of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada (Dr Zemek); Department of Psychology (Dr Yeates), Alberta Children's Hospital Research Institute (Dr Yeates), and Hotchkiss Brain Institute (Dr Yeates), University of Calgary, Calgary, Alberta, Canada; Department of Neurosurgery, Medical College of Wisconsin, Milwaukee (Dr Meier); Departments of Cell Biology, Neurobiology and Anatomy (Dr Meier) and Biomedical Engineering (Dr Meier), Medical College of Wisconsin, Milwaukee; Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts (Dr Mannix); and UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York (Dr Leddy).
Insights
Neurosensory testing in pediatric mild traumatic brain injury (pmTBI) shows limited diagnostic value at one week but can identify those with delayed recovery. This aids in prognosis for children with concussion.
Area of Science:
- Pediatric neurology
- Neuroscience
- Sports medicine
Background:
- Pediatric mild traumatic brain injury (pmTBI) requires effective diagnostic and prognostic tools.
- Neurosensory deficits are common sequelae of TBI, impacting various functional domains.
Purpose of the Study:
- To evaluate the diagnostic and prognostic implications of neurosensory testing in the subacute stage of pediatric mild TBI.
- To assess the utility of neurosensory testing for identifying children at risk for persistent postconcussive symptoms.
Main Methods:
- A prospective cohort study involving 146 pmTBI patients and 104 healthy controls (HCs).
- Neurosensory examinations included 10 tests assessing vestibular-ocular, oculomotor, vestibulospinal, and visual functions.
- Assessments were conducted approximately 1 week and 4 months post-injury.
Main Results:
- pmTBI patients exhibited significantly increased symptom provocation and deficits in accommodation and visual-motor skills compared to HCs at 1 week post-injury.
- Symptom provocation at 1 week did not significantly improve diagnostic accuracy compared to pretest symptom ratings.
- Clinically significant symptom provocation at 1 week enhanced the sensitivity for identifying persistent postconcussive symptoms at 4 months.
Conclusions:
- Neurosensory testing at 1 week post-TBI has limited diagnostic utility due to natural recovery in many pediatric patients.
- Neurosensory screening may be more valuable for identifying children likely to experience delayed recovery and persistent symptoms.
- These findings suggest a role for neurosensory assessment in predicting long-term outcomes in pediatric mild TBI.
Objective:
To evaluate diagnostic/prognostic implications of neurosensory testing during the subacute stage in patients with pediatric mild traumatic brain injury (pmTBI).
Setting:
Recruitment from pediatric emergency department and urgent care clinics, assessment in a controlled environment.
Participants:
In total, 146 pmTBI patients evaluated 7.4 ± 2.3 days and approximately 4 months postinjury; 104 age/sex-matched healthy controls (HCs) at equivalent time points.
Design:
Prospective cohort study.
Main Measures:
Neurosensory examination based on sequence of 10 established tests of vestibular-ocular, oculomotor, vestibulospinal, and visual functioning.
Results:
The amount of symptom provocation (positive change from pretest symptomatology) was significantly increased in pmTBI relative to HCs on every subtest 1 week postinjury, as were deficits in monocular accommodative amplitude and King-Devick Test errors. However, symptom provocation did not meaningfully alter diagnostic sensitivity/specificity relative to more easily obtained pretest symptom ratings. Evidence of clinically significant symptom provocation 1 week postinjury improved sensitivity (Δ = +12.9%) of identifying patients with persistent postconcussive symptoms 4 months postinjury on an independent symptom measure.
Conclusions:
The diagnostic sensitivity/specificity of neurosensory testing in acutely concussed youth may be limited at 1 week postinjury as a function of natural recovery occurring in most emergency department cohorts. Neurosensory screening may have greater utility for identifying patients who experience delayed recovery.
