Related Experiment Video
Updated: Oct 15, 2025
A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)
Published on: February 7, 2025
Early cognitive impairment is common in pediatric patients following mild traumatic brain injury
Megan Elizabeth Keys1, Patrick Delaplain, Katharine A Kirby
1From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery (M.E.K., P.D., K.I.B., K.R., M.L., J.N.), University of California, Irvine, Orange, CA; Center for Statistical Consulting (K.A.K.), University of California, Irvine; and Department of Surgery, Los Angeles, CA (K.I.).
Insights
Nearly 40% of pediatric trauma patients experience early cognitive impairment after mild traumatic brain injury. Lower initial Glasgow Coma Scale scores and higher Injury Severity Scores increase this risk.
Area of Science:
- Pediatric Traumatology
- Neuroscience
- Cognitive Impairment Research
Background:
- Early cognitive impairment (ECI) incidence and factors post-mild traumatic brain injury (mTBI) in pediatric trauma patients (PTPs) remain largely unknown.
- Adult studies indicate a high ECI incidence (51%) following mTBI, linked to Glasgow Coma Scale (GCS) and Brain Injury Guidelines (BIG) category.
Purpose of the Study:
- To determine the incidence of ECI in PTPs following mTBI.
- To identify factors associated with ECI in this population, hypothesizing a link with initial GCS and BIG category.
Main Methods:
- Retrospective review of PTPs (ages 8-17) with mTBI and intracranial hemorrhage.
- ECI defined as a Ranchos Los Amigos score < 8; outcomes compared using statistical tests.
- Multivariable logistic regression analyzed odds of ECI based on Injury Severity Score (ISS), demographics, and injury mechanisms.
Main Results:
- 18 of 47 PTPs (38.3%) exhibited ECI.
- ECI was associated with higher ISS (19.7 vs. 12.6) and motor vehicle-related injuries (55% vs. 15%).
- Lower GCS (OR 6.60), higher ISS (OR 1.12), and auto-involved injuries (OR 6.06) significantly increased ECI risk; BIG category showed no association.
Conclusions:
- Approximately 40% of PTPs with mTBI experience ECI.
- Lower initial GCS, higher ISS, and auto-involved injuries are significant risk factors for ECI.
- The Brain Injury Guidelines category is not a predictor of ECI in pediatric patients.
Introduction:
The incidence and factors related to early cognitive impairment (ECI) after mild traumatic brain injury (mTBI) in pediatric trauma patients (PTPs) are unknown. Prior data in the adult population demonstrated an ECI incidence of 51% after mTBI and strong correlation with initial Glasgow Coma Scale (GCS) and Brain Injury Guidelines (BIG) category. Therefore, we hypothesized that ECI is common after mTBI in PTPs and associated with initial GCS and BIG category.
Methods:
A single-center, retrospective review of PTPs (age, 8-17 years) from 2015 to 2019 with intracranial hemorrhage and mTBI (GCS score, 13-15) was performed. Primary outcome was ECI, defined as Ranchos Los Amigos score less than 8. Comparisons between ECI and non-ECI groups regarding Injury Severity Score (ISS), demographics, and cognitive and clinical outcomes were evaluated using χ2 statistics and Wilcoxon rank sum tests. Odds of ECI were evaluated using multivariable logistic regression.
Results:
From 47 PTPs with mTBI, 18 (38.3%) had ECI. Early cognitive impairment patients had a higher ISS than non-ECI patients (19.7 vs. 12.6, p = 0.003). Injuries involving motor vehicles were more often related to ECI than non-auto-involved mechanisms (55% vs. 15%, p = 0.005). Lower GCS score (odds ratio [OR], 6.60; 95% confidence interval [CI], 1.34-32.51, p = 0.02), higher ISS (OR, 1.12; 95% CI, 1.01-1.24; p = 0.030), and auto-involved injuries (OR, 6.06; 95% CI, 1.15-31.94; p = 0.030) were all associated with increased risk of ECI. There was no association between BIG category and risk of ECI (p > 0.05).
Conclusion:
Nearly 40% of PTPs with mTBI suffer from ECI. Lower initial GCS score, higher ISS, and autoinvolved mechanism of injury were associated with increased risk of ECI. Brain Injury Guidelines category was not associated with ECI in pediatric patients.
Level Of Evidence:
Prognostic study, Level III.
