Neurocognitive Outcome After Pediatric Traumatic Brain Injury: Patient Subgroups With Diverging Outcome

To investigate whether the heterogeneity in neurocognitive outcome following pediatric traumatic brain injury (TBI) can be reduced by distinguishing subgroups of children with distinct profiles of neurocognitive functioning, and to investigate whether these subgroups differ in demographic, premorbid, and clinical characteristics.

In this multicenter study, 113 children with TBI (mild [82%], moderate [7%], severe [11%]) and 113 demographically matched neurologically healthy (NH) children were assessed using comprehensive computerized neurocognitive testing at 6 months post-TBI. The TBI and NH groups were compared on neurocognitive domains, and the TBI group was subjected to cluster analysis to identify neurocognitive subgroups. Resulting subgroups were compared on demographic, premorbid, and clinical characteristics.

Children with TBI had lower performance than NH children in Speed, Stability, Attention & Control, Verbal Working Memory, and Visual Working Memory (P < 0.05, d ≤ -0.42, small effect sizes). Cluster analysis identified four distinct subgroups: one had good outcome and three had adverse outcomes characterized by weak global outcome, weak visual-processing outcome, or weak executive functioning outcome. While subgroups did not differ in clinical characteristics including TBI severity, the weak global outcome subgroup had more premorbid behavioral problems, and the good outcome subgroup had higher socioeconomic status.

This study indicates that children with mild to severe TBI exhibit neurocognitive deficits at 6 months post-TBI, among which subgroups of children with distinct neurocognitive outcome profiles exist. The neurocognitive outcome subgroups represent children with diverging severity and configuration of neurocognitive weaknesses. Clinical characteristics were not related to the outcome subgroups, highlighting the importance to consider other factors for the prognosis of neurocognitive outcome.