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Neurocognitive Outcome After Pediatric Traumatic Brain Injury: Patient Subgroups With Diverging Outcome
Cece C Kooper1, Marsh Königs2, Marjan E Steenweg3
1Emma Neuroscience Group, Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
Insights
Pediatric traumatic brain injury (TBI) can lead to neurocognitive deficits. Identifying distinct subgroups of children with TBI can help understand varying outcomes and inform prognosis beyond clinical factors.
Area of Science:
- Pediatric Neuropsychology
- Traumatic Brain Injury Research
- Neuroscience
Background:
- Heterogeneity in neurocognitive outcomes after pediatric TBI is a significant clinical challenge.
- Understanding distinct subgroups may refine prognosis and intervention strategies.
Purpose of the Study:
- To identify neurocognitive subgroups in children with TBI.
- To examine demographic, premorbid, and clinical differences between these subgroups.
Main Methods:
- Multicenter study involving 113 children with TBI and 113 matched healthy controls.
- Comprehensive computerized neurocognitive testing at 6 months post-TBI.
- Cluster analysis to identify neurocognitive subgroups within the TBI cohort.
Main Results:
- Children with TBI showed deficits in speed, stability, attention, and working memory compared to controls.
- Four neurocognitive subgroups were identified: one with good outcome and three with adverse outcomes (global, visual-processing, or executive functioning deficits).
- Subgroups did not differ by TBI severity, but differed in premorbid behavioral issues and socioeconomic status.
Conclusions:
- Distinct neurocognitive outcome profiles exist in children 6 months post-TBI.
- These subgroups reflect varying degrees and patterns of neurocognitive weaknesses.
- Prognosis of neurocognitive outcome may depend on factors beyond clinical characteristics.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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