A-182 Depression Symptoms Predict Neurocognitive Functioning Following Pediatric Traumatic Brain Injury in the Acute Recovery Phase

Abstract

Objective: Pediatric Intensive Care Unit (PICU) survivors are at elevated risk for developing neurocognitive concerns. Lower premorbid abilities, pediatric traumatic brain injury (pTBI) severity, and post-injury depression symptoms have been shown to predict greater neurocognitive deficits. However, limited extant research has focused on the acute recovery phase or used objective neuropsychological assessment measures. We examined the impact of pTBI severity and post-injury depression symptoms on neurocognitive functioning in the acute recovery phase. Method: Seventy-four trauma patients (8 to 19 years) were assessed 1-3 months after PICU discharge. Demographic and clinical data were extracted from the electronic medical record. Caregivers completed questionnaires about their children’s physical, cognitive and emotional functioning. The direct assessment included measures of WRAT5 word-reading; CMS/WISC-V/WAIS-IV digit span; WISC-V/WAIS-IV coding and symbol search; and DKEFS Trails-4, verbal phonemic and semantic fluencies. Given the high intercorrelations between aspects of executive function, principal components analysis (PCA) was conducted to create a cumulative neurocognitive index (NCI). A simple linear regression was used to test if moderate-severe Glasgow Coma scores and clinically elevated Promis Depression scores predicted NCI, controlling for reading ability. Results: Combining all participant data in the PCA yielded a single component solution accounting for 52.79% of total explained variance. The overall regression was significant (R2=.40), F(df=3,70) =15.23, p<.001. Elevated depression predicted NCI (p=.03) whereas greater pTBI severity was not predictive above the impact of premorbid factors. Conclusions: Neurocognitive functioning in PICU survivors within the acute recovery phase may be more related to concurrent depression symptoms than injury severity markers when premorbid factors are considered.

Exposure to Sedation and Analgesia Medications: Short-term Cognitive Outcomes in Pediatric Critical Care Survivors With Acquired Brain Injury

“…80,81 As expected, prior analyses show WRAT Word Reading scores account for a significant amount of variance in regression models using NCI as the outcome. 78,82 To account for this strong association between NCI and WRAT Word Reading, we calculated standardized residuals using simple linear regression of NCI predicted by WRAT Word Reading. With this method, the variability in residuals can be considered independent of baseline estimates of cognitive function estimated using WRAT Word Reading.…”