Cognition in the Emergency Department as a Predictor of Recovery after Pediatric Mild Traumatic Brain Injury

Abstract

Cognitive abilities can be acutely disrupted in children and adolescents who sustain a mild traumatic brain injury (mTBI), with the potential that these disruptions may be predictive of recovery. The objective of this study was to determine if cognitive abilities in the emergency department (ED) can differentiate and predict poor symptom recovery following a pediatric mTBI. Participants included 77 male and female youth with a mTBI (mean age=13.6; SD=2.6). All participants completed computerized cognitive testing (four subtests from the CNS Vital Signs) when they presented to the ED. Symptom measurement occurred in the ED (for pre-injury), at 7-10 days, 1 month, 2 months, and 3 months post-mTBI using the post-concussion symptom inventory (PCSI). Recovery was determined using reliable change scores for symptom ratings from 28 orthopedic injury controls (mean age=13.9 years; SD=2.1). Significantly worse Reaction Time scores (i.e., rapid information processing) in the ED were found in those who remained symptomatic at 1 month. Performances on the Reaction Time and Cognitive Flexibility domain scores were predictive of symptom outcome at 1 month for youth (above and beyond sex and baseline symptom burden). Youth with low scores on Reaction Time and/or Cognitive Flexibility were nearly 15 times (95% CI=1.8-323.5) more likely to remain symptomatic at 1 month post-mTBI. No significant group differences were found at 7-10 days, 2 months, or 3 months post-injury. Rapid computerized cognitive testing in the ED following a mTBI may help clinicians predict which youth may or may not remain symptomatic at follow-up.

Advancing Concussion Assessment in Pediatrics (A-CAP): a prospective, concurrent cohort, longitudinal study of mild traumatic brain injury in children: study protocol

“…Neurocognitive skills, including processing speed, executive functioning and visual memory, are assessed using three of the seven subtests of the computerised Central Nervous System Vital Signs test battery: the Stroop Test, Shifting Attention Test and Visual Memory Test. These three subtests can be completed in about 15 min with minimal disruption to the ED flow, 31 and have been shown to discriminate children with concussion from children with OI, 32 to predict symptoms 1 month after concussion 33 and to not negatively alter symptom recovery. 34 The tests generate composite scores for reaction time, cognitive flexibility and visual memory.…”

A review of sleep disturbances following traumatic brain injury

“…Others have demonstrated the utility of post-injury neuropsychological testing in predicting which patients develop chronic neurocognitive impairments (Carlsson et al 1987;Konrad et al 2011;Ponsford et al 2008;De Beaumont et al 2009;Himanen et al 2006;Monti et al 2013). One such study (n = 105) showed that cognitive flexibility and reaction times testing in the emergency department predicted symptoms one month following TBI in the pediatric population (Brooks et al 2016). Another study (n = 61) demonstrated that older age and male sex portended a higher risk of developing chronic deficits in visuospatial ability and visual memory .…”

Diagnosing mild traumatic brain injury using saliva RNA compared to cognitive and balance testing

“…2,7 mTBI is also associated with missed school or work, and increased healthcare utilization. 8 mTBI can have a wide range of effects on physical, cognitive, and psychological function, negatively impacting cognitive abilities, academic performance, behavior, social interaction, and employment. [9][10][11] It can be difficult to identify the physical and neurocognitive effects of mTBI, as some effects may be attributed to other causes such as anxiety, depression, attention deficit hyperactivity disorder (ADHD), exercise-related fatigue, or chronic headache disorder.…”