Cognitive outcome in children and adolescents following severe traumatic brain injury: Influence of psychosocial, psychiatric, and injury-related variables

Abstract

Previous studies of childhood traumatic brain injury (TBI) have emphasized injury-related variables rather than psychiatric or psychosocial factors as correlates of cognitive outcomes. We addressed this concern by recruiting a consecutive series (N 5 24) of children age 5 through 14 years who suffered a severe TBI, a matched group who sustained a mild TBI, and a second matched group who sustained an orthopedic injury. Standardized intellectual, memory, psychiatric, family functioning, family psychiatric history, neurological, and neuroimaging assessments were conducted at an average of 2 years following injury. Severe TBI, when compared to mild TBI and orthopedic injury, was associated with significant decrements in intellectual and memory function. A principal components analysis of independent variables that showed significant ( p , .05) bivariate correlations with the outcome measures yielded a neuropsychiatric factor encompassing severity of TBI indices and postinjury psychiatric disorders and a psychosocial disadvantage factor. Both factors were independently and significantly related to intellectual and memory function outcome. Postinjury psychiatric disorders added significantly to severity indices and family functioning and family psychiatric history added significantly to socioeconomic status in explaining several specific cognitive outcomes. These results may help to define subgroups of children who will require more intensive services following their injuries. (JINS, 1999, 5, 58-68.)

Online Problem-Solving Therapy After Traumatic Brain Injury: A Randomized Controlled Trial

“…5,34 Previous research suggests that social disadvantage, including lower family income and lower levels of parental education, is associated with poorer outcomes after TBI. [38][39][40] Disadvantaged youth may lack access to treatment 30 and may have greater difficulty adhering to treatment when available. 40 The current intervention addressed many barriers to care by delivering care within the home at times convenient for the family.…”

Pediatric Head Injury: Priorities, Challenges, Perspectives and Necessities

“…The physiological and psychological effects of traumatic brain injury are possibly well established but is still unclear how long these effects can remain and how they can interact with the development of the brain network during specific ages [5,6]. Recently strong evidence has emerge in order to support the use of different measures such as decompressive craniectomy [7] and hyperosmolar therapy [8] in children.…”

Mild Traumatic Brain Injury in Children: Ringing the Alert Bell

“…Intervention also involves informing and explaining the injury to the family members. In the first 24 hours after the head injury, the outcome is entirely dependent on the development of intracranial complications that may have not been demonstrated during the first assessment [19,20]. Intracranial hematomas were reported to occur in about 1% of patients and 10% of those individuals will die [20].…”

“…In the first 24 hours after the head injury, the outcome is entirely dependent on the development of intracranial complications that may have not been demonstrated during the first assessment [19,20]. Intracranial hematomas were reported to occur in about 1% of patients and 10% of those individuals will die [20]. Children and adults were uniformly having an excel-lent outcome if intracranial hematomas were drained before clinical deterioration occurred.…”