Neurocognition in the Emergency Department after a Mild Traumatic Brain Injury in Youth

Abstract

The early cognitive effects from a mild traumatic brain injury (mTBI) are poorly understood in youth. The aim of this study was to examine acute neurocognitive functioning in children and adolescents who presented to the emergency department (ED) after an mTBI. Youth 8-17 years of age with an mTBI (n=77; mean age, 13.6 years; 95% confidence interval [CI], 13.0-14.2) and an orthopedic injury control (OIC) group (n=28; mean age, 13.9 years; 95% CI, 13.1-14.7) underwent a very brief computerized neurocognitive assessment (four subtests from CNS Vital Signs) in a pediatric trauma hospital ED. The mTBI and OIC groups were not significantly different on age, gender, handedness, computer familiarity, race, median family income, pain rating scales, or time from injury to assessment. There were no significant differences between the mTBI and OIC groups for accuracy on immediate memory, delayed memory, and measures of attention and executive functioning. However, the mTBI group performed significantly worse than the OIC on nearly all measures of psychomotor speed and reaction time. Further, cognitive functioning appears to worsen as more time passes since the mTBI. Neurocognitive deficits are detectable in youth with an mTBI who present to the ED, despite having a Glasgow Coma Scale score of 15/15 and normal neuroimaging (or their presentation does not warrant neuroimaging). Their profile appears to include preserved accuracy on cognitive measures, but at the expense of slower psychomotor speed and longer reaction time.

Microstructure of the Corpus Callosum Long after Pediatric Concussion

“…CNSVS domain scores generally have medium to large correlations with more conventional neuropsychological measures used in youth populations (Plourde, Hrabok, Sherman, & Brooks, 2018) and marginal (r = .63) to high (r = .82) test-retest reliabilities (Brooks & Barlow, 2011). CNSVS has sensitivity in samples with mixed neurological disorders , concussion (Brooks, Khan, Daya, Mikrogianakis, & Barlow, 2014), and moderate to severe traumatic brain injury (TBI) (Plourde & Brooks, 2017) and is part of the NINDS pediatric brain injury common data elements (McCauley et al, 2012). CNSVS domain scores have a normalized mean of 100 (SD = 15) based on a standardized sample.…”

“…In the present study, select domains scores for verbal memory, reaction time, and cognitive flexibility were used. These measures have previously been shown to differentiate youth with concussions from youth with OI in the emergency department (Brooks et al, 2014).…”

Neurocognitive testing in the emergency department: A potential assessment tool for mild traumatic brain injury

“…There are limited comparable data on neurocognitive testing in the ED, with most assessments occurring in the sub-acute time period. In similar studies, results have been mixed, with slower reaction times being demonstrated by the majority, [10][11][12] but not all studies. 13 Visual memory dysfunction was also found in mTBI patients; 12,13 however, equivocal findings have also been noted.…”

“…Visual memory dysfunction was also found in mTBI patients; however, equivocal findings have also been noted . Measures of executive functioning are not commonly included in acute testing; with just one previous study finding no differences between mTBI and orthopaedic controls on the CNS Vital Signs computerised battery Stroop task and shifting attention tests . The potential challenge faced in evaluating executive dysfunction across studies is that the complexity of this cognitive construct makes it difficult to operationalise a standard definition and method for its testing.…”

“…10 Measures of executive functioning are not commonly included in acute testing; with just one previous study finding no differences between mTBI and orthopaedic controls on the CNS Vital Signs computerised battery Stroop task and shifting attention tests. 11 The potential challenge faced in evaluating executive dysfunction across studies is that the complexity of this cognitive construct makes it difficult to operationalise a standard definition and method for its testing. This may, in part, account for the variability of results in studies evaluating the neurocognitive sequelae following concussion.…”