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

Published online by Cambridge University Press:  20 January 2016

Brian L. Brooks ,
Hussain Daya ,
Samna Khan ,
Helen L. Carlson ,
Angelo Mikrogianakis  and
Karen M. Barlow
Brian L. Brooks*
Affiliation:
Neurosciences (Brain Injury and Vi Riddell Rehabilitation Program), Alberta Children’s Hospital, Calgary, Alberta, Canada Departments of Paediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada Alberta Children’s Hospital Research Institute for Child & Maternal Health, University of Calgary, Calgary, Alberta, Canada
Hussain Daya
Affiliation:
Department of Psychology, University of Lethbridge, Lethbridge, Alberta, Canada
Samna Khan
Affiliation:
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
Helen L. Carlson
Affiliation:
Neurosciences (Brain Injury and Vi Riddell Rehabilitation Program), Alberta Children’s Hospital, Calgary, Alberta, Canada Alberta Children’s Hospital Research Institute for Child & Maternal Health, University of Calgary, Calgary, Alberta, Canada
Angelo Mikrogianakis
Affiliation:
Departments of Paediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Alberta Children’s Hospital Research Institute for Child & Maternal Health, University of Calgary, Calgary, Alberta, Canada Section of Emergency Medicine, Alberta Children’s Hospital, Alberta, Canada
Karen M. Barlow
Affiliation:
Neurosciences (Brain Injury and Vi Riddell Rehabilitation Program), Alberta Children’s Hospital, Calgary, Alberta, Canada Departments of Paediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Alberta Children’s Hospital Research Institute for Child & Maternal Health, University of Calgary, Calgary, Alberta, Canada
*
Correspondence and reprint requests to: Brian L. Brooks, Neurosciences program, Alberta Children’s Hospital, 2888 Shaganappi Trail NW, Calgary, Alberta, Canada T3B 6A8. E-mail: brian.brooks@albertahealthservices.ca
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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. (JINS, 2016, 22, 379–387)

Keywords

Brain injuriesTraumaticConcussionMildCognitionOutcomes researchChildPost-concussion syndrome
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 22 , Issue 4 , April 2016 , pp. 379 - 387
Copyright
Copyright © The International Neuropsychological Society 2016 

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