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Advanced Neurology Cognition in children with mild TBI

1. Introduction 2.1.1. Inclusion criteria

Traumatic brain injury (TBI) annually affects >3,000,000 All articles published in English that focused on neurocognitive
children worldwide and is the leading cause of death and and psychological assessments of children aged 0 – 18 years
1
disability in the pediatric age group. Although most with a history of mTBI (defined as a Glasgow coma scale
2-4
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children with TBI achieve full recovery, some of them [GCS] score of >8) were included in the analysis. Narrative
with mild TBI (mTBI) or severe TBI may experience reviews, opinion and clinical commentary articles, and single
a combination of cognitive, behavioral, and emotional case reports were excluded. First, the titles and abstracts of
sequelae. Consistently, a small number of mildly the articles were screened. Duplicates and articles with no
5,6
injured patients experience chronic physical, cognitive, available English summary were excluded. Articles reporting
and emotional impairments. This condition, known as information on both children and adults were included only
7
persistent postconcussive symptoms (PCS), is related to if pediatric data could be retrieved and extracted. Similarly,
reduced quality of life, challenges at school, and poorer studies on different types of TBI were included only if the data
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long-term psychological and behavioral outcomes. 10 of patients with mTBI could be separated. Two researchers
(I.L. and T.Z.) independently performed the literature search
TBI management in acute settings has been and screening of eligible studies.
extensively reported in several national and international
guidelines. 11-14 However, there is no consensus regarding 2.1.2. Data extraction
the recommendations for neuroradiological and We developed a standardized grid to collect the extracted
cognitive follow-up of these patients. Furthermore, all data. The following data were collected: first author name,
published studies have demonstrated a high variation in date and journal of publication, country of study, study design
neuropsychological domains and TBI severity. 15-19 The (prospective, retrospective, or case–control), sample size,
current study findings also suggested that these patients age (mean or median and range), outcome measures, main
experienced deficits mainly in linguistic abilities and results, and conclusions. The data were organized into tables
15
communication, 20,21 psychomotor skills, and attentional to easily compare the characteristics of the included studies.
capacity and executive functions. 22
This study aimed to review the current evidence on the 2.2. Monocentric cohort study
follow-up of children with mTBI to provide a systematic 2.2.1. Participants
and comprehensive overview of integrating extensive
neuropsychological and neuroradiological evaluations Children aged 4 – 16 (median, 9) years who were
as part of the long-term management of these patients. evaluated for TBI at our institution between March 2017
Furthermore, we described the clinical and neurocognitive and September 2018 were retrospectively enrolled in this
aspects of a group of Italian children with a history of study. We intentionally analyzed the data of children who
mTBI by studying their development over time. had been followed-up before the COVID-19 pandemic
to avoid potentially confounding factors. Data regarding
2. Materials and methods anthropometric and demographic characteristics,
comorbidities, mechanism of injury, GCS, and clinical
2.1. Literature review symptoms at baseline evaluation (T0), clinical data related
We conducted a systematic review in compliance with the to admission (e.g. labs report, complications report,
Preferred Reporting Items for Systematic Reviews and diagnostic test), and length of stay were collected.
Meta-analyses guidelines. 23,24 An electronic search was The inclusion criteria were as follows: (a) availability of
conducted using PubMed and Google Scholar databases head computed tomography (CT) at baseline, (b) complete
to identify articles published in English between January neuropsychological evaluation, and (c) good knowledge
1, 2012, and January 1, 2024. The following search terms of Italian language. The exclusion criteria were as follows:
were used: TBI AND/OR head trauma AND/OR brain (a) pre-existing neurological comorbidity or a former
injury AND/OR brain trauma AND/OR post-concussive diagnosis of neuropsychiatric disorder and (b) parent’s
syndrome AND children AND/OR pediatric AND/OR refusal to provide informed consent. The follow-up, mainly
youth AND/OR adolescent AND psychosocial AND/OR focused on neurocognitive assessments, was performed
cognitive AND/OR psychological AND/OR psychiatric. according to our clinical practice. Neurocognitive
The reference list of each article was also reviewed to assessments were performed at the following time points:
identify possible missing studies, and those eligible for the baseline (T0), i.e., within 7 days after the event; T1, i.e.,
screening process were evaluated according to inclusion 6 months after the event; and T2, i.e., 18 – 24 months after
criteria. the event.

Volume 3 Issue 4 (2024) 2 doi: 10.36922/an.3886