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Advanced Neurology Cognition in children with mild TBI

conducted at different time points were analyzed using (the risk would be higher if mTBI occurs before the age of
paired t-test or Wilcoxon matched-pairs signed rank test 11 years). 47
for nonparametric variables, as appropriate. The Fisher’s Recent findings have confirmed that psychiatric
and Chi-square tests were used to compare frequencies disorders frequently newly develop 6 – 12 months after
and percentages. The differences were presented as odds mTBI. This is associated with significant deficits in
ratio (OR) with 95% confidence interval. adaptive functioning and other pre-injury psychosocial
A post hoc power calculation demonstrated that risk factors, such as lower socioeconomic status (SES),
the sample size was sufficient to reach 80% power for greater psychosocial adversity, and decline in school
neuropsychological evaluations (100% for CBCL scores, performance. However, objective testing should be
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78% for NEPSY, and 81% for WISC-IV/WPPSI-III). adopted to diagnose psychosocial problems because the
GraphPad Prism (version 8.4.2; Boston, Massachusetts incidence of anxiety and depression according to the
USA was used to perform all analyses. P < 0.05 is considered caregiver’s perspective may not be reliable. 38
significant.
3.1.2. Patient-related issues
3. Results Pre-existing learning difficulties and adverse behavioral
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3.1. Literature review functioning of the child are significant predictors of
PCS as well as decreased activity and social participation
A total of 195 articles on pediatric mTBI published in in the post-injury phase. Hospitalization, motor vehicle
the past 12 years were initially identified. After careful accidents, loss of consciousness, and MRI abnormality
screening of titles and abstracts, 92 articles were evaluated are also associated with a higher risk of poor school
for eligibility. Of the 29 articles that met the inclusion performance in children with mTBI. 34
criteria, 17 were finally included (14 original studies 30-42
and 3 reviews; 43-45 Figure 1). Segev et al. analyzed the interaction between sex
and TBI injury. They found that among children with
The 17 examined studies encompassed a comprehensive posttraumatic stress disorder, TBI significantly affected
sample of 1336 children (790 males, 62%) who suffered the neurocognitive performance of girls, whereas it had
from mTBI, with a weighted mean age of 12.2 (range, a reduced effect on boys. On the other hand, the role of
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2 – 17) years. Most of the studies included only school- age as risk factor for negative neurocognitive outcome in
aged children. 31-34,36-43 The timeframe for psychosocial and children with TBI remains unclear. Taylor et al. reported
cognitive assessments after injury ranged from 1 week to that younger children had higher post-injury ratings on
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23 months, with most of them being conducted between the CBCL total scale than controls. However, Bernard
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3 and 12 months. 31,33,34,36,37,40,43 A summary of the reviewed et al. reported that an older age at the time of injury is a
articles is presented in Table 1. significant predictor of PCS at 1 month after injury. A
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The cognitive and psychological outcomes were recent review focusing on preschool children reported
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extensively assessed as primary objectives through several that there is a lack of empirical data regarding the
different assessment tools in almost all studies. Potential presentation and progression of PCS in this group of
risk factors and effects of psychological intervention were patients. Therefore, evidence regarding how to optimally
also explored in some studies. manage these patients during recovery is lacking.
3.1.1. Neuropsychological morbidity 3.1.3. Family-related issues
Previously published systematic reviews demonstrated Most studies exploring the role of family factors
that PCS was relatively frequent in children with demonstrated that there is a significant discrepancy
mTBI. 44,46 However, they were mostly investigated acutely. between a parent’s and a child’s perception of PCS. 31,42
Furthermore, higher rates of inattentive/hyperactive Persistent PCS can be predicted by higher levels of pre-
symptoms and mood disorder diagnoses as well as an injury parent distress. 32,35 Similarly, decreased activity and
increased risk of anxiety have been described immediately social participation among children with mTBI may be
after mTBI. In addition, if hospitalized, the likelihood associated with adverse pre-injury family functioning.
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of a substance abuse diagnosis increases by three fold. However, evidence regarding the impact of familial
Adolescents with mTBI are more likely to have disruptive SES on neurocognitive outcome in children with TBI
behaviors compared to younger children. Moreover, is contradictory. Some authors reported an association
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mTBI may be associated with schizophrenia diagnosis between persistent PCS and lower parental SES, whereas
in patients with a familial predisposition for the disorder others reported an association between persistent PCS
Volume 3 Issue 4 (2024) 4 doi: 10.36922/an.3886