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

2016 ◽  
Vol 22 (4) ◽  
pp. 379-387 ◽  
Author(s):  
Brian L. Brooks ◽  
Hussain Daya ◽  
Samna Khan ◽  
Helen L. Carlson ◽  
Angelo Mikrogianakis ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Reaction Time ◽  
Mild Traumatic Brain Injury ◽  
Cognitive Flexibility ◽  
Cognitive Abilities ◽  
Cognitive Testing ◽  
Significant Group ◽  
Orthopedic Injury

AbstractCognitive 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)

scholarly journals Brain white matter after pediatric mild traumatic brain injury: a diffusion tensor and neurite orientation and dispersion imaging study

2021 ◽  
Author(s):  
Ayushi Shukla ◽  
Ashley L Ware ◽  
Sunny Guo ◽  
Bradley Gooodyear ◽  
Miriam H Beauchamp ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
White Matter ◽  
Mild Traumatic Brain Injury ◽  
Diffusion Tensor ◽  
Univariate Analysis ◽  
Significant Group ◽  
Brain White Matter ◽  
Orthopedic Injury ◽  
White Matter Microstructure

Background: Pediatric mild traumatic brain injury (mTBI) affects millions of children annually. Diffusion tensor imaging (DTI) is sensitive to axonal injuries and white matter microstructure and has been used to characterize the brain changes associated with mild traumatic brain injury (mTBI). Neurite orientation dispersion and density imaging (NODDI) is a diffusion model that can provide additional insight beyond traditional DTI metrics, but has not been examined in pediatric mTBI. The goal of this study was to employ DTI and NODDI to gain added insight into white matter alterations in children with mTBI compared to children with mild orthopedic injury (OI). Methods: Children (mTBI n=320, OI n=176) aged 8-16.99 years (12.39 ± 2.32 years) were recruited from emergency departments at five hospitals across Canada and underwent 3T MRI on average 11 days post-injury. DTI and NODDI metrics were calculated for seven major white matter tracts and compared between groups using univariate analysis of covariance controlling for age, sex, and scanner type. False discovery rate (FDR) was used to correct for multiple comparisons. Results: Univariate analysis revealed no significant group main effects or interactions in DTI or NODDI metrics. Fractional anisotropy and neurite density index in all tracts exhibited a significant positive association with age and mean diffusivity in all tracts exhibited a significant negative association with age in the whole sample. Conclusions: Overall, there were no differences between mTBI and OI groups in brain white matter microstructure from either DTI or NODDI in the seven tracts. This indicates that mTBI is associated with only relatively minor white matter differences, if any, at the post-acute stage. Brain differences may evolve at later stages of injury, so longitudinal studies with long-term follow-up are needed.

Test or Rest? Computerized Cognitive Testing in the Emergency Department after Pediatric Mild Traumatic Brain Injury Does Not Delay Symptom Recovery

2016 ◽  
Vol 33 (23) ◽  
pp. 2091-2096 ◽  
Author(s):  
Brian L. Brooks ◽  
Trevor A. Low ◽  
Hussain Daya ◽  
Samna Khan ◽  
Angelo Mikrogianakis ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Cognitive Testing ◽  
Symptom Recovery

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

2018 ◽  
Vol 31 (3) ◽  
pp. 355-361 ◽  
Author(s):  
Catherine M Lunter ◽  
Ellen L Carroll ◽  
Charlotte Housden ◽  
Joanne Outtrim ◽  
Faye Forsyth ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Assessment Tool ◽  
Neurocognitive Testing

scholarly journals Coping Strategies as a Predictor of Post-concussive Symptoms in Children with Mild Traumatic Brain Injury versus Mild Orthopedic Injury

2011 ◽  
Vol 17 (2) ◽  
pp. 317-326 ◽  
Author(s):  
Stacey E. Woodrome ◽  
Keith Owen Yeates ◽  
H. Gerry Taylor ◽  
Jerome Rusin ◽  
Barbara Bangert ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Coping Strategies ◽  
Mild Traumatic Brain Injury ◽  
Group Differences ◽  
Post Injury ◽  
Mild Tbi ◽  
Orthopedic Injury ◽  
Children's Coping ◽  
Over Time

AbstractThis study examined whether children's coping strategies are related to post-concussive symptoms following mild traumatic brain injury (TBI) versus orthopedic injury (OI). Participants were 8- to 15-year-old children with mild TBI (n = 167) or OI (n = 84). They rated their current preferred coping strategies and post-injury symptoms at 2 weeks (baseline) and 1, 3, and 12 months post-injury. Children's reported use of coping strategies did not vary significantly over time, so their baseline coping ratings were examined as predictors of post-concussive symptoms across time. Self-ratings of symptoms were positively related to emotion-focused strategies and negatively related to problem-focused engagement after both mild TBI and OI. Higher problem-focused disengagement predicted larger group differences in children's ratings of symptoms, suggesting that problem-focused disengagement moderates the effects of mild TBI. Coping strategies collectively accounted for approximately 10–15% of the variance in children's post-concussive symptoms over time. The findings suggest that coping may play an important role in accounting for children's perceptions of post-concussive symptoms after mild TBI. (JINS, 2011, 17, 317–326)

scholarly journals Understanding Why Patients Return to the Emergency Department after Mild Traumatic Brain Injury within 72 Hours

2015 ◽  
Vol 16 (3) ◽  
pp. 481-485 ◽  
Author(s):  
Latha Ganti ◽  
Lauren Conroy ◽  
Aakash Bodhit ◽  
Yasamin Daneshvar ◽  
Pratik Patel ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury

scholarly journals An experimental study of the effect on activity intentions of postconcussion recovery advice

2019 ◽  
Vol 3 ◽  
pp. 205970021987267
Author(s):  
Karen A Sullivan ◽  
Leanne Billing
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Time Frame ◽  
Activity Levels ◽  
Activity Type ◽  
Post Injury ◽  
Significant Group ◽  
Cognitive Rest ◽  
Activity Types

This study tested the effect of issuing return-to-activity advice on activity intentions at Day 2 and Day 10 days post simulated mild traumatic brain injury. One hundred and twenty-eight volunteers were randomly allocated to one of two groups who received ( n =  65) or did not receive standardized post-injury advice ( n =  63). To prime the simulation, the participants read a mild traumatic brain injury vignette about a person who is concussed while playing sport. Then the participants role-played the injured person and reported activity intentions for three activity types (cognitive, physical and restful) twice, once for each time frame (i.e. Day 2 and Day 10). The advice was to rest for the first 24–48 h and then gradually resume normal activities. There was no significant group by activity-type interaction ( p > .05) at Day 2. When both time frames were considered, there was no significant group × time frame interaction for any activity type or any item, except for an increase in non-manual (clerical) work and weight training at Day 10 compared to Day 2 in the group with the advice. In general, the intentions for all activity types were consistent with the recovery advice (i.e., rest then increasing activity), even when the advice was not given. However, at Day 10, cognitive and physical activity levels were still expected to be lower than usual (pre-injury), and many participants were uncertain about the concept of cognitive rest. These factors, along with individual patient circumstances, should be taken into account in rehabilitation planning.

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