The impact of traumatic brain injury on developmental functioning in children: Mild TBI at home and school

Abstract Background: Traumatic Brain Injury (TBI) is the leading cause of morbidity and mortality all over the world and the impact is much worse in Pakistan. The objective here is to describe the epidemiological characteristics of patients with TBI in our country and to determine the immediate outcomes of patients with TBI after the presentation.Method: This was a cross-sectional study conducted at the Lady Reading Hospital, Peshawar, Pakistan. Data were extracted from the medical records from January 1st to December 31st, 2019. Patient age, sex, type of trauma, and immediate outcome of the referral to the Emergency Department were recorded. The severity of TBI was categorized based on Glasgow Coma Scale (GCS) in mild (GCS 13-15), moderate (GCS 9-12), and severe (GCS <8) classes. The Emergency Department referral profile was classified as admissions, disposed, detained and disposed, referred.Results: Out of 5047 patients, 3689 (73.1%) males and 1358 (26.9%) females. The most commonly affected age group was 0-10 years (25.6%) and 21-30 years (20.1%). Road Traffic accident was the predominant cause of injury (38.8%, n=1960) followed by fall (32.7%, n=1649). Most (93.6%, n=4710) of the TBIs were mild. After the full initial assessment and workup, and completing all first-aid management, the immediate outcome was divided into four, most frequent (67.2%, n=3393) of which was “disposed (discharged)”, and 9.3% (n=470) were admitted for further management.Conclusion: Our study represents a relatively commonplace picture of epidemiological data on the burden of TBI in Pakistan. As a large proportion of patients had a mild TBI, and there is a high risk of mild TBI being under-diagnosed, we warrant further investigation of mild TBI in population-based studies.

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The impact of attention deficit hyperactivity disorder on recovery from mild traumatic brain injury

Journal of Neurosurgery Pediatrics ◽

10.3171/2013.5.peds12424 ◽

2013 ◽

Vol 12 (2) ◽

pp. 97-102 ◽

Cited By ~ 30

Author(s):

Christopher M. Bonfield ◽

Sandi Lam ◽

Yimo Lin ◽

Stephanie Greene

Keyword(s):

Traumatic Brain Injury ◽

Attention Deficit Hyperactivity Disorder ◽

Brain Injury ◽

Head Injury ◽

Attention Deficit ◽

Mild Tbi ◽

Hyperactivity Disorder ◽

Gcs Score ◽

The Impact

Object Attention deficit hyperactivity disorder (ADHD) and traumatic brain injury (TBI) are significant independent public health concerns in the pediatric population. This study explores the impact of a premorbid diagnosis of ADHD on outcome following mild TBI. Methods The charts of all patients with a diagnosis of mild closed head injury (CHI) and ADHD who were admitted to Children's Hospital of Pittsburgh between January 2003 and December 2010 were retrospectively reviewed after institutional review board approval was granted. Patient demographics, initial Glasgow Coma Scale (GCS) score, hospital course, and King's Outcome Scale for Childhood Head Injury (KOSCHI) score were recorded. The results were compared with a sample of age-matched controls admitted with a diagnosis of CHI without ADHD. Results Forty-eight patients with mild CHI and ADHD, and 45 patients with mild CHI without ADHD were included in the statistical analysis. Mild TBI due to CHI was defined as an initial GCS score of 13–15. The ADHD group had a mean age of 12.2 years (range 6–17 years), and the control group had a mean age of 11.14 years (range 5–16 years). For patients with mild TBI who had ADHD, 25% were moderately disabled (KOSCHI Score 4b), and 56% had completely recovered (KOSCHI Score 5b) at follow-up. For patients with mild TBI without ADHD, 2% were moderately disabled and 84% had completely recovered at follow-up (p < 0.01). Patients with ADHD were statistically significantly more disabled after mild TBI than were control patients without ADHD, even when controlling for age, sex, initial GCS score, hospital length of stay, length of follow-up, mechanism of injury, and presence of other (extracranial) injury. Conclusions Patients who sustain mild TBIs in the setting of a premorbid diagnosis of ADHD are more likely to be moderately disabled by the injury than are patients without ADHD.

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The Immune System's Role in the Consequences of Mild Traumatic Brain Injury (Concussion)

Frontiers in Immunology ◽

10.3389/fimmu.2021.620698 ◽

2021 ◽

Vol 12 ◽

Author(s):

Laura N. Verboon ◽

Hiren C. Patel ◽

Andrew D. Greenhalgh

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Immune Cell ◽

Chronic Traumatic Encephalopathy ◽

Anxiety And Depression ◽

Mild Tbi ◽

Patient Health ◽

History Of ◽

The Impact

Mild traumatic brain injury (mild TBI), often referred to as concussion, is the most common form of TBI and affects millions of people each year. A history of mild TBI increases the risk of developing emotional and neurocognitive disorders later in life that can impact on day to day living. These include anxiety and depression, as well as neurodegenerative conditions such as chronic traumatic encephalopathy (CTE) and Alzheimer's disease (AD). Actions of brain resident or peripherally recruited immune cells are proposed to be key regulators across these diseases and mood disorders. Here, we will assess the impact of mild TBI on brain and patient health, and evaluate the recent evidence for immune cell involvement in its pathogenesis.

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Mild cranioencephalic trauma in the child population. Experience at the Baca Ortiz Hospital, Quito-Ecuador, 2016-2019

Peruvian Journal of Neurosurgery ◽

10.53668/2021.pjns33165 ◽

2021 ◽

Vol 3 (3) ◽

Author(s):

Andrea Paez ◽

◽

Alicia Torres ◽

Adriana Gonzales ◽

Rodolfo Bernal ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mechanical Energy ◽

Craniocerebral Trauma ◽

Referral And Consultation ◽

Preschool Age ◽

Pediatric Hospital ◽

Cross Sectional ◽

Mild Tbi ◽

At Home

Introduction: The alteration at the anatomical and/or functional level, both motors, sensory and cognitive, a product of the sudden exchange of mechanical energy caused by an external force on the skull, is what defines a traumatic brain injury (TBI). The permanence or transience of these alterations determines the severity of the TBI, with 70 to 80% of a mild type whose neurological symptoms are of little intensity and duration. Clinical observation in mild TBI includes observing children under 2 years of age with trauma without fracture or admission criteria clinically for 2 to 4 hours and observing children with symptoms or mechanism of fall for 4 to 6 hours not known. The objective of the study is to describe mild TBI at Baca Ortiz Pediatric Hospital, a national children's referral hospital in Ecuador, during the period from January 2016 to December 2019. Methods: Cross-sectional, descriptive, and retrospective study that includes patients diagnosed with mild head trauma evaluated and treated in the Neurosurgery Service of the Baca Ortiz Pediatric Hospital, from January 2016 to December 2019. Results: During the period 2016 to 2019, 105 children with mild TBI were diagnosed and treated, this being more frequent in males (62.85%) and during the preschool stage (51.42%). Of all of them, 82.85% received specialty medical care in the first 6 hours after the trauma. The main etiology was the fall produced at home (66.66%). Conclusions: Mild traumatic brain injury is one of the main reasons for pediatric hospital consultation in our setting. It mostly occurs in male patients of preschool age, because of falls at home. Keywords: Craniocerebral Trauma, Child, Hospitals, Pediatric, Referral and Consultation (Source: MeSH NLM)

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Faculty Opinions recommendation of Prognostic value of demographic characteristics in traumatic brain injury: results from the IMPACT study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1087001.539961 ◽

2007 ◽

Author(s):

Donald Marion

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Prognostic Value ◽

Demographic Characteristics ◽

Impact Study ◽

The Impact

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Impact of routine S100B protein assay on CT scan use in children with mild traumatic brain injury

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2020-1293 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Fleur Lorton ◽

Jeanne Simon-Pimmel ◽

Damien Masson ◽

Elise Launay ◽

Christèle Gras-Le Guen ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

University Hospital ◽

S100b Protein ◽

Research Network ◽

Ct Scans ◽

Intermediate Risk ◽

Protein Assay ◽

The Impact

AbstractObjectivesTo evaluate the impact of implementing a modified Pediatric Emergency Care Applied Research Network (PECARN) rule including the S100B protein assay for managing mild traumatic brain injury (mTBI) in children.MethodsA before-and-after study was conducted in a paediatric emergency department of a French University Hospital from 2013 to 2015. We retrospectively included all consecutive children aged 4 months to 15 years who presented mTBI and were at intermediate risk for clinically important traumatic brain injury (ciTBI). We compared the proportions of CT scans performed and of in-hospital observations before (2013–2014) and after (2014–2015) implementation of a modified PECARN rule including the S100B protein assay.ResultsWe included 1,062 children with mTBI (median age 4.5 years, sex ratio [F/M] 0.73) who were at intermediate risk for ciTBI: 494 (46.5%) during 2013–2014 and 568 (53.5%) during 2014–2015. During 2014–2015, S100B protein was measured in 451 (79.4%) children within 6 h after mTBI. The proportion of CT scans and in-hospital observations significantly decreased between the two periods, from 14.4 to 9.5% (p=0.02) and 73.9–40.5% (p<0.01), respectively. The number of CT scans performed to identify a single ciTBI was reduced by two-thirds, from 18 to 6 CT scans, between 2013–2014 and 2014–2015. All children with ciTBI were identified by the rules.ConclusionsThe implementation of a modified PECARN rule including the S100B protein assay significantly decreased the proportion of CT scans and in-hospital observations for children with mTBI who were at intermediate risk for ciTBI.

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Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury

Injury Epidemiology ◽

10.1186/s40621-021-00308-y ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Lauren Alexis De Crescenzo ◽

Barbara Alison Gabella ◽

Jewell Johnson

Keyword(s):

Public Health ◽

Traumatic Brain Injury ◽

Emergency Department ◽

Brain Injury ◽

Interrupted Time Series ◽

Emergency Department Visits ◽

Control And Prevention ◽

Icd 10 ◽

Ed Visits ◽

The Impact

Abstract Background The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017. Results The monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97). Conclusion The reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.

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