Pediatric Traumatic Brain Injury - Neurocognitive and Psychosocial Outcome 6 Months Post-Injury: A Follow-Up Study in a Norwegian Pediatric Sample

Background: The most frequent cause of interruption to a child's normal course of brain development, is acquired brain injury. Norwegian data regarding long-term outcomes and rehabilitation needs following pediatric traumatic brain injury (pTBI) is limited and therefore much needed in order to design interventions and provide appropriate rehabilitation for this patient population. This study is one of the few Norwegian explorations of neurocognitive and psychosocial outcomes after pTBI and aims to contribute to a better understanding of this population. Method: Recruitment took place January 2015 throughout 2016, and participants were recruited from the South-Eastern Health Region of Norway. Fifty children aged 12 months to 15 years presenting to Oslo University Hospital (OUH) with verified traumatic brain injury (TBI) and CT scan within 24 hours were included. Acute medical and demographic data was collected shortly after inclusion. Assessment of neurocognitive and psychosocial symptom burden was performed 6 months post-injury through neuropsychological assessment and questionnaires (parental and self-report). Results: Transportation was the main cause of injury, with falls being most common for the youngest children, while the proportion of sports related injuries increased with age. The sample was skewed towards the severe end of the spectrum, with 64% of the injuries classified as mild, and 22% and 14% moderate and severe respectively, when classified based on Glasgow Coma Scale (GCS). A substantial amount of the mild injuries had intracranial abnormalities on CT/MRI, resulting in a subdivision of the mild group into uncomplicated (n=21) and complicated (n=11) mild TBI. Regarding the neuropsychological outcome, The WISC-IV Working memory index was significantly lower than the standardization sample mean values, and this domain specific vulnerability was further supported by the performance on this index being significantly lower than both the verbal comprehension and perceptual reasoning indexes on paired samples t-tests. Although the remaining neuropsychological test results appeared to be largely within average levels, 44% of the sample had clinically significant WISC-IV index discrepancies, which covaried with head injury severity. Also, when examining a neuropsychological impairment variable, a 40% impairment rate appeared, with the impairment rate being highest in the complicated mild group. Of note was the significant increase in parent reported post concussive symptoms (PCS) post-injury. Aspects of injury severity, family functioning, and child pre-injury symptom levels were all correlated with PCS, everyday life measures of executive function, as well as aspects of behavioral and emotional functioning after 6 months, supporting the link between premorbid vulnerability and post-injury function. The sample reported few symptoms within the psychosocial domain. Conclusion: This study demonstrates how stratifying pTBI severity based exclusively on the GCS can result in a too wide spectrum of injuries falling within the mild classification and underscores the importance of integrating radiological findings when identifying children at risk for persisting symptoms after pTBI. If intra-individual performance variation is not investigated in this patient population, neurocognitive symptoms may go undetected, which can consequently can lead to these children not receiving the treatment and educational support they need