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Chan V, Thurairajah P, Colantonio A. Defining traumatic brain injury in children and youth using international classification of diseases version 10 codes: a systematic review protocol. Syst Rev 2013; 2:102. [PMID: 24219843 PMCID: PMC3833640 DOI: 10.1186/2046-4053-2-102] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 10/30/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Although healthcare administrative data are commonly used for traumatic brain injury research, there is currently no consensus or consistency on using the International Classification of Diseases version 10 codes to define traumatic brain injury among children and youth. This protocol is for a systematic review of the literature to explore the range of International Classification of Diseases version 10 codes that are used to define traumatic brain injury in this population. METHODS/DESIGN The databases MEDLINE, MEDLINE In-Process, Embase, PsychINFO, CINAHL, SPORTDiscus, and Cochrane Database of Systematic Reviews will be systematically searched. Grey literature will be searched using Grey Matters and Google. Reference lists of included articles will also be searched. Articles will be screened using predefined inclusion and exclusion criteria and all full-text articles that meet the predefined inclusion criteria will be included for analysis. The study selection process and reasons for exclusion at the full-text level will be presented using a PRISMA study flow diagram. Information on the data source of included studies, year and location of study, age of study population, range of incidence, and study purpose will be abstracted into a separate table and synthesized for analysis. All International Classification of Diseases version 10 codes will be listed in tables and the codes that are used to define concussion, acquired traumatic brain injury, head injury, or head trauma will be identified. DISCUSSION The identification of the optimal International Classification of Diseases version 10 codes to define this population in administrative data is crucial, as it has implications for policy, resource allocation, planning of healthcare services, and prevention strategies. It also allows for comparisons across countries and studies. This protocol is for a review that identifies the range and most common diagnoses used to conduct surveillance for traumatic brain injury in children and youth. This is an important first step in reaching an appropriate definition using International Classification of Diseases version 10 codes and can inform future work on reaching consensus on the codes to define traumatic brain injury for this vulnerable population.
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Affiliation(s)
- Vincy Chan
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto M5G 2A2, ON, Canada
- University of Toronto, 160-500 University Avenue, Toronto M5G 1V7, ON, Canada
| | | | - Angela Colantonio
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto M5G 2A2, ON, Canada
- University of Toronto, 160-500 University Avenue, Toronto M5G 1V7, ON, Canada
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102
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Shuttleworth-Edwards AB, Radloff SE, Whitefield-Alexander VJ, Smith IP, Horsman M. Practice effects reveal visuomotor vulnerability in school and university rugby players. Arch Clin Neuropsychol 2013; 29:86-99. [PMID: 23917347 DOI: 10.1093/arclin/act061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article reports on three pre- versus post-season prospective studies in which male university and high school contact sport players predominantly of Rugby Union (hereafter rugby) were compared with age, education, and IQ equivalent non-contact sport controls on the ImPACT (Immediate Postconcussion Assessment and Cognitive Testing) test. All analyses revealed a relative absence of practice effects on the Visual Motor Speed (VMS) composite for contact sport groups compared with controls. The VMS data for rugby players from each study were pooled and subjected to additional analysis (Rugby, n = 145; Controls, n = 106). Controls revealed significant improvement over the season (p < .001), whereas no learning effect was in evidence for rugby players whose performance remained the same (interaction effect, p = .028). It is apparent that practice effects have diagnostic potential in this context, implicating vulnerability on speeded visuomotor processing in association with participation in rugby. Pointers for further research and concussion management in the individual case are explored.
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Beauchamp MH, Dooley JJ, Anderson V. A preliminary investigation of moral reasoning and empathy after traumatic brain injury in adolescents. Brain Inj 2013; 27:896-902. [PMID: 23789866 DOI: 10.3109/02699052.2013.775486] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE Traumatic brain injury (TBI) sustained during childhood can affect a number of socio-cognitive skills; however, little attention has focused on the integrity of moral reasoning in the assessment of post-TBI social sequelae and the role of empathy and intelligence on moral maturity. RESEARCH DESIGN In a quasi-experimental, cross-sectional research design, moral reasoning maturity and empathy in adolescents with mild-to-severe TBI (n = 25) were compared to typically-developing peers (n = 66). METHODS AND PROCEDURES Participants were administered the So-Moral and So-Mature, tasks of socio-moral reasoning and maturity, the Index of Empathy for Children and Adolescents, the Wechsler Abbreviated Scale of Intelligence and a demographic questionnaire. MAIN OUTCOMES AND RESULTS Participants with TBI had significantly lower levels of moral reasoning maturity. Further, adolescents with moderate-to-severe TBI had lower levels of empathy. Empathy correlated positively with moral reasoning abilities and, together with intellectual function, predicted a small, but significant proportion of moral reasoning outcome. CONCLUSIONS Youth who sustained TBI during childhood have poorer moral reasoning abilities than their non-injured peers, potentially placing them at risk for poor social decision-making and socially maladaptive behaviour. This can have a significant impact on long-term social functioning.
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Affiliation(s)
- M H Beauchamp
- Department of Psychology, University of Montreal, Montreal, QC, Canada.
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Yeates KO, Kaizar E, Rusin J, Bangert B, Dietrich A, Nuss K, Wright M, Taylor HG. Reliable change in postconcussive symptoms and its functional consequences among children with mild traumatic brain injury. ACTA ACUST UNITED AC 2013; 166:615-22. [PMID: 22393171 DOI: 10.1001/archpediatrics.2011.1082] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine reliable change in postconcussive symptoms and its functional consequences among children with mild traumatic brain injury (TBI) over the first year postinjury as compared with children with orthopedic injuries. DESIGN Prospective, longitudinal cohort. SETTING Emergency departments at 2 children's hospitals. PARTICIPANTS Eight- to 15-year-old children with mild TBI (n = 186) or orthopedic injuries (n = 99). MAIN EXPOSURE Closed-head or orthopedic trauma. MAIN OUTCOME MEASURES Parents rated preinjury symptoms retrospectively shortly after injury and postconcussive symptoms at 2 weeks and 3 and 12 months postinjury. A regression-based approach was used to determine whether each child displayed reliable increases in postconcussive symptoms at each postinjury occasion. Health-related quality of life was assessed at 3 and 12 months postinjury. Information regarding children's educational programming was collected at the initial and 12-month assessments. RESULTS Children with mild TBI were significantly more likely than those with orthopedic injuries to show reliable increases in both cognitive and somatic symptoms. Group differences in the likelihood of reliable increases became less common with time for somatic symptoms but persisted to 12 months postinjury for cognitive symptoms. Among children with mild TBI, reliable increases in symptoms were more common among children with loss of consciousness or abnormalities on neuroimaging. Reliable increases in symptoms were associated with significant declines in health-related quality of life and an increased likelihood of educational intervention. CONCLUSION Many children with mild TBI show reliable increases in postconcussive symptoms that are associated with significant functional impairment in their daily lives.
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105
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Predictors of 1-month and 1-year neurocognitive functioning from the UCLA longitudinal mild, uncomplicated, pediatric traumatic brain injury study. J Int Neuropsychol Soc 2013; 19:145-54. [PMID: 23157821 DOI: 10.1017/s135561771200104x] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Although more severe brain injuries have long been associated with persisting neurocognitive deficits, an increasing body of literature has shown that children/adolescents with single, uncomplicated mild traumatic brain injury (mTBI) do not exhibit long-lasting neurocognitive impairments. Nonetheless, clinical experience and our previous report (Babikian, 2011) showed that a minority of children/adolescents exhibit persistent cognitive problems using performance based measures following what appear to be relatively mild injuries. Predictors of poor neurocognitive outcomes were evaluated in 76 mTBI and 79 Other Injury subjects to determine the relative contributions of indices of injury severity, clinical symptomatology, demographic factors, and premorbid functioning in predicting 1-month and 12-month neurocognitive impairment on computerized or paper and pencil measures. Injury severity indicators or type of injury (head vs. other body part) did not predict either 1-month or 12-month cognitive impairment status. Rather, premorbid variables that antedated the injury (parental education, premorbid behavior and/or learning problems, and school achievement) predicted cognitive impairments. When post-injury neurocognitive impairments are observed in survivors of mild injuries (head or other body part), a sound understanding of their etiology is critical in designing appropriate intervention plans. Clinical and research implications are discussed.
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106
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McNally KA, Bangert B, Dietrich A, Nuss K, Rusin J, Wright M, Taylor HG, Yeates KO. Injury versus noninjury factors as predictors of postconcussive symptoms following mild traumatic brain injury in children. Neuropsychology 2013; 27:1-12. [PMID: 23356592 PMCID: PMC3760010 DOI: 10.1037/a0031370] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To examine the relative contributions of injury characteristics and noninjury child and family factors as predictors of postconcussive symptoms (PCS) following mild traumatic brain injury (TBI) in children. METHOD Participants were 8- to 15-year-old children, 186 with mild TBI and 99 with mild orthopedic injuries (OI). Parents and children rated PCS shortly after injury and at 1, 3, and 12 months postinjury. Hierarchical regression analyses were conducted to predict PCS from (1) demographic variables; (2) premorbid child factors (WASI IQ; WRAT-3 Reading; Child Behavior Checklist; ratings of preinjury PCS); (3) family factors (Family Assessment Device General Functioning Scale; Brief Symptom Inventory; and Life Stressors and Social Resources Inventory); and (4) injury group (OI, mild TBI with loss of consciousness [LOC] and associated injuries [AI], mild TBI with LOC but without AI, mild TBI without LOC but with AI, and mild TBI without LOC or AI). RESULTS Injury group predicted parent and child ratings of PCS but showed a decreasing contribution over time. Demographic variables consistently predicted symptom ratings across time. Premorbid child factors, especially retrospective ratings of premorbid symptoms, accounted for the most variance in symptom ratings. Family factors, particularly parent adjustment, consistently predicted parent, but not child, ratings of PCS. CONCLUSIONS Injury characteristics predict PCS in the first months following mild TBI but show a decreasing contribution over time. In contrast, noninjury factors are more consistently related to persistent PCS.
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Affiliation(s)
- Kelly A. McNally
- Section of Pediatric Psychology and Neuropsychology, Nationwide Children’s Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Barbara Bangert
- Departments of Radiology and Neurosurgery, University Hospitals Health System, Cleveland, Ohio
| | - Ann Dietrich
- Department of Pediatrics, The Ohio State University, Columbus, Ohio
- Department of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Kathy Nuss
- Department of Pediatrics, The Ohio State University, Columbus, Ohio
- Department of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Jerome Rusin
- Department of Radiology, Nationwide Children’s Hospital, Columbus, Ohio
| | - Martha Wright
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
- Rainbow Babies & Children’s Hospital, University Hospitals Case Medical Center, Cleveland, Ohio
| | - H. Gerry Taylor
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
- Rainbow Babies & Children’s Hospital, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Keith Owen Yeates
- Department of Pediatrics, The Ohio State University, Columbus, Ohio
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
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Abstract
AbstractPurpose: The purpose of this article is to inform speech-language pathologists in the schools about issues related to the care of children with traumatic brain injury.Method: Literature review of characteristics, outcomes and issues related to the needs serving children.Results: Due to acquired changes in cognition, children with traumatic brain injury have unique needs in a school setting.Conclusions: Speech-Language Pathologists in the school can take a leadership role with taking care of children after a traumatic brain injury and coordination of medical and educational information.
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Affiliation(s)
- Julie Haarbauer-Krupa
- Researcher, Children's Healthcare of Atlanta Health Scientist, Traumatic Brain Injury Team, Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention Atlanta, GA
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108
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Loher S, Fatzer ST, Roebers CM. Executive Functions After Pediatric Mild Traumatic Brain Injury: A Prospective Short-Term Longitudinal Study. APPLIED NEUROPSYCHOLOGY-CHILD 2012; 3:103-14. [DOI: 10.1080/21622965.2012.716752] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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109
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Vidal PG, Goodman AM, Colin A, Leddy JJ, Grady MF. Rehabilitation strategies for prolonged recovery in pediatric and adolescent concussion. Pediatr Ann 2012; 41:1-7. [PMID: 22953976 DOI: 10.3928/00904481-20120827-10] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Paul G Vidal
- Specialized Physical Therapy, LLC, Cherry Hill, NJ 08003, USA. specializedpt@verizon. net
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110
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Embracing chaos: the scope and importance of clinical and pathological heterogeneity in mTBI. Brain Imaging Behav 2012; 6:255-82. [DOI: 10.1007/s11682-012-9162-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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111
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Current world literature. Curr Opin Pediatr 2012; 24:134-44. [PMID: 22245849 DOI: 10.1097/mop.0b013e328350498a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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112
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Maugans TA, Farley C, Altaye M, Leach J, Cecil KM. Pediatric sports-related concussion produces cerebral blood flow alterations. Pediatrics 2012; 129:28-37. [PMID: 22129537 PMCID: PMC3255471 DOI: 10.1542/peds.2011-2083] [Citation(s) in RCA: 257] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES The pathophysiology of sports-related concussion (SRC) is incompletely understood. Human adult and experimental animal investigations have revealed structural axonal injuries, decreases in the neuronal metabolite N-acetyl aspartate, and reduced cerebral blood flow (CBF) after SRC and minor traumatic brain injury. The authors of this investigation explore these possibilities after pediatric SRC. PATIENTS AND METHODS Twelve children, ages 11 to 15 years, who experienced SRC were evaluated by ImPACT neurocognitive testing, T1 and susceptibility weighted MRI, diffusion tensor imaging, proton magnetic resonance spectroscopy, and phase contrast angiography at <72 hours, 14 days, and 30 days or greater after concussion. A similar number of age- and gender-matched controls were evaluated at a single time point. RESULTS ImPACT results confirmed statistically significant differences in initial total symptom score and reaction time between the SRC and control groups, resolving by 14 days for total symptom score and 30 days for reaction time. No evidence of structural injury was found on qualitative review of MRI. No decreases in neuronal metabolite N-acetyl aspartate or elevation of lactic acid were detected by proton magnetic resonance spectroscopy. Statistically significant alterations in CBF were documented in the SRC group, with reduction in CBF predominating (38 vs 48 mL/100 g per minute; P = .027). Improvement toward control values occurred in only 27% of the participants at 14 days and 64% at >30 days after SRC. CONCLUSIONS Pediatric SRC is primarily a physiologic injury, affecting CBF significantly without evidence of measurable structural, metabolic neuronal or axonal injury. Further study of CBF mechanisms is needed to explain patterns of recovery.
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Affiliation(s)
- Todd A. Maugans
- Division of Neurosurgery, Department of Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Chad Farley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mekibib Altaye
- Division of Epidemiology and Biostatistics,Department of Pediatrics
| | - James Leach
- Department of Pediatrics,,Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kim M. Cecil
- Department of Pediatrics,,Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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113
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Daneshvar DH, Riley DO, Nowinski CJ, McKee AC, Stern RA, Cantu RC. Long-term consequences: effects on normal development profile after concussion. Phys Med Rehabil Clin N Am 2011; 22:683-700, ix. [PMID: 22050943 DOI: 10.1016/j.pmr.2011.08.009] [Citation(s) in RCA: 178] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Each year in the United States, approximately 1.7 million people are diagnosed with a traumatic brain injury (TBI), about 75% of which are classified as mild TBIs or concussions. Although symptoms typically resolve in a matter of weeks, both children and adults may suffer from postconcussion syndrome for months or longer. A progressive tauopathy, chronic traumatic encephalopathy, is believed to stem from repeated brain trauma. Alzheimer-like dementia, Parkinsonism, and motor neuron disease are also associated with repetitive brain trauma. Effective diagnoses, treatments, and education plans are required to reduce the future burden and incidence of long-term effects of head injuries.
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Affiliation(s)
- Daniel H Daneshvar
- Department of Neurology, Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston 02118, MA, USA.
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Babikian T, Satz P, Zaucha K, Light R, Lewis RS, Asarnow RF. The UCLA longitudinal study of neurocognitive outcomes following mild pediatric traumatic brain injury. J Int Neuropsychol Soc 2011; 17:886-95. [PMID: 21813031 PMCID: PMC4579245 DOI: 10.1017/s1355617711000907] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Comprehensive reviews of neurocognitive outcomes following mild, uncomplicated traumatic brain injury (TBI) in children have shown minimal effects on neurocognition, especially in methodologically rigorous studies. In this study, we report longitudinal (1, 6, and 12 months post injury) results in four domains of neurocognitive functioning in a large sample of children with mild TBI (n = 124, ages 8-17 at injury) relative to two demographically matched control groups (other injury: n = 94 and non-injury: n = 106). After accounting for age and parental education, significant main effects of group were observed on 7 of the 10 neurocognitive tests. However, these differences were not unique to the TBI sample but were found between both the TBI and other injury groups relative to the non-injured group, suggesting a general injury effect. Effects were primarily within the domains measuring memory, psychomotor processing speed, and language. This is the largest longitudinal study to date of neurocognitive outcomes at discrete time points in pediatric mild TBI. When controlling for pre-injury factors, there is no evidence of long-term neurocognitive impairment in this group relative to another injury control group. The importance of longitudinal analyses and use of appropriate control groups are discussed in the context of evaluating the effects of mild TBI on cognition.
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Affiliation(s)
- Talin Babikian
- Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA 90024, USA.
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115
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Yeates KO, Taylor HG, Rusin J, Bangert B, Dietrich A, Nuss K, Wright M. Premorbid child and family functioning as predictors of post-concussive symptoms in children with mild traumatic brain injuries. Int J Dev Neurosci 2011; 30:231-7. [PMID: 21651973 DOI: 10.1016/j.ijdevneu.2011.05.008] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 05/05/2011] [Accepted: 05/20/2011] [Indexed: 11/16/2022] Open
Abstract
STUDY AIM This study sought to determine whether premorbid child and family functioning accounts for or moderates group differences in post-concussive symptoms following mild traumatic brain injury (TBI) in childhood. METHODS This prospective, longitudinal cohort study recruited 8- to 15-year-old children, 186 with mild TBI and 99 with orthopedic injuries (OI), from consecutive emergency department admissions. Parents and children rated post-concussive symptoms within 3 weeks of injury and at 1, 3, and 12 months post injury. Parents also provided retrospective ratings of pre-injury symptoms, as well as of premorbid child behavioral adjustment, overall family functioning, and other stressors and resources in the family environment. RESULTS Children with mild TBI reported more post-concussive symptoms than those with OI, as did their parents, although premorbid child behavioral adjustment and symptoms also were significant predictors of post-concussive symptoms. Group differences in somatic symptoms as reported by parents were more pronounced among children from families that were higher functioning and had more environmental resources. DISCUSSION Mild TBI during childhood results in more post-concussive symptoms than OI, even after children's premorbid adjustment is taken into account. Counter to expectations, post-concussive symptoms following mild TBI may actually be more apparent among children from higher-functioning families with greater resources.
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Affiliation(s)
- Keith Owen Yeates
- Department of Pediatrics, The Ohio State University, Columbus, OH 43205, USA.
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