Long‐Term Outcomes of Traumatic Brain Injury in Early Childhood

Comparison of concordance and predictive validity of head injuries from parental reports and medical records

OBJECTIVE

To examine agreement between parental reports of head injury and evidence of head injury in medical records and to compare these two measures in predicting early conduct disorder (CD).

DESIGN AND SETTING

Parent survey data was compared with records of child head injury from the National Health Services Register (Régie de l'assurance maladie du Québec, RAMQ) administrative database.

PARTICIPANTS

Children (N = 685) ages 6-9 with and without CD. There were 147 children with RAMQ recorded head injury and 39 children with parent-reported head injury.

MAIN MEASURES

Indication of one or more head injury before 6 years of age as reported by parents and/or as noted in medical data. Early CD (present by age 9) according to parents and/or teachers.

RESULTS

Results indicated poor agreement between the two forms of reporting κ = .161 (95% CI, .083 to .239), p < 0.001. Medical data significantly predicted the presence of CD in children, with a RAMQ coded head injury suggesting a child was 1.88 times more likely to have CD. Parent reports of head injuries did not significantly predict CD. Conclusion: Medical data should be prioritized in research addressing pediatric head injury, given that parent reports may fail to capture incidence of injury and therefore may be less predictive of other known correlates of head injury.

Comparing post-concussion symptom reporting between adults with and without a TBI history within an adult male correctional facility

BACKGROUND

A higher proportion of people in prison have a history of traumatic brain injury (TBI) than the general population. However, little is known about potentially related persistent symptoms in this population.

AIMS

To compare symptom reporting in men with and without a history of TBI following admission to a correctional facility.

METHODS

All men transferred to the South Auckland Correctional Facility in New Zealand complete a lifetime TBI history and the Rivermead Post-Concussion Symptom Questionnaire (RPQ) as part of their routine health screen. Data collected between June 2020 and March 2021 were extracted and anonymised. Participants were classified as reporting at least one TBI in their lifetime or no TBI history. The underlying factor structure of the RPQ was determined using principal components analysis. Symptom scores between those with and without a TBI history were compared using Mann Whitney U tests.

RESULTS

Of the N = 363 adult male participants, 240 (66%) reported experiencing at least one TBI in their lifetime. The RPQ was found to have a two-factor structure (Factor 1: cognitive, emotional, behavioural; Factor 2: visual-ocular) explaining 61% of the variance. Men reporting a TBI history had significantly higher cognitive, emotional and behavioural (U = 50.4, p < 0.001) and visuo-ocular symptoms (U = 68.5, p < 0.001) in comparison to men reporting no TBI history.

CONCLUSION

A history of TBI was associated with higher symptom burden on admission to a correctional facility. Screening for TBI history and current symptoms on admission may assist prisoners experiencing persistent effects of TBI to access rehabilitation.

Age of First Concussion and Cognitive, Psychological, and Physical Outcomes in NCAA Collegiate Student Athletes

OBJECTIVE

Concussions are common among youth athletes and could disrupt critical neurodevelopment. This study examined the association between age of first concussion (AFC) and neurocognitive performance, psychological distress, postural stability, and symptoms commonly associated with concussion in healthy collegiate men and women student athletes.

METHODS

Participants included 4267 collegiate athletes from various contact, limited-contact, and non-contact sports (1818 women and 2449 men) who completed baseline assessments as part of the Concussion Assessment, Research and Education (CARE) Consortium. Psychological distress was assessed with the Brief Symptom Inventory 18; neurocognitive performance was assessed with the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT); symptoms commonly associated with concussion were assessed with the ImPACT Post-Concussion Symptom Scale; postural stability was assessed with the Balance Error Scoring System. Generalized linear models were used to examine the effects of AFC on clinical outcomes separately in men and women.

RESULTS

Later AFC was associated with lower global (Exp(B) = 0.96, P = 0.001) and somatic (Exp(B) = 0.96, P = 0.002) psychological distress on the Brief Symptom Inventory 18 and faster ImPACT reaction time (B =  - 0.003, P = 0.001) in women. AFC was not associated with any clinical outcomes in men.

CONCLUSION

Younger AFC was associated with some differences in psychological distress and reaction time among women but not men; however, these results are likely not clinically meaningful. Sociodemographic disparities, pre-existing conditions, and sport type may impact clinical and cognitive outcomes in collegiate athletes more than concussion history. Future work should examine the relationship between AFC and lifespan-related outcomes.

Juvenile confinement exacerbates adversity burden: A neurobiological impetus for decarceration

Every year, about 700,000 youth arrests occur in the United States, creating significant neurodevelopmental strain; this is especially concerning as most of these youth have early life adversity exposures that may alter brain development. Males, Black, and Latinx youth, and individuals from low socioeconomic status households have disproportionate contact with the juvenile justice system (JJS). Youth confined in the JJS are frequently exposed to threat and abuse, in addition to separation from family and other social supports. Youths’ educational and exploratory behaviors and activities are substantially restricted, and youth are confined to sterile environments that often lack sufficient enrichment resources. In addition to their demonstrated ineffectiveness in preventing future delinquent behaviors, high recidivism rates, and costs, juvenile conditions of confinement likely exacerbate youths’ adversity burden and neurodevelopmentally harm youth during the temporally sensitive window of adolescence. Developmentally appropriate methods that capitalize on adolescents’ unique rehabilitative potential should be instated through interventions that minimize confinement. Such changes would require joint advocacy from the pediatric and behavioral health care communities. “The distinct nature of children, their initial dependent, and developmental state, their unique human potential as well as their vulnerability, all demand the need for more, rather than less, legal and other protection from all forms of violence (United Nations Committee on the Rights of the Child, 2007).”

An International Exploration of the Effect of Media Portrayals of Postconcussion Management on Concussion Identification in the General Public

BACKGROUND

Concussion portrayal in media broadcasts of sporting events may contribute to lack of public understanding regarding concussion.

METHODS

In total, 828 participants from Australia, New Zealand, and the United Kingdom completed a questionnaire assessing concussion knowledge. Participants were randomly assigned to either receive sports return-to-play (RTP) guideline information (RTP group) or not (no-RTP group). Participants viewed 12 short clips from televised rugby games and indicated whether they believed the player in each clip had sustained a concussion. Participants were then informed whether the player was removed, returned, or stayed in the game and again asked whether they thought a concussion had occurred.

RESULTS

Probability of reporting a likely concussion over all videos was 65.6%. When told a player's possible concussion was managed by removal from the game, participants were more likely to change their response from "no" (no concussion) to "yes" (concussion) than from "yes" to "no." When told the player stayed or returned to the game, participants were more likely to change their response from "yes" (concussion) to "no" (no concussion) than from "no" to "yes." There was no significant main effect for RTP guideline manipulation or interaction effect with RTP information.

CONCLUSION

Additional player's injury management information influenced participants' judgments of concussion occurrence. Results show that information provided via sports media broadcasts influenced viewers' perceptions of concussion and appropriate concussion management.

Long-Term Intellectual Function After Traumatic Brain Injury in Very Young Children

OBJECTIVE

To investigate long-term intellectual function following a traumatic brain injury (TBI) in early childhood and to identify the contribution of injury and environment to outcome.

PARTICIPANTS

Fifty children younger than 3 years with a diagnosis of accidental TBI were recruited through a pediatric hospital emergency department. Children with TBI were compared with a group (n = 33) of typically developing children (TDC) matched on demographics.

DESIGN

Longitudinal, single-site, case-control study.

MEASURES

Children completed intellectual assessments (IQ) at 4.5 to 5.5 years of age (average 3.5 years after TBI) and at 7.5 to 9 years of age (average 6.5 years after TBI). Information on injury and environmental predictors of outcome was collected.

RESULTS

IQ scores for all groups were in the average range; however, children with TBI of any severity had lower scores than TDC at both time points. There was some suggestion of children with TBI achieving lower verbal IQ scores over time than TDC. IQ scores were predicted by family environment, not injury characteristics.

CONCLUSIONS

A TBI in early childhood is associated with lower IQ scores that persist several years postinjury. Socioeconomic status is an influential factor on IQ at 6.5 years post-TBI.

Utility of the Brain Injury Screening Index in Identifying Female Prisoners With a Traumatic Brain Injury and Associated Cognitive Impairment

There is a high prevalence of traumatic brain injury (TBI) in prisoners, but screening tools for identifying TBI in female prisoners are not readily available. Using a cross-sectional design, the psychometric properties of the Brain Injury Screening Index (BISI) were investigated in a closed United Kingdom female prison. Purposive sampling comprised 56 females. Assessment included clinical interview, the BISI, self-report measures of mood, and a battery of measures of cognitive functioning. Seven of the 10 clinical indicators on the BISI met test-retest reliability criteria. Two of the three BISI summary variables demonstrated correlations with questionnaires in the hypothesized directions; however, only two BISI variables were associated with cognitive functioning. Findings support further investigation into the validity and reliability of the BISI with a larger sample.

Anxiety Disorders in Adults With Childhood Traumatic Brain Injury: Evidence of Difficulties More Than 10 Years Postinjury

OBJECTIVE

To explore long-term psychiatric outcomes in individuals with a history of childhood traumatic brain injury (TBI) or orthopedic injury (OI).

SETTING

Hospital emergency department, medical admission records and outpatient settings.

PARTICIPANTS

There were 95 males (M = 22.78 years, SD = 3.44 years) and 74 females (M = 22.27 years, SD = 3.09 years), 65 with mild TBI (M = 23.25 years, SD = 3.58 years), 61 with moderate-severe TBI (M = 22.34 years, SD = 2.79 years), and 43 with OI (M = 21.81 years, SD = 3.36 years).

DESIGN

Longitudinal, between-subjects, cross-sectional design using retrospective and current data.

MAIN MEASURES

Semistructured interview to obtain psychiatric diagnoses and background information, and medical records for identification of TBI.

RESULTS

Group with moderate-severe TBI presented with significantly higher rates of any anxiety disorder (χ2 = 6.81, P = .03) and comorbid anxiety disorder (χ2 = 6.12, P < .05). Group with overall TBI presented with significantly higher rates of any anxiety disorder (χ1 = 5.36, P = .02), panic attacks (χ1 = 4.43, P = .04), specific phobias (χ1 = 4.17, P = .04), and depression (χ1 = 3.98, P < .05). Prediction analysis revealed a statistically significant model (χ7 = 41.84, P < .001) explaining 23% to 37% of the variance in having any anxiety disorder, with significant predictors being group (TBI) and gender (female).

CONCLUSIONS

Children who have sustained a TBI may be vulnerable to persistent anxiety, panic attacks, specific phobias, and depression, even 13 years after the injury event.

Acute post-concussive symptoms in young children

OBJECTIVES

Despite peaks of mild traumatic brain injury (mTBI) incidence in young children, few studies have examined the nature of post-concussive symptoms (PCSs) in children under the age of eight, whilst controlling for pre-injury symptoms and effects of trauma. The current study aimed to identify which PCSs differentiate children with mTBI from trauma controls early post-injury, and whether these differed among preschool and school-aged children.

METHODS

The sample comprised 101 children aged 2-12 presenting to an emergency department, with concussion or other minor bodily injury (control). Groups were divided by age (preschool and school-aged). PCSs were assessed within 72 hours post-injury using a comprehensive PCS checklist, administered to their parents via structured interview.

RESULTS

Parents of children with mTBI reported significantly more symptoms in their children than parents of children with other minor bodily trauma, p < 0.001, r = 0.84. Parents of preschool and school-aged children reported an equal number of symptoms. However, subtle differences were observed between symptom profiles of preschool and school-aged children.

CONCLUSIONS

Primary care clinicians should be aware of post-concussive symptom presentations in children of varying ages, in order to provide optimal care, especially in younger children. Methods of eliciting symptoms may influence the identification of symptoms. This issue warrants further examination in the paediatric population. ABBREVIATIONS ED emergency department; GCS Glasgow coma scale; mTBI mild traumatic brain injury; PCS post-concussive symptoms; PTA post-traumatic amnesia; TC trauma control.