Neurocognitive evaluation of mild traumatic brain injury in the hospitalized pediatric population.
OBJECTIVE
To test the feasibility of inpatient neurocognitive testing and measure the degree of disability in children hospitalized with mild traumatic brain injury (MTBI).


BACKGROUND
MTBI is common in the pediatric population. A standardized approach to identify neurocognitive impairment and determine optimal time to return to exertional activities (eg, school, sports) is lacking.


METHODS
For a 2-year period, children (age: 11-17 years) hospitalized at a level 1 urban Pediatric Trauma Center with MTBI were prospectively enrolled. Neurocognitive performance was assessed utilizing previously validated computer-based tests (Immediate Postconcussion Assessment and Cognitive Testing) as inpatient and in follow-up clinic after discharge. The feasibility of inpatient testing and the degree neurocognitive impairment and symptomatology were assessed. This study was approved by the IRB and registered with clinicaltrials.gov (NCT00715949).


RESULTS
For the 2 years of study, 116 subjects were prospectively enrolled and tested. The population had a mean age of 14 years and 69.8% were male. On initial in-hospital testing, the overall population demonstrated considerable neurocognitive deficits (mean values for all 4 subtests below 25th percentile, norm 50%) with at least one subtest score below 25% in 95.7% and an abnormal symptom score in 83.4% of patients. In comparing initial testing to follow-up testing (N = 63), significant improvements were noted for all subtests (verbal memory: 28.0% vs. 37.5%, respectively, norm 50%, P = 0.02; visual memory: 24.9% vs. 38.1%, respectively, norm 50%, P < 0.01; visual motor: 21.8% vs. 31.1%, respectively, norm 50%, P = 0.01; reaction time: 21.8% vs. 30.3%, respectively, norm 50%, P = 0.05), with a decline in the symptom score (26.9 vs. 9.2, respectively, norm 0-8, P < 0.01) as well. Patients not seen in follow-up (N = 53) did not differ demographically from those seen in clinic.


CONCLUSIONS
Inpatient neurocognitive testing was feasible in pediatric MTBI patients. Neurocognitive abnormalities were nearly universally present on initial evaluation with significant improvements demonstrated at the time of outpatient follow-up. Return to activity recommendations are thus best deferred for most hospitalized MTBI children until formal assessment can be performed after discharge.
Nance
Michael L
ML
Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. nance@email.chop.edu
Polk-Williams
Alison
A
Collins
Michael W
MW
Wiebe
Douglas J
DJ
D000293:Adolescent; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis*; D002648:Child; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D020127:Recovery of Function; D012720:Severity of Illness Index