title: Identifying neurocognitive deficits in adolescents following concussion.
abstract: OBJECTIVE
  This study of concussed adolescents sought to determine if a computer-based neurocognitive assessment (Immediate Postconcussion Assessment and Cognitive Test [ImPACT]) performed on patients who present to the emergency department (ED) immediately following head injury would correlate with assessments performed 3 to 10 days postinjury and if ED neurocognitive testing would detect differences in concussion severity that clinical grading scales could not.
  
  
  METHODS
  A prospective cohort sample of patients 11 to 17 years of age presenting to the ED within 12 hours of a head injury were evaluated using two traditional concussion grading scales and neurocognitive testing. ED neurocognitive scores were compared to follow-up scores obtained at least 3 days postinjury. Postconcussive symptoms, outcomes, and complications were assessed via telephone follow-up for all subjects.
  
  
  RESULTS
  Sixty patients completed phone follow-up. Thirty-six patients (60%) completed follow-up testing a median of 6 days postinjury. Traditional concussion grading did not correlate with neurocognitive deficits detected in the ED or at follow-up. For the neurocognitive domains of verbal memory, processing speed, and reaction time, there was a significant correlation between ED and follow-up scores trending toward clinical improvement. By 2 weeks postinjury, 23 patients (41%) had not returned to normal activity. At 6 weeks, six patients (10%) still had not returned to normal activity.
  
  
  CONCLUSIONS
  Immediate assessment in the ED can predict neurocognitive deficits seen in follow-up and may be potentially useful to individualize management or test therapeutic interventions. Neurocognitive assessment in the ED detected deficits that clinical grading could not and correlated with deficits at follow-up.
authors.affiliation: Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. dthomas@mcw.edu
authors.forename: Danny G
authors.initials: DG
authors.lastname: Thomas
authors.forename: Michael W
authors.initials: MW
authors.lastname: Collins
authors.forename: Richard A
authors.initials: RA
authors.lastname: Saladino
authors.forename: Virginia
authors.initials: V
authors.lastname: Frank
authors.forename: Jenny
authors.initials: J
authors.lastname: Raab
authors.forename: Noel S
authors.initials: NS
authors.lastname: Zuckerbraun
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D001924:Brain Concussion / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D002648:Child; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012720:Severity of Illness Index