title: Perception of recovery after pediatric mild traumatic brain injury is influenced by the "good old days" bias: tangible implications for clinical practice and outcomes research.
abstract: Recovery from mild traumatic brain injury (mTBI) is primarily based on the resolution of post-concussive symptoms back to a premorbid level. However, the "good old days" bias means fewer premorbid symptoms are retrospectively recalled, thus skewing the determination of recovery relative to pre-injury. The objectives of this study were to investigate the "good old days" bias in pediatric mTBI and demonstrate the implications of this bias on perceived recovery. Children and adolescents 2-18 years old (mean = 10.9, SD = 4.4, N = 412) were recruited after sustaining an mTBI. Ratings of premorbid symptoms were provided: (a) in the Emergency Department (ED; by parents), (b) retrospectively at a 1-month follow-up (by parents and adolescents), and (c) retrospectively at a 3-month follow-up (by parents and adolescents). Parent ratings of premorbid symptoms decreased by 80% from the ED to 1-month post-injury (p < .001) but were stable from 1 to 3 months post-injury (p < .05). Adolescents premorbid ratings declined from 1 to 3 months post-injury. Slow recovery did not have a differential impact on premorbid reporting. Using premorbid ratings obtained in the ED, instead of retrospective symptom reporting at the time of follow-up, suggests that a significant minority of patients believed to be "not recovered" actually have the "same or lower" symptom ratings at 1 (29%) and 3 months (41%) post-injury compared with before the injury. The "good old days" bias is present in pediatric mTBI by 1-month post-injury, influences retrospective symptom reporting, and has measureable implications for determining recovery in research and clinical practice.
authors.affiliation: Neurosciences (Brain Injury and Rehabilitation), Alberta Children's Hospital, Calgary, Alberta, Canada.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Brooks
authors.forename: Basil
authors.initials: B
authors.lastname: Kadoura
authors.forename: Brenda
authors.initials: B
authors.lastname: Turley
authors.forename: Susan
authors.initials: S
authors.lastname: Crawford
authors.forename: Angelo
authors.initials: A
authors.lastname: Mikrogianakis
authors.forename: Karen M
authors.initials: KM
authors.lastname: Barlow
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D015982:Bias; D001930:Brain Injuries / Q000503:physiopathology* / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D011939:Mental Recall / Q000502:physiology*; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care; D010290:Parents / Q000523:psychology; D010372:Pediatrics; D010465:Perception / Q000502:physiology*; D020127:Recovery of Function / Q000502:physiology*; D057566:Self Report; D013997:Time Factors
keywords: Bias; Children; Concussion; Post-concussion syndrome; Recovery; Symptom