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PEDIATRICS Vol. 108 No. 6 December 2001, pp. 1297-1303

Impact of Early Intervention on Outcome After Mild Traumatic Brain Injury in Children

Jennie Ponsford, PhD^*,, Catherine Willmott, MSc^*,, Andrew Rothwell, MSc, Peter Cameron, FACEM^||, Gary Ayton, FACEM^¶, Robyn Nelms, Grad Dip App Psych, Carolyn Curran, MPsych, Kim Ng, PhD^*

^* Monash University, Melbourne, Australia
Bethesda Rehabilitation Unit, Epworth Hospital, Melbourne, Australia
Julia Farr Services, Adelaide, Australia
^|| Royal Melbourne Hospital, Melbourne, Australia
^¶ Western Hospital, Melbourne, Australia

Objectives. The impact of mild head injury or mild traumatic brain injury (TBI) in children is variable, and determinants of outcome remain poorly understood. There have been no previous attempts to evaluate the impact of interventions to improve outcome. Results of previous intervention studies in adults have been mixed. This study aimed to evaluate the impact of providing information on outcome measured in terms of reported symptoms, cognitive performance, and psychological adjustment in children 3 months after injury.

Methods. A total of 61 children with mild TBI were assessed 1 week and 3 months after injury, and 58 children with mild TBI were assessed 3 months after injury only. They were compared with 2 control groups (N = 45 and 47) of children with minor injuries not involving the head. Participants completed measures of preinjury behavior and psychological adjustment, postconcussion symptoms, and tests of attention, speed of information processing, and memory. Children with mild TBI seen at 1 week were also given an information booklet outlining symptoms associated with mild TBI and suggested coping strategies. Those seen 3 months after injury only did not receive this booklet.

Results. Children with mild TBI reported more symptoms than controls at 1 week but demonstrated no impairment on neuropsychological measures. Initial symptoms had resolved for most children by 3 months after injury, but a small group of children who had previous head injury or a history of learning or behavioral difficulties reported ongoing problems. The group not seen at 1 week and not given the information booklet reported more symptoms overall and was more stressed 3 months after injury.

Conclusions. Providing an information booklet reduces anxiety and thereby lowers the incidence of ongoing problems.

Key Words: mild head injury • mild traumatic brain injury • intervention • outcome

Abbreviations: TBI, traumatic brain injury • PTA, posttraumatic amnesia • GCS, Glasgow Coma Scale • CBCL, Child Behavior Checklist • BRI, Behavioural Rating Inventory • PCSC, Post Concussion Syndrome Checklist • WRAML, Wide Range Assessment of Memory and Learning • CHIPASAT, Children’s Paced Auditory Serial Addition Task • CNT, Contingency Naming Task

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Received for publication Aug 3, 2000; Accepted Jun 25, 2001.

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