Published online March 2, 2009
PEDIATRICS Vol. 123 No. 3 March 2009, pp. 735-743 (doi:10.1542/peds.2008-1056)

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Yeates, K. O. Articles by Jones, B. L. Search for Related Content PubMed PubMed Citation Articles by Yeates, K. O. Articles by Jones, B. L. Related Collections Neurology & Psychiatry Social Bookmarking                         What's this?

ARTICLE

Longitudinal Trajectories of Postconcussive Symptoms in Children With Mild Traumatic Brain Injuries and Their Relationship to Acute Clinical Status

Keith Owen Yeates, PhD^a,b, H. Gerry Taylor, PhD^c,d, Jerome Rusin, MD^e, Barbara Bangert, MD^f, Ann Dietrich, MD^a,g, Kathryn Nuss, MD^a,g, Martha Wright, MD^c,d, Daniel S. Nagin, PhD^h, Bobby L. Jones, PhD^h

^a Department of Pediatrics, Ohio State University, Columbus, Ohio
^b Center for Biobehavioral Health, Research Institute at Nationwide Children's Hospital, Columbus, Ohio
^c Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
^d Rainbow Babies & Children's Hospital, Cleveland, Ohio; Departments of
^e Radiology
^g Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio
^f Departments of Radiology and Neurosurgery, University Hospitals Health System, Cleveland, Ohio
^h Heinz College, Carnegie Mellon University, Pittsburgh, Pennsylvania

OBJECTIVE. We examined whether mild traumatic brain injuries in children and adolescents, especially when associated with acute clinical features reflecting more severe injury, result in different postinjury trajectories of postconcussive symptoms compared with mild orthopedic injuries.

PARTICIPANTS AND METHODS. Participants in this prospective and longitudinal cohort study were 8- to 15-year-old children, 186 with mild traumatic brain injuries and 99 with mild orthopedic injuries, who were recruited from consecutive admissions to emergency departments in 2 large children's hospitals. Parents rated current postconcussive symptoms within 3 weeks of injury and at 1, 3, and 12 months after injury. At the initial assessment, parents also provided retrospective ratings of preinjury symptoms, and children with mild traumatic brain injuries received MRI of the brain. Clinical features examined as predictors of postconcussive symptoms included loss of consciousness, Glasgow Coma Scale score below 15, other injuries, acute symptoms of concussion, and intracranial abnormalities on the MRI.

RESULTS. Finite mixture modeling identified 4 longitudinal trajectories of postconcussive symptoms (ie, no postconcussive symptoms, moderate persistent postconcussive symptoms, high acute/resolved postconcussive symptoms, high acute/persistent postconcussive symptoms). The mild traumatic brain injuries and orthopedic injuries groups demonstrated a different distribution of trajectories. Children with mild traumatic brain injuries were more likely than those with orthopedic injuries to demonstrate high acute/resolved and high acute/persistent trajectories relative to the no postconcussive symptoms group. The 2 trajectories with high acute levels of postconcussive symptoms were especially likely among children with mild traumatic brain injuries whose acute clinical presentation reflected more severe injury.

CONCLUSIONS. Mild traumatic brain injuries, particularly those that are more severe, are more likely than orthopedic injuries to result in transient or persistent increases in postconcussive symptoms in the first year after injury. Additional research is needed to elucidate the range of factors, both injury related and non–injury related, that place some children with mild traumatic brain injuries at risk for postconcussive symptoms.

---

Key Words: mild traumatic brain injury • postconcussive symptoms • clinical predictors

Abbreviations: TBI—traumatic brain injury • PCS—postconcussive symptom • OI—orthopedic injury • LOC—loss of consciousness • GCS—Glasgow Coma Scale • AIS—Abbreviated Injury Scale • CI—confidence interval

---

Accepted Jun 16, 2008.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?