Early cognitive impairment is common in pediatric patients following mild traumatic brain injury. Issue 5 (November 2021)

• Record Type: Journal Article
• Authors: Keys, Megan Elizabeth; Delaplain, Patrick; Kirby, Katharine A.; Boudreau, Kate Irene; Rosenbaum, Kathryn; Inaba, Kenji; Lekawa, Michael; Nahmias, Jeffry
• Is Part Of: Journal of trauma and acute care surgery. Volume 91:Issue 5(2021)
• Publication Date: 2021-11
• Subjects: Traumatic brain injury -- cognitive impairment -- intracranial hemorrhage; Surgical intensive care -- Periodicals; Surgical emergencies -- Periodicals; Wounds and injuries -- Surgery -- Periodicals; 617.026
• DOI: 10.1097/TA.0000000000003266
• Languages: English
• ISSNs: 2163-0755

Abstract

Abstract : INTRODUCTION: The incidence and factors related to early cognitive impairment (ECI) after mild traumatic brain injury (mTBI) in pediatric trauma patients (PTPs) are unknown. Prior data in the adult population demonstrated an ECI incidence of 51% after mTBI and strong correlation with initial Glasgow Coma Scale (GCS) and Brain Injury Guidelines (BIG) category. Therefore, we hypothesized that ECI is common after mTBI in PTPs and associated with initial GCS and BIG category. METHODS: A single-center, retrospective review of PTPs (age, 8–17 years) from 2015 to 2019 with intracranial hemorrhage and mTBI (GCS score, 13–15) was performed. Primary outcome was ECI, defined as Ranchos Los Amigos score less than 8. Comparisons between ECI and non-ECI groups regarding Injury Severity Score (ISS), demographics, and cognitive and clinical outcomes were evaluated using χ 2 statistics and Wilcoxon rank sum tests. Odds of ECI were evaluated using multivariable logistic regression. RESULTS: From 47 PTPs with mTBI, 18 (38.3%) had ECI. Early cognitive impairment patients had a higher ISS than non-ECI patients (19.7 vs. 12.6, p = 0.003). Injuries involving motor vehicles were more often related to ECI than non-auto-involved mechanisms (55% vs. 15%, p = 0.005). Lower GCS score (odds ratio [OR], 6.60; 95% confidence interval [CI], 1.34–32.51, p = 0.02), higher ISS (OR, 1.12; 95% CI, 1.01–1.24; p = 0.030), and auto-involved injuries (OR, 6.06; 95% CI, 1.15–31.94; p = 0.030) were all associated with increased risk of ECI. There was no association between BIG category and risk of ECI ( p > 0.05). CONCLUSION: Nearly 40% of PTPs with mTBI suffer from ECI. Lower initial GCS score, higher ISS, and autoinvolved mechanism of injury were associated with increased risk of ECI. Brain Injury Guidelines category was not associated with ECI in pediatric patients. LEVEL OF EVIDENCE: Prognostic study, Level III.