What happens to kids who experience mild traumatic brain injuries?
Keith Yeates, a prominent pediatric neuropsychologist working at Ohio State University, recently published an article that examines the long term effects of traumatic brain injuries in children. The authors report that close to half a million children and adolescents experience a mild traumatic brain injury every year. Yet, there is little research on the long term stability of “postconcussive” symptoms (PCSs). Postconcussive syndrome consists of a conglomeration of subjective somatic, cognitive, and emotional problems experienced after a traumatic brain injury (TBI).
Postconcussive symptoms include:
- being tired
- memory difficulties
- light sensitivity
- feeling dizzy
- irritability (crankiness)
- attention problems
- depression or sad mood
- difficulty concentrating/thinking
- vision problems
- noise sensitivity
- difficulty sleeping
- anhedonia (lack of interest in pleasurable activities)
- change in personality
In the study, the authors followed 186 children and adolescents for 12 months after experiencing a TBI and compared them to 99 children and adolescents who experienced orthopedic (non-brain) injuries. In addition to examining how these two group differed in their experience of PCSs over time, the authors were also interested in examining the effects of acute clinical status after the injury and how such clinical status affects recovery from the injury. Acute clinical status refers to a number of factors observed immediately after the injury (within minutes). These include: loss of consciousness, injury to other body parts, posttraumatic amnesia, vomiting, nausea, headache, diplopia ( double vision), dizziness, and disorientation (not knowing where you are, what day/hour it is, or who you are).
The authors found 4 different type of developmental trajectories when comparing the initial symptoms (PCSs) to the outcome 12 months later:
Among the TBI group:
1) 64% of the TBI children experienced no postconcussive symptoms at any time.
2) 12% experienced moderate symptoms after 2 weeks that continued 12 months later.
3) 15% experienced sever symptoms after 2 weeks that resolved during the following 12 months.
4) 9% of the children experienced severe symptoms after 2 weeks that continued 12 months later.
In contrast, the profile of the orthopedic injury (OI) group looked like this:
1) 79% of these children experienced no postconcussive symptoms at any time.
2) 15% experienced moderate symptoms after 2 weeks that continued 12 months later.
3) 5% experienced sever symptoms after 2 weeks that resolved during the following 12 months.
4) 1% of the children experienced severe symptoms after 2 weeks that continued 12 months later.
When comparing the TBI to the OI group, the TBI group was more likely than the OI group to experience severe symptoms after two weeks that resolved within 12 months. The TBI group was also more likely to experience severe symptoms after two weeks that did not resolve. That is, the TBI children were more likely to experience severe symptoms in the days following the accident, and 37% of these children continued to experience postconcussive symptoms 12 month later.
In regards to the effects of immediate acute clinical status: amnesia and disorientation predicted having severe PCSs symptoms two weeks after the accident that subside within 12 months. In contrast, Loss of consciousness, injuries to other part of the body, nausea, dizziness, disorientation, predicted having severe PCSs symptoms two weeks later that continue for at least 12 months. Therefore, it appears that amnesia and disorientation alone (in the absence of other symptoms) immediately after a TBI, may be a sign of a more positive prognosis (no PCSs symptoms within one year).
These findings are very surprising because it is usually believed that the effects of mild traumatic brain injury in children subside within 3 months after the injury. The authors argued that such erroneous conclusion was based on research that had mostly excluded cases with more acute mild traumatic brain injuries.
Many previous studies of PCSs have excluded children with more severe injuries, and this has engendered potentially erroneous conclusions about the outcomes of mild TBI. Indeed, the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury reviewed the prognosis of mild TBIs and cited 2 studies to justify their conclusion that PCSs in children “are usually transient in nature”4 (p88) and “appear to be largely resolved within 2 to 3 months of the injury”4 (p85). However, both studies they cited excluded children with complicated mild TBI, as have some more recent studies.15 Studies that have included children with more severe injuries have tended to find more pronounced and persistent differences in PCSs compared with children with OI or healthy children.
Unfortunately, the current study shows that the prognosis for children with TBI is not as positive as it was once thought, specially when the TBI is accompanied by acute clinical symptoms. In fact, 21% of the children who experienced a TBI will continue to show somatic, cognitive, and emotional difficulties as long as 12 months after injury. Yet, on a positive note, the study does indicate that 64% of kids that suffered a mild TBI will not experience any postconcussive symptoms.
Yeates, K., Taylor, H., Rusin, J., Bangert, B., Dietrich, A., Nuss, K., Wright, M., Nagin, D., & Jones, B. (2009). Longitudinal Trajectories of Postconcussive Symptoms in Children With Mild Traumatic Brain Injuries and Their Relationship to Acute Clinical Status PEDIATRICS, 123 (3), 735-743 DOI: 10.1542/peds.2008-1056
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