In children and adolescents, mild traumatic brain injuries (TBI), including concussions, are common. However, according to a new study, children with mild TBI may display more post-concussive symptoms, such as headache, fatigue, cognitive complaints, and cognitive complaints including forgetfulness and inattention, than healthy children or children who experience an orthopedic injury. Injury severity may play a role.

The study is published in Archives of Pediatrics & Adolescent Medicine.

Keith O. Yeates, Ph.D., director of Behavioral Health Services at Nationwide Children’s Hospital and one of the study authors, explains:

“Group differences in post-concussive symptoms are most pronounced shortly after injury. Comparing group averages is informative, but does not indicate whether individual children show significant increases in post-concussive symptoms following mild TBI more commonly than after other injuries.

Health providers need to be able to identify children with mild TBI who are at risk for persistent post-concussive symptoms so that they can target such children for appropriate management.”

A common method to evaluate individual alterations in neurobehavioral functioning are estimates of reliable change. Evaluations of reliable change conclude if a person shows a statistically reliable change in neurobehavioral test score or symptom ratings over two incidents.

Dr. Yeates, and his team used data from a prospective, longitudinal study in order to analyze reliable change in post-concussive symptoms among children with mild TBI, as well as those with orthopedic injuries. The study is the first to evaluated reliable change in this patient population.

The study enrolled children aged between 8 and 15 years with either mild TBI or orthopedic injury who either came to the emergency department at Nationwide Children’s Hospital or Rainbow Babies and Children’s Hospital in Cleveland.

The researchers asked parents to rate their children’s pre-injury symptoms in order to determine reliable change. The team then compared these ratings to parent symptom ratings after the injury, during a 3-month and 12-month evaluation.

The researchers found that compared to children with orthopedic injury, those with mild TBI were more likely to display reliable increases in both cognitive and somatic symptoms. These differences persisted to 12 months after the injury occurred for cognitive symptoms, although they became less common over time for somatic symptoms. Furthermore, the they found that among children who experience mild TBI with loss of consciousness or abnormalities on neuroimaging, symptom increases were more prevalent.

Dr. Yeates, said:

“These results extend previous findings by showing that many individual children with mild TBI show substantial and persistent increases in post-concussive symptoms relative to their pre-injury functioning.”

In addition, the researchers found that reliable increases in somatic and cognitive symptoms were linked to physical and psychosocial quality of life declining, and that reliable increases in somatic symptoms at 3 months after the injury occurred predicted a greater chance of educational intervention.

According to Dr. Yeates:

“These results indicate that persistent post-concussive symptoms have functional consequences that are likely to reflect impairment in children’s daily functioning.”

Dr. Yeates cautions that results from the study represents children with clear evidence of a mild TBI and do not encompass the entire population of children who go to emergency departments for minor closed-head trauma.

Dr. Yeates, explained:

“Research is needed to clarify which injury and non-injury related factors increase the likelihood of reliable increases in post-concussive symptoms. The current research suggests that injury severity is one key factor. Advanced neuroimaing techniques may more clearly differentiate injury severity and its relationship to outcomes.”

Written by Grace Rattue