image: Sixty percent of patients in the TBI cohort were free from new neuropsychiatric diagnosis at 5 ear follow-up whereas 80 percent of patients in the orthopedic cohort were free from new diagnosis at 5 years. view more
Credit: Lindsey Armstrong
ORLANDO, Fla. - Traumatic brain injury is a leading cause of morbidity and mortality in children, and rates of injury have increased over the past decade. According to a study being presented at the 2018 American Academy of Pediatrics National Conference & Exhibition, these injuries have long-term consequences; researchers found children who experience traumatic brain injury are at higher risk of developing headache, depression, and mental or intellectual disorders up to five years after the event.
For the study abstract, "Long-term Outcomes Following Traumatic Brain Injury (TBI) in Children," researchers obtained diagnostic codes from medical records in the Military Health System Data Repository to analyze clinical data on children. They compared patients diagnosed with traumatic brain injury to those who suffered orthopedic injury, matching patients by age, gender and injury severity score.
In the study population, 55 percent had mild injury severity score, 41 percent had moderate injury severity score, and 4 percent had severe injury severity score. Among children who sustained traumatic brain injury, 39 percent of children developed neuropsychiatric symptoms as follows:
- Headaches - 15 percent
- Mental disorder - 15 percent
- Intellectual disability - 13 percent
- Depression/anxiety - 5 percent
- Seizure - 4 percent
- Brain damage - 4 percent
Researchers found that 16 percent of children who experienced orthopedic injury also developed neuropsychiatric symptoms including:
- Intellectual disability - 8 percent
- Mental disorder - 4 percent
- Depression/anxiety - 3 percent
- Headaches - 2 percent
- Seizure - less than 1 percent
- Brain damage - less than 1 percent
"With the incidence of concussion and traumatic brain injury rising in this nation's children, it is vital that we continue to evaluate mechanisms for prevention and treatment," said Lindsey Armstrong, MD MPH, surgical critical care and research fellow, Boston Children's Hospital, Boston, Mass. "These data provide evidence to support close monitoring of injured children, even years after the event"
Researchers examined how injuries affected children up to five years later. They found that only 59 percent of children with traumatic brain injury could expect to be symptom-free in 5 years, versus 80 percent of those with orthopedic injuries.
"While primary prevention is most important, early recognition and education are essential to ensure the best possible outcome for these children," Armstrong said. "Neuropsychiatric diagnosis following traumatic brain injury can cause impairment in cognitive function thus affected children may experience difficulty in school or with personal relationships. It's our hope that data we are presenting will help clinicians identify children at increased risk, resulting in improved follow-up and care."
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Dr. Armstrong will present the study abstract, included below, at 9:45 a.m. ET, Sunday, Nov. 4, in the Windemere Ballroom at the Orange County Convention Center in Orlando, Fla.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media or may be preparing a longer article for submission to a journal.
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org.
Abstract Title: Long-term outcomes following traumatic brain injury (TBI) in children
Lindsey Armstrong
Boston, MA, United States
Introduction: TBI is a leading cause of death and disability in children. Concern for increased risk of post- traumatic neuropsychiatric impairment exists, but long-term data are lacking. Methods: This analysis was conducted using the Military Health System Data Repository, a national cohort containing >3 million child dependents of active and retired members of the U.S. Armed Forces. Using diagnostic codes, all children who sustained TBI were identified and matched on age, sex, and Injury Severity Score (ISS) to children who sustained non-TBI orthopedic injuries. Primary outcome was incident diagnosis of neuropsychiatric disease, defined as: mental or intellectual disorder, headache, seizure, depression/anxiety, or brain damage. The Kaplan-Meier estimator (log-rank test) compared outcomes between cohorts. Results: In the matched cohorts of children who sustained TBI (n=1260) or orthopedic trauma (n=1260), 55%, 41%, and 4% had mild, moderate, and severe ISS, respectively. 33% were female and 48% were <5 years old. Median (interquartile range) follow-up was 42.2 (25.9-62.1) months in the TBI cohort and 43.5 (26.0-64.1) months in the orthopedic cohort (p=0.19). In the TBI group, 492 (39%) children developed ≥1 neuropsychiatric diagnoses, including headache (n=187, 15%), depression/anxiety (n=67, 5%), mental disorder (n=194, 15%), intellectual disability (n=160, 13%), seizure (n=51, 4%), brain damage (n=44, 4%), and other (n=99, 8%). In the orthopedic injury group, 197 (16%) children developed ≥1 neuropsychiatric diagnoses, including headache (n=26, 2%), depression/anxiety (n=35, 3%), mental disorder (n=54, 4%), intellectual disability (n=102, 8%), seizure (n=5, <1%), brain damage (n=3, <1%), and other (n=46, 4%). As displayed in Figure, 5-year estimates of freedom from new neuropsychiatric diagnosis were 59.6% (95% CI=56.3-63.1%) in the TBI and 80.3% (95% CI=80.3-85.6%) in the orthopedic cohort (p<0.01). Conclusion: Children who suffer TBI are at significantly increased risk of developing new post-traumatic neuropsychiatric disorders, and may benefit from ongoing outpatient follow-up to facilitate early detection and intervention.