First-Year Psychiatric Outcome of Pediatric Mild Traumatic Brain Injury: A Prospective Longitudinal Controlled Study.

Abstract

The objective of this study was to clarify the occurrence, phenomenology, and risk factors for novel psychiatric disorder (NPD) in the first 12 months after mild traumatic brain injury (mTBI) and orthopedic injury (OI). Children aged 8-15 years with mTBI (n = 220) and with OI but no TBI (n = 110) from consecutive admissions to Rady Children's Hospital Emergency Department were followed prospectively at baseline, 3-, 6-, and 12-month postinjury with semi-structured psychiatric interviews to document the presence of NPDs that developed in each participant. Preinjury child variables (academic, adaptive, and cognitive function, and psychiatric disorder), preinjury family variables (family function, family psychiatric history, and socioeconomic status), and injury severity were assessed and analyzed as potential confounders and predictors of NPD that occurred at any assessment in the 12 months after injury. This study extends our analyses of counts of NPD that were limited to the first 3 months of follow-up published in this journal. In multipredictor analyses adjusted for potential confounders, NPD risk increased over time in children with OI: 6-month versus 3-month adjusted odds ratio (aOR) = 17.766, CI₉₅ (1.712, 184.376), p = 0.020; 12-month versus 3-month aOR = 21.165, CI₉₅ (1.481, 302.473), p = 0.020, but not in the mTBI arm, corresponding to a significant group-by-time interaction: adjusted ratio of ORs for mTBI versus OI at 6-month versus 3-month aROR = 0.029, CI₉₅ (0.002, 0.411), p = 0.012, and at 12-month versus 3-month aROR = 0.024, CI₉₅ (0.001, 0.496), p = 0.012. Higher NPD risk was associated in unadjusted analyses with preinjury lifetime psychiatric disorder (OR = 8.995, CI₉₅ [1.935, 41.802], p = 0.003) and poorer preinjury family function (OR = 0.383, CI₉₅ [0.171, 0.861], p = 0.014), and in adjusted analyses with poorer preinjury family function, adjusted OR = 0.491, CI₉₅ [0.243, 0.989], p = 0.047, and with preinjury lifetime psychiatric disorder (OR = 5.081, CI₉₅ [0.997, 25.901], p = 0.050). These findings demonstrate that when considering the entire first postinjury year, mild injury to the brain and OI had similar effects on psychiatric outcome, but the onset of deleterious effects was earlier in the mTBI group. NPD in the first year after mTBI and OI is predicted primarily by preinjury family function.