Characteristics and time course of postconcussive symptoms in children and adolescents with moderate to severe extracranial trauma with and without mild traumatic brain injury.
Susan E Biffl, Walter L Biffl, Romeo C Ignacio, Matthew R Castelo, Anna Burch, Adam Gorra, Brandon Schoonover, Paul Cohen, Nancy Rivera, Todd Hightower, Terri-Ann Wattsman, Whitney Wilkes, Nicole Fox, Adam Goldsmith, Johanna Askegard
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引用次数: 0
Abstract
Background: Mild traumatic brain injury (mTBI), including concussion, is common and has received a great deal of attention, but terminology and diagnosis can be confusing. Postconcussive symptoms (PCS) are well-described in the setting of concussion and isolated mTBI, but the individual symptoms are nonspecific and may be present in patients with extracranial injuries without TBI. The time course of PCS has not been well-characterized in patients with extracranial trauma, either with or without concomitant mTBI. We hypothesized that patients with mTBI with moderate/severe extracranial trauma would experience a unique, more severe and longer-lasting pattern of PCS with more negative impact on quality of life (QOL) when compared with similar trauma patients without mTBI.
Methods: Prospective multicenter study (2018-2024) of patients aged 5 to 17 with extracranial Injury Severity Score >8, excluding moderate/severe TBI. Patients with and without mTBI (GCS 13-15, alteration of mental status or other signs/symptoms of TBI) were included. Patients were assessed at 1 week, 3 weeks, and 3 months with the Rivermead PCS Inventory and PedsQL QOL assessments.
Results: One hundred thirty-four patients were included: 53 (40%) had mTBI. Adolescent mTBI patients had significantly higher PCS Inventory scores than non-mTBI adolescents at T1 and T2. Symptoms persisted in >25% of both groups at T3. The QOL was impacted by the PCS burden.
Conclusions: Although attrition compromised the statistical power of the study, many patients with moderate/severe extracranial trauma have a significant PCS burden at 3 months postinjury. Those with mTBI have a greater symptom burden and unique symptomatology compared with those without mTBI. Attention to diagnosis and treatment of mTBI and support and anticipatory guidance for all pediatric moderate/severe trauma patients is warranted.
Level of evidence: Prognostic/Epidemiological; Level III.
期刊介绍：
The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.
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