The UCLA study of Predictors of Cognitive Functioning Following Moderate/Severe Pediatric Traumatic Brain Injury

Abstract Objectives: Following pediatric moderate-to-severe traumatic brain injury (msTBI), few predictors have been identified that can reliably identify which individuals are at risk for long-term cognitive difficulties. This study sought to determine the relative contribution of detailed descriptors of injury severity as well as demographic and psychosocial factors to long-term cognitive outcomes after pediatric msTBI. Methods: Participants included 8- to 19-year-olds, 46 with msTBI and 53 uninjured healthy controls (HC). Assessments were conducted in the post-acute and chronic stages of recovery. Medical record review provided details regarding acute injury severity. Parents also completed a measure of premorbid functioning and behavioral problems. The outcome of interest was four neurocognitive measures sensitive to msTBI combined to create an index of cognitive performance. Results: Results indicated that none of the detailed descriptors of acute injury severity predicted cognitive performance. Only the occurrence of injury, parental education, and premorbid academic competence predicted post-acute cognitive functioning. Long-term cognitive outcomes were best predicted by post-acute cognitive functioning. Discussion: The findings suggest that premorbid factors influence cognitive outcomes nearly as much as the occurrence of a msTBI. Furthermore, of youth with msTBI who initially recover to a level of moderate disability or better, a brief cognitive battery administered within several months after injury can best predict which individuals will experience poor long-term cognitive outcomes and require additional services. (JINS, 2016, 22, 1–8)

[1]  D. Drotar,et al.  Predicting Longitudinal Patterns of Functional Deficits in Children with Traumatic Brain Injury Many Studies Have Found Evidence of Deterioration in Behavioral Adjust- Ment across Time and Persistent Postinjury Behavior Problems In , 2022 .

[2]  D. Drotar,et al.  A prospective study of short- and long-term neuropsychological outcomes after traumatic brain injury in children. , 2002, Neuropsychology.

[3]  D. Francis,et al.  Longitudinal neuropsychological outcome in infants and preschoolers with traumatic brain injury , 1997, Journal of the International Neuropsychological Society.

[4]  H. Taylor,et al.  The family environment as a moderator of psychosocial outcomes following traumatic brain injury in young children. , 2010, Neuropsychology.

[5]  Rebeccah L. Brown Epidemiology of injury and the impact of health disparities , 2010, Current opinion in pediatrics.

[6]  J. Rosenfeld,et al.  Predictors of Cognitive Function and Recovery 10 Years After Traumatic Brain Injury in Young Children , 2012, Pediatrics.

[7]  S. Chapman,et al.  Predictors of attention-deficit/hyperactivity disorder within 6 months after pediatric traumatic brain injury. , 2005, Journal of the American Academy of Child and Adolescent Psychiatry.

[8]  C. Schatschneider,et al.  Preinjury family environment as a determinant of recovery from traumatic brain injuries in school-age children , 1997, Journal of the International Neuropsychological Society.

[9]  Keith Owen Yeates,et al.  A prospective study of short- and long-term neuropsychological outcomes after traumatic brain injury in children. , 2002, Neuropsychology.

[10]  J. Langlois,et al.  The Incidence of Traumatic Brain Injury Among Children in the United States: Differences by Race , 2005, The Journal of head trauma rehabilitation.

[11]  S. Broman,et al.  Traumatic head injury in children , 1995 .

[12]  J. Rosenfeld,et al.  Identifying factors contributing to child and family outcome 30 months after traumatic brain injury in children , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

[13]  J. Donders,et al.  Predictors of Neuropsychological Test Performance After Pediatric Traumatic Brain Injury , 2004, Assessment.

[14]  J. Rosenfeld,et al.  Recovery of Intellectual Ability following Traumatic Brain Injury in Childhood: Impact of Injury Severity and Age at Injury , 2000, Pediatric Neurosurgery.

[15]  D. Drotar,et al.  Influences on first-year recovery from traumatic brain injury in children. , 1999, Neuropsychology.

[16]  M. McDaniel,et al.  The relationship between working memory capacity and executive functioning: evidence for a common executive attention construct. , 2010, Neuropsychology.

[17]  Talin Babikian,et al.  Neurocognitive outcomes and recovery after pediatric TBI: meta-analytic review of the literature. , 2009, Neuropsychology.

[18]  N. Polissar,et al.  Recovery trends over three years following pediatric traumatic brain injury. , 1995, Archives of physical medicine and rehabilitation.

[19]  R. Grace,et al.  An investigation of the pre-injury risk factors associated with children who experience traumatic brain injury , 2010, Injury Prevention.

[20]  E. Vakil,et al.  Comparison of the predictive power of socio-economic variables, severity of injury and age on long-term outcome of traumatic brain injury: sample-specific variables versus factors as predictors , 2002, Brain injury.

[21]  D. Robin,et al.  Cognitive outcome in children and adolescents following severe traumatic brain injury: Influence of psychosocial, psychiatric, and injury-related variables , 1999, Journal of the International Neuropsychological Society.

[22]  J. Langlois,et al.  Traumatic brain injury in the United States; emergency department visits, hospitalizations, and deaths , 2006 .

[23]  Tricia L. Merkley,et al.  Chronic Aspects of Pediatric Traumatic Brain Injury: Review of the Literature. , 2015, Journal of neurotrauma.

[24]  H. Xiang,et al.  Incidence of Pediatric Traumatic Brain Injury and Associated Hospital Resource Utilization in the United States , 2006, Pediatrics.

[25]  M. Wald,et al.  Traumatic brain injury in the United States; emergency department visits, hospitalizations, and deaths, 2002-2006 , 2010 .

[26]  J. Rosenfeld,et al.  Predictors of Acute Child and Family Outcome following Traumatic Brain Injury in Children , 2001, Pediatric Neurosurgery.

[27]  Linda Ewing-Cobbs,et al.  Modeling of Longitudinal Academic Achievement Scores After Pediatric Traumatic Brain Injury , 2004, Developmental neuropsychology.

[28]  V. Anderson,et al.  Predictors of very-long-term sociocognitive function after pediatric traumatic brain injury: evidence for the vulnerability of the immature "social brain". , 2014, Journal of neurotrauma.

[29]  J. Joseph,et al.  Pediatric traumatic brain injury: do racial/ethnic disparities exist in brain injury severity, mortality, or medical disposition? , 2005, Ethnicity & disease.