Abstract
Objective
To evaluate the ability of risk strata generated by a neuroimaging rule, developed
to assess risk of clinically important traumatic brain injury (ciTBI), to predict
postconcussive symptoms in youth with an acute mild traumatic brain injury.
Methods
We performed a prospective cohort study of youth aged 5 to 17 years presenting to
an emergency department (ED) within 24 hours of mild traumatic brain injury. Risk
strata (very low, intermediate, and at risk) of ciTBI were determined in ED by criteria
set forth by the neuroimaging rule. Postconcussive symptoms were assessed using the
Health and Behavior Inventory (HBI) in the ED and at 1, 2, and 4 weeks after injury.
General linear models were used to examine the relationship between the HBI score
at 1 week and risk strata. Repeated measures analysis was used to measure change in
HBI over time.
Results
Of the 120 participants, 46 were categorized by the Pediatric Emergency Care Applied
Research Network (PECARN) rule as very low risk, 39 as intermediate risk, and 35 as
at risk for ciTBI. Adjusted mean HBI scores (95% confidence intervals) at 1 week were
18.0 (13.9, 22.2) for at risk, 13.8 (9.9, 17.6) for intermediate risk, and 17.1 (13.4,
20.8) for very low risk. Risk strata were not significantly associated with the adjusted
HBI score at 1 week (P = .17). While adjusted HBI scores declined significantly over time (P < .0001), the trajectories of the HBI score over time did not differ significantly
by risk strata (P = .68).
Conclusions
Risk of ciTBI as determined by factors within a neuroimaging rule alone is insufficient
to predict children with persistent postconcussive symptoms.
Keywords
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Article Info
Publication History
Published online: October 30, 2015
Accepted:
October 24,
2015
Received:
May 6,
2015
Footnotes
The authors declare that they have no conflict of interest.
Identification
Copyright
© 2015 Academic Pediatric Association.
