Long-term neurocognitive follow-up in children with traumatic brain injury: A literature review and monocentric cohort study

Abstract

Children with mild traumatic brain injury (mTBI) may experience long-term cognitive sequelae. However, previous study results have been controversial. It remains unclear whether clinical follow-up is useful, how long patients should be followed-up, and which psychological dimensions should be investigated. Herein, we described neurocognitive evolution in a small sample of Italian children who were hospitalized for mTBI and systematically reviewed the existing evidence in this setting. In total, 15 children aged 4 – 16 (median, 9) years who were evaluated for mTBI at our institution between March 2017 and September 2018 were retrospectively enrolled. All patients underwent computed tomography or magnetic resonance imaging for clinical reasons; moreover, they underwent neurocognitive evaluation within few days from the event (T0), after 3 – 6 months (T1), and after 18 – 24 months (T2). Neuropsychological assessment included the Child Behavior Checklist, Developmental Neuropsychology Assessment II Edition, and Wechsler Intelligence Scale for Children. An electronic search was conducted to identify studies published in the past 12 years. Neurocognitive assessments revealed low scores in memory, sensorimotor, and social perception tasks at T1 and T2. Univariate analysis of neuroradiological and clinical findings revealed no risk factors for cognitive deficits. Overall, 17 studies involving 1336 children were reviewed and analyzed. Following mTBI, psychiatric disorders were frequently newly diagnosed and were associated with significant deficits in adaptive functioning and other pre-injury psychosocial risk factors. Our study findings demonstrate that children with mTBI exhibit subtle persistent cognitive difficulties that may affect academic and social functioning. Thus, follow-up using extensive neuropsychological evaluation is essential.