Abstract
This study aims to (1) investigate the neuropathology of mild to severe pediatric TBI and (2) elucidate the predictive value of conventional and innovative neuroimaging for functional outcome. Children aged 8–14 years with trauma control (TC) injury (n = 27) were compared to children with mild TBI and risk factors for complicated TBI (mildRF+, n = 20) or moderate/severe TBI (n = 17) at 2.8 years post-injury. Neuroimaging measures included: acute computed tomography (CT), volumetric analysis on post-acute conventional T1-weighted magnetic resonance imaging (MRI) and post-acute diffusion tensor imaging (DTI, analyzed using tract-based spatial statistics and voxel-wise regression). Functional outcome was measured using Common Data Elements for neurocognitive and behavioral functioning. The results show that intracranial pathology on acute CT-scans was more prevalent after moderate/severe TBI (65%) than after mildRF+ TBI (35%; p = .035), while both groups had decreased white matter volume on conventional MRI (ps ≤ .029, ds ≥ −0.74). The moderate/severe TBI group further showed decreased fractional anisotropy (FA) in a widespread cluster affecting all white matter tracts, in which regional associations with neurocognitive functioning were observed (FSIQ, Digit Span and RAVLT Encoding) that consistently involved the corpus callosum. FA had superior predictive value for functional outcome (i.e. intelligence, attention and working memory, encoding in verbal memory and internalizing problems) relative to acute CT-scanning (i.e. internalizing problems) and conventional MRI (no predictive value). We conclude that children with mildRF+ TBI and moderate/severe TBI are at risk of persistent white matter abnormality. Furthermore, DTI has superior predictive value for neurocognitive out-come relative to conventional neuroimaging.
Highlights
Traumatic brain injury (TBI) is the leading cause of disability in children and young adults (World Health Organization 2006)
The results indicate that the Superior Longitudinal Fasciculus (SLF), Inferior Longitudinal Fasciculus (ILF) and inferior frontal occipital fasciculus (IFOF) are primarily involved in the white matter pathology of moderate/severe pediatric TBI, while the Genu of Corpus Callosum (GCC), BCC and Splenium of Corpus Callosum (SCC) most are the most extensively affected tracts
The results show that lower fractional anisotropy (FA) in parts of: (A) the GCC, BCC and Cingulate part of Cingulum Bundle (CCB) was associated with lower FSIQ (r = .45, p < .001); (B) the GCC, BCC, SCC, ILF, IFOF and SLF was associated with lower Digit Span scores (r = .53, p < .001); and (C) the GCC and BCC was associated with lower RAVLT Encoding scores (r = .35, p = .005); while no regional associations between FA and ratings of internalizing or externalizing problems were identified
Summary
Traumatic brain injury (TBI) is the leading cause of disability in children and young adults (World Health Organization 2006). Children with moderate to severe TBI are typically at risk of poor functional outcome in terms of neurocognitive impairment and behavior problems. Recent evidence indicates that even after mild TBI, children with risk factors for intracranial pathology (i.e. mildRF+; e.g. skull fracture, persistent vomiting, focal neurological impairment) are at risk of poor neurocognitive and behavioral outcome (Königs et al 2015a, b). Functional outcome of mild to severe TBI is characterized by a distinct interindividual heterogeneity that remains poorly understood (Polinder et al 2015), and complicates reliable prognosis of neurocognitive and behavioral outcome. The lowest score on the GCS on the day of admission, presence of the described risk factors for complicated mild TBI (Vos and Battistin 2002), and length of hospital stay were extracted from medical files, as was information on any executed surgical procedures. The radiological results as evaluated by a senior radiologist were extracted from the medical files.
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