Traumatic Brain Injury In Children Research Articles

Novel Oppositional Defiant Disorder 6 Months After Traumatic Brain Injury in Children and Adolescents.

The investigators aimed to assess predictive factors of novel oppositional defiant disorder (ODD) among children and adolescents in the first 6 months following traumatic brain injury (TBI). Children ages 5-14 years who experienced a TBI were recruited from consecutive admissions to five hospitals. Testing of a biopsychosocial model that may elucidate the development of novel ODD included assessment soon after injury (baseline) of preinjury characteristics, including psychiatric disorders, adaptive function, family function, psychosocial adversity, family psychiatric history, socioeconomic status, injury severity, and postinjury processing speed (which may be a proxy for brain injury). MRI analyses were also conducted to examine potential brain lesions. Psychiatric outcome, including that of novel ODD, was assessed 6 months after the injury. A total of 177 children and adolescents were recruited for the study, and 134 who were without preinjury ODD, conduct disorder, or disruptive behavior disorder not otherwise specified (DBD NOS) returned for the 6-month assessment. Of those who returned 6 months postinjury, 11 (8.2%) developed novel ODD, and none developed novel conduct disorder or DBD NOS. Novel ODD was significantly associated with socioeconomic status, preinjury family functioning, psychosocial adversity, and processing speed. These findings show that an important minority of children with TBI developed ODD. Psychosocial and injury-related variables, including socioeconomic status, lower family function, psychosocial adversity, and processing speed, significantly increase risk for this outcome.

Epidemiology of paediatric moderate and severe traumatic brain injury in the Netherlands.

Traumatic brain injury (TBI) is the main cause of death in children around the world. The last Dutch epidemiological study described the incidence over 10 years ago. Mechanism of injury seems to change with the age of the child, therefore it is important to appreciate different age groups. To be able to lower the impact of childhood TBI, an understanding of current incidence, mechanism of injury and outcome is necessary. A nationwide retrospective cohort study was conducted. The Dutch National Trauma Database was used to identify all patients 18 years and younger who were admitted to a Dutch hospital with moderate-severe TBI (Abbreviated Injury Score≥3) in the Netherlands, from January 2015 until December 2017. Subanalyses were done for different age groups. In total, 1413 patients were included, of whom 5% died. The incidence rate of moderate-severe TBI was 14/100,000 person years. Median age was 10.4 years. Largest age group was patients <5 years, incidence rate was highest in patients ≥16 years. Falls were more common than road traffic accidents (RTA), but RTAs occurred far more frequently amongst children over 10. RTAs predominantly consisted of bicycle accidents. Mortality rates increased from youngest to oldest age groups, as did the chances of a Glasgow Outcome Scale score of 3. Paediatric moderate-severe TBI represents a significant problem in the Netherlands. Falls are the most common mechanism of injury amongst younger children and RTAs amongst older children. Unique for the Netherlands is the vast amount of bicycle accident related injuries.

Injury patterns of concussion/mild traumatic brain injury in children presenting to a major Australian paediatic trauma centre

Background: Children commonly present to emergency departments for concussion/mild traumatic brain injury(mTBI), yet little is known of this pattern of paediatric injury. The aim of the study was to estimate the incidence, demographics and injury pattern of concussion/mTBI in children coming to a major Australian paediatic trauma centre for emergency care. Methods: This is a single centre retrospective study of children 0-16 years old, with a diagnosis of concussion/mTBI presenting for emergency care over a 6-year period (Jan 2014-Jan 2020). The patient electronic Medical Records (eMR) were accessed using the diagnostic codes S0.09+; these codes being for head and neck injury. Data was retrieved on 37,000 emergency department visits, with only those visits fulfilling criteria for concussion/mTBI being eligible for comprehensive review of the eMR. Simple descriptive statistics were used. Results: Of the 37,000 paediatric visits in the 6-year sample, there were 10,530 concussion/mTBI giving an approximate rate of 1,755 visits annually for concussion/mTBI; 39% being sports-related. The mean age of patients was 12.9 years, with males accounting for 69% of patients and 39% sports-related injuries. Of this total cohort, 28% were discharged without specific instructions to follow-up with an out-patient provider for further management. Three main injury patterns were revealed upon further review. In 70.8% of cases, the injury was a single isolated injury, with rapid symptom recovery and a mean hospital stay of 6.6 hours, and in 1% a parent or caregiver insisted upon imaging. The remaining 29.2% of cases were complex injuries. Of these, approximately one-third of patients were predominantly male and clinically important, having either altered mental state, significant amnesia, symptom spiking and/or a seizure. Almost all cases were imaged and hospitalised with a mean stay of 28.8 hour and needed specialist follow-up. The remaining two-thirds of patients with complex injury had a complicated recovery course marked by high symptom burden with possible co-morbidity; 18.9% were imaged. Almost all cases were hospitalised with a mean stay of 26.5 hours and given specialist follow-up. Discussion: In our institution, approximately 1,800 paediatric patients present with a concussion/mTBI each year for emergency care. Simple injuries are rapidly assessed with little burden placed on the system, while complex injuries place a significant burden on the health system with most needing specialty follow-up care. This construct is being used to form the framework of a common concussion/mTBI pathway for use in paediatric emergency care and enable planning for essential health services. Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.

Prognostic Models of Mortality from Accidental Severe Traumatic Brain Injury in Children and Adolescents: A Systematic Review

Introduction: Prognostic models are statistical models that combine two or more items of patient data to predict clinical outcomes. Objective: Identify prognostic models of mortality developed and published in the medical literature for possible applicability in children and adolescents victims of severe traumatic brain injury (TBI). Methods: Systematic review in the Medline electronic database (PubMed platform) of scientific articles published from 2006 (year of publication of the last systematic review on prognostic models for TBI before 2017) until July 29, 2017. Results: Ten studies on prognostic models of mortality in children and adolescents victims of severe TBI were identified for final inclusion in the review. There were eight development and two validation studies conducted in different countries. Conclusion: The analysis of this systematic review makes it possible to conclude that the ten prognostic models included in the final sample provide health professionals with a scientific evidence-based understanding of the severity of pediatric victims of severe TBI. This systematic review is classified as presenting 2A and 1 level of evidence (systematic review of homogeneous cohorts), according to the 2009 and 2011 classifications, respectively, of the Oxford Center for Evidence-Based Medicine

Language performance within three months of early childhood traumatic brain injury.

To examine language outcomes in the short-term stage (i.e., within three months) of early childhood traumatic brain injury (TBI). A retrospective chart review over a 10-year period (January 1, 2007 to December 31, 2016) was completed at a single-site inpatient rehabilitation hospital. Inclusion criteria were children aged 15 months to five years 11 months with a diagnosis of closed TBI. Twenty-four charts were included in the descriptive analysis of language; there were fewer children with expressive language scores (n = 18) than receptive language scores (n = 24), likely due to word retrieval difficulties as per clinical documentation. Effects of TBI on language performance were more pronounced in receptive than expressive language. For children with scores in both receptive and expressive language areas (n = 18), five children had below average scores. These children were described as having language delays pre-injury (n = 2), lower exposure to English (n = 1), information processing difficulties (n = 1), and difficulties with formulation and organization of language (n = 1). This study represents an initial step in understanding expressive and receptive language performance shortly after early childhood TBI. Challenges with assessment as well as directions for future research are discussed.

Clinical profile and outcome of traumatic brain injury in children: record-based descriptive study

Background: Paediatric head injury is considered to be a major public health problem and is often associated with significant morbidity and mortality in severe cases. The present study aimed to explore the demographics, mechanism of injury and clinical aspects of injury in children in a peripheral hospital attached to tertiary care centre.Methods: Electronic medical records of all paediatric patients aged ≤12 years with traumatic brain injury admitted during one-year period from January to December 2018 were reviewed. Epidemiological and clinical data of paediatric patients with traumatic brain injury (TBI) were analysed using SPSS version 20.Results: The medical records of 203 paediatric patients with TBI were analysed. The majority of the injury occurred in patients belonging to age-group 1-6 years. The number of male children outnumbered (58.1%) that of female children (41.9%). Fall from height was the most common mode of injury, followed by fall from a staircase. As per the Glasgow coma scale, 4% patients had severe head injury. Vomiting and headache was the most common symptom at admission (50.2%), a subdural hematoma was the most common lesion seen on computed tomography scans; frontal bone was the most common site of skull bone injury. Cutaneous injuries associated with contused lacerated wounds were the most common external injuries, 92.1% completely recovered with conservative management.Conclusions: Increasing incidence of paediatric trauma suggests the need for supervision during play and identification of environmental risk factors for such injuries. Parental advice and supervision is recommended to prevent accidental falls.

Determining the Agreement Between Common Measures Of VOR Function After A Mild Traumatic Brain Injury in Children and Adolescents

<h3>Research Objectives</h3> Alterations to vestibulo-ocular reflex (VOR) function (1-3) and cervical spine injury (4-6) may contribute to dizziness reported following pediatric mild traumatic brain injury (mTBI). Moreover, dizziness has been correlated with a more negative prognosis. While various measures are used to assess VOR function, there is no consensus on what the optimal battery of tests may be. The influence of cervical injury on findings from these tests remains unclear. Objectives: i) to determine the level of agreement between symptom- and performance-based tests of VOR function in a pediatric mTBI sample; ii) to characterize the level of symptom provocation induced by VOR tests in individuals with and without cervical findings. <h3>Design</h3> Cross-sectional study. <h3>Setting</h3> Tertiary care pediatric hospital. <h3>Participants</h3> 101 participants (54.5% female), mean age 13.92 years (SD 2.63), completed a VOR assessment (mean time since injury 18.26 days (SD 6.16)). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Symptom provocation was measured by the Vestibular/ocular motor screening tool (VOMS). Performance was measured by VOMS VOR performance, the head thrust test (HTT), the computerized dynamic visual acuity test, and the video head impulse test. Cervical impairment was measured by the cervical flexion rotation test, range of motion test and self-reported neck pain. <h3>Results</h3> No outcomes demonstrated agreement with VOR symptom provocation (k=-0.15-0.14). Among performance-based measures, fair agreement was demonstrated between VOMS VOR performance and the clinical HTT (k=0.32), while little to no agreement was demonstrated between the remaining measures. VOR dizziness symptoms were reported in a greater proportion of individuals with cervical findings (41.1-41.8%) than without (2.3-6.8%). <h3>Conclusions</h3> The findings indicate i) that symptom-based VOR tests measure a different construct than performance-based tests, ii) the distinct role of each measure when assessing VOR function should be further understood, and iii) cervical injury may contribute to symptoms induced by tests of VOR function. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to disclose. This study was funded by an ERA-Net NEURON JTC Cofund Program.

Traumatic Brain Injury in Children and Adolescents: Psychiatric Disorders 24 Years Later.

The investigators aimed to extend findings regarding predictive factors of psychiatric outcomes among children and adolescents with traumatic brain injury (TBI) from 2 to 24 years postinjury. Youths aged 6-14 years who were hospitalized following TBI from 1992 to 1994 were assessed at baseline for TBI severity and for preinjury psychiatric, adaptive, and behavioral functioning; family functioning; family psychiatric history; socioeconomic status; and intelligence within weeks of injury. Predictors of psychiatric outcomes following pediatric TBI at 3, 6, 12, and 24 months postinjury have previously been reported. In this study, repeat psychiatric assessments were completed at 24 years postinjury with the same cohort, now adults aged 29-39 years, with the outcome measure being presence of a psychiatric disorder not present before the TBI ("novel psychiatric disorder"). Fifty participants with pediatric TBI were initially enrolled, and the long-term outcome analyses focused on data from 45 individuals. Novel psychiatric disorder was present in 24 out of 45 (53%) participants. Presence of a current novel psychiatric disorder was independently predicted by the presence of a preinjury lifetime psychiatric disorder and by severity of TBI. Long-term psychiatric outcome (mean=23.92 years [SD=2.17]) in children and adolescents hospitalized for TBI can be predicted at the point of the initial hospitalization encounter by the presence of a preinjury psychiatric disorder and by greater injury severity.

Adherence to Guidelines for Managing Severe Traumatic Brain Injury in Children.

Pediatric traumatic brain injury (TBI) protocols vary widely among institutions, despite the existence of published guidelines. This study seeks to identify significant differences in management of pediatric TBI across several institutions. Severe pediatric TBI protocols were collected from major US pediatric hospitals through direct communication with trauma staff. Of 24 institutions identified and contacted, 10 did not respond and 5 did not have a pediatric TBI protocol. Pediatric TBI protocols were successfully collected from 9 institutions. These 9 protocols were separated into treatment tiers analogous to those in the 2019 Society of Critical Care Medicine and World Federation of Pediatric Intensive and Critical Care Societies guidelines, and the intervention variables were identified and compared across the 9 institutions. First-line therapies were similar between institutions, including seizure prophylaxis, maintenance of normoglycemia and normothermia, and avoidance of hypoxia, hyponatremia, and hypotension. However, significant variation across institutions was found regarding timing of cerebrospinal fluid drainage, hyperventilation, and neuromuscular blockade. When included in institutional protocols, most therapies are in line with the 2019 guidelines, except for diversion of cerebrospinal fluid, hyperventilation, maintenance of cerebral perfusion pressure, and use of neuromuscular blocking agents. Although these variations may represent differences in style or preference, the optimal timing of these specific treatment variations should be studied to determine the impact of each protocol on clinical outcomes.

Traumatic Brain Injury in Children: Glial fibrillary Acidic Protein and Clinical Outcomes.

Glial fibrillary acidic protein (GFAP) is a neuronal protein released after traumatic brain injury (TBI) and detectable in serum samples. GFAP correlates with symptom severity in adults and may be a marker of brain injury in children with milder symptoms or preverbal children. GFAP was examined in children with severe TBI (initial Glasgow Coma Scale score <8), with mild TBI (Glasgow Coma Scale score 14/15), and at 0 to 4 and at 10 to 14 days after TBI and was compared with healthy age-matched controls. Mechanism, time points from injury, and symptoms were recorded. The study enrolled 208 children including 110 with TBI (n = 104 mild, 6 severe) and controls (n = 98). GFAP was higher in mild TBI than in controls and highest in the severe TBI cohort, with a maximum value at 6 hours from injury. Vomiting was significantly associated with higher GFAP levels, but no association was found with amnesia, loss of consciousness, and the Sports Concussion Assessment Tool. Children reporting >1-point changes from their preinjury functioning on the Post-Concussive Symptom Inventory had higher initial GFAP but not total Post-Concussive Symptom Inventory score changes. GFAP identifies children with TBI, even at the milder end of the spectrum, and is strongly associated with postinjury vomiting. It may be a useful marker of pediatric TBI; however, sampling is time critical.

Abusive Head Trauma

Abusive head trauma(AHT) is a leading cause of severe traumatic brain injury in children under 2 years old. Patients with AHT present with various clinical features, including acute subdural hematoma, retinal hemorrhage, and extensive hemispheric hypodensity, which has recently been reproduced in a basic experimental model. Despite multidisciplinary treatment, the outcome is poor, and neurological sequelae often remain. However, functional recovery seems possible with aggressive rehabilitation. The medical rationale for the diagnosis of AHT has a significant impact on the judicial decision-making process to determine evidence of child abuse, enabling collaboration with the police, prosecutors, and other investigative agencies, including lawyers. In Japan, infantile acute subdural hematoma(hematoma type I)is a clinical form of hematoma that often occurs after 6-10 months, when the child is able to walk. It is accompanied by backward fall, sudden loss of consciousness, pallor, spastic paralysis of the extremities, and retinal hemorrhage. A nationwide survey of infant acute subdural hematoma due to minor injury is currently being planned, and it is hoped that this would be comprehensive in Japan. Medical personnel involved in neurosurgical emergencies have an important responsibility as a safety network for pediatric care and are expected to play a central role in the diagnosis of AHT through collaboration with many specialized departments.

Association of Lifetime History of Traumatic Brain Injury With Prescription Opioid Use and Misuse Among Adults

To investigate associations of lifetime history of traumatic brain injury (TBI) with prescription opioid use and misuse among noninstitutionalized adults. Ohio Behavioral Risk Factor Surveillance System (BRFSS) participants in the 2018 cohort who completed the prescription opioid and lifetime history of TBI modules (n = 3448). Secondary analyses of a statewide population-based cross-sectional survey. Self-report of a lifetime history of TBI using an adaptation of the Ohio State University TBI-Identification Method. Self-report of past year: (1) prescription pain medication use (ie, prescription opioid use); and (2) prescription opioid misuse, defined as using opioids more frequently or in higher doses than prescribed and/or using a prescription opioid not prescribed to the respondent. In total, 22.8% of adults in the sample screened positive for a lifetime history of TBI. A quarter (25.5%) reported past year prescription opioid use, and 3.1% met criteria for prescription opioid misuse. A lifetime history of TBI was associated with increased odds of both past year prescription opioid use (adjusted odds ratio [AOR] = 1.52; 95% CI, 1.27-1.83; P < .01) and prescription opioid misuse (AOR = 1.65; 95% CI, 1.08-2.52; P < .05), controlling for sex, age, race/ethnicity, and marital status. Results from this study support the "perfect storm" hypothesis-that persons with a history of TBI are at an increased risk for exposure to prescription opioids and advancing to prescription opioid misuse compared with those without a history of TBI. Routine screening for a lifetime history of TBI may help target efforts to prevent opioid misuse among adults.

A-5 Brain-Derived Neurotrophic Factor Val66Met and Neuropsychological Functioning Following Early Childhood Traumatic Brain Injury

Abstract Objective The present study examined the differential effect of the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism on neuropsychological functioning in children with traumatic brain injury (TBI) relative to children with orthopedic injury (OI). Method Participants were drawn from a prospective, longitudinal study of children who sustained a TBI (n = 69) or OI (n = 72) between 3 and 7 years of age. Children completed a battery of neuropsychological measures targeting attention, memory, and executive functions at four time points spanning the immediate post-acute period to 18 months post-injury. Children also completed a comparable age-appropriate battery of measures approximately 7 years post-injury. Parents rated children’s executive functioning at all time points. Results Longitudinal mixed models revealed a significant allele status x injury group interaction for verbal fluency (p = 0.007) and a non-significant trend for parent-rated dysexecutive behaviors (p = 0.069), and cross-sectional models at 7 years post-injury revealed a non-significant trend for the allele status x injury group interaction for fluid reasoning skills (p = 0.074). Post hoc analyses suggested a consistent pattern of poorer neuropsychological functioning in Met carriers relative to Val/Val homozygotes in the TBI group; in contrast, the opposite trend was observed in the OI group. Conclusions The results suggest a differential effect of the BDNF Val66Met polymorphism on verbal fluency, dysexecutive behaviors, and fluid reasoning skills in children with early TBI relative to OI, and that the Met allele—associated with reduced activity-dependent secretion of BDNF—confers risk for poorer neuropsychological functioning in children with TBI.

Management of Severe Traumatic Brain Injury in Children by Decompressive Craniectomy: Technical Note and Therapy Concepts

The goal of this study was to evaluate the therapeutic role of decompressive craniectomy for severe brain injury in children. Between 1993 and 2020 we treated 37 children with severe brain injury (Glasgow Coma Scores lower than 8) and primary intracranial pressure of 30 mmHg or higher. In all cases follow up data could be obtained. Mean age was 6.5 years (range 2 years - 16 years). Initial computerized tomography scans of all patients demonstrated diffuse brain injury with generalized brain swelling without large mass lesion. In all patients unilateral decompressive craniectomy was performed.

Traumatic brain injury in children in Moscow

Traumatic brain injury (TBI) is the main cause of unnatural death and disability in the child population, ranking first among all injuries requiring hospitalization. The lack of full and detailed medical and social statistics on the prevalence of TBI and its consequences impedes their reasonable assessment and reduces the possibility of prevention. The aim is to study and assess the current epidemiological situation of TBI in children in Moscow. Materials and methods. Comparative study of main trends in the incidence and mortality of TBI in children in Moscow in 2003–2018 with the average Russian indicators based on state statistical data. Results and conclusions. Megacities are a high risk area for TBI in children, therefore policies require additional prevention strategies. Limitations in the existing forms for state statistics impede an objective assessment and establishment of true levels of morbidity and mortality in children from TBI, as well as identification of its causes. Increased hospitalization rate of children with TBI in Moscow at high morbidity levels contributes to low mortality and lethality rates in children from this type of injury.

Low‐value injury admissions in an integrated Canadian trauma system: A multicentre cohort study

Injury represents 260000 hospitalisations and $27 billion in healthcare costs each year in Canada. Evidence suggests that there is significant variation in the prevalence of hospital admissions among emergency department presentations between countries and providers, but we lack data specific to injury admissions. We aimed to estimate the prevalence of potentially low-value injury admissions following injury in a Canadian provincial trauma system, identify diagnostic groups contributing most to low-value admissions and assess inter-hospital variation. We conducted a retrospective multicentre cohort study based on all injury admissions in the Québec trauma system (2013-2018). Using literature and expert consultation, we developed criteria to identify potentially low-value injury admissions. We used a multilevel logistic regression model to evaluate inter-hospital variation in the prevalence of low-value injury admissions with intraclass correlation coefficients (ICC). We stratified our analyses by age (1-15; 16-64; 65-74; 75+ years). The prevalence of low-value injury admissions was 16% (n=19163) among all patients, 26% (2136) in children, 11% (4695) in young adults and 19% (12345) in older adults. Diagnostic groups contributing most to low-value admissions were mild traumatic brain injury in children (48% of low-value paediatric injury admissions; n=922), superficial injuries (14%, n=660) or minor spinal injuries (14%, n=634) in adults aged 16-64 and superficial injuries in adults aged 65+ (22%, n=2771). We observed strong inter-hospital variation in the prevalence of low-value injury admissions (ICC=37%). One out of six hospital admissions following injury may be of low value. Children with mild traumatic brain injury and adults with superficial injuries could be good targets for future research efforts seeking to reduce healthcare services overuse. Inter-hospital variation indicates there may be an opportunity to reduce low-value injury admissions with appropriate interventions targeting modifications in care processes.

Traumatic brain injury in children with thoracic injury: clinical significance and impact on ventilatory management.

PurposeThis study aims to describe the epidemiology and management of chest trauma in our center, and to compare patterns of mechanical ventilation in patients with or without associated moderate-to-severe traumatic brain injury (TBI).MethodsAll children admitted to our level-1 trauma center from February 2012 to December 2018 following chest trauma were included in this retrospective study.ResultsA total of 75 patients with a median age of 11 [6–13] years, with thoracic injuries were included. Most patients also had extra-thoracic injuries (n = 71, 95%) and 59 (79%) had TBI. A total of 52 patients (69%) were admitted to intensive care and 31 (41%) were mechanically ventilated. In patients requiring mechanical ventilation, there was no difference in tidal volume or positive end-expiratory pressure in patients with moderate-to-severe TBI when compared with those with no-or-mild TBI. Only one patient developed Acute Respiratory Distress Syndrome. A total of 6 patients (8%) died and all had moderate-to-severe TBI.ConclusionIn this small retrospective series, most patients requiring mechanical ventilation following chest trauma had associated moderate-to-severe TBI. Mechanical ventilation to manage TBI does not seem to be associated with more acute respiratory distress syndrome occurrence.

Social Cognition in Paediatric Traumatic Brain Injury: A Systematic Review and Meta-analysis.

Recent evidence suggests social cognitive deficits may be among the most profound and disabling consequences of childhood traumatic brain injury (TBI); however, it is only over the last decade that this area has received increasing research attention. This study aims to systematically review all studies reporting on the effects of childhood TBI on social cognition. Meta-analytic techniques were employed to determine the magnitude of social cognitive deficits in childhood TBI. Literature searches were conducted in electronic databases (Medline/PubMed, Scopus, Cochrane, EMBASE, PsycINFO and CINAHL) to retrieve relevant articles on social cognitive outcomes of paediatric TBI published from 2007-2019. The systematic review identified fourteen eligible studies, which examined the effect of paediatric TBI on five dimensions of social cognition, including emotion recognition or perception, theory of Mind (ToM), pragmatic language, moral reasoning, and social problem solving. Of these studies, eleven articles were included in subsequent meta-analyses, which included 482 children with TBI. Meta-analysis using a random-effects model revealed non-significant differences between TBI and typically developing (TD) control groups on measures of emotion perception or recognition. In contrast, children and adolescents with TBI performed significantly worse than control groups on ToM and pragmatic language tasks, with small and medium effect sizes, respectively (Hedge's g = -0.46; -0.73). Meta-regression indicated that post-injury social cognitive deficits were not moderated by child age. While the effect of time since injury was not statistically significant, poorer social cognitive outcomes are documented soon after injury. Despite relatively intact basic social cognitive skills (i.e. emotion perception or recognition) children and adolescents with TBI are vulnerable to deficits in higher-order aspects of social cognition, including ToM and pragmatic language. These findings underscore the importance of further research, using well-validated, standardised outcome instruments, in larger paediatric TBI samples. Furthermore, longitudinal prospective studies are needed to evaluate the respective contribution of injury and non-injury factors to individual variation in outcome and recovery of social cognition after paediatric TBI.

Memory functioning 7 years after severe childhood traumatic brain injury: Results of the Traumatisme Grave de l'Enfant study.

To explore memory functioning 7 years after severe paediatric traumatic brain injury (TBI), associated factors, and relationships with other outcomes. Children aged 0-15 years (n = 65), consecutively admitted over a 3-year period in a single trauma centre, who survived after severe non-inflicted TBI, were included in a prospective longitudinal study. Memory assessments were performed 7 years post-injury using the Children's Memory Scale or the Wechsler Memory Scale (WMS IV), according to age. The General Memory Score (GMS-7) was the primary outcome. Thirty-seven patients were available for assessment at 7 years post-injury. Mean GMS-7 was in the low average range (M = 84.9, SD = 12.1). Lower GMS-7 was significantly associated with markers of higher injury severity, such as length of coma. One year post-injury functional and disability outcomes explained 74% of the variance of GMS-7. Concurrent intellectual ability and type of ongoing education correlated strongly with GMS-7. Age at injury and parental education were not associated with memory outcome. Memory functioning is variable but often strongly impaired several years after severe paediatric TBI, and is mostly related to injury severity, functional outcomes measured 1 year post-injury, and concomitant cognitive and educational outcomes. GMS-7 was lower at 7 years than one year post-injury, supporting the importance of long term follow-up.

Brain-Derived Neurotrophic Factor Val66Met and Behavioral Adjustment after Early Childhood Traumatic Brain Injury.

The present study examined the differential effect of the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism on behavioral adjustment in children with traumatic brain injury (TBI) relative to children with orthopedic injury (OI). Participants were drawn from a prospective, longitudinal study of children who sustained a TBI (n = 69) or OI (n = 72) between 3 and 7 years of age. Parents completed the Child Behavior Checklist (CBCL) at the immediate post-acute period, 6, 12, and 18 months after injury, and an average of 3.5 and 7 years after injury. Longitudinal mixed models examined the BDNF Val66Met allele status (Met carriers vs. Val/Val homozygotes) × injury group (TBI vs. OI) interaction in association with behavioral adjustment. After adjusting for continental ancestry, socioeconomic status, time post-injury, and pre-injury functioning, the allele status × injury group interaction was statistically significant for Internalizing, Externalizing, and Total Behavior problems. Post hoc within-group analysis suggested a consistent trend of poorer behavioral adjustment in Met carriers relative to Val/Val homozygotes in the TBI group; in contrast, the opposite trend was observed in the OI group. These within-group differences, however, did not reach statistical significance. The results support a differential effect of the BDNF Val66Met polymorphism on behavioral adjustment in children with early TBI relative to OI, and suggest that the Met allele associated with reduced activity-dependent secretion of BDNF may impart risk for poorer long-term behavioral adjustment in children with TBI.