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Original Articles

Day of injury CT and late MRI findings: Cognitive outcome in a paediatric sample with complicated mild traumatic brain injury

Erin D. BiglerDepartment of Psychology, Neuroscience Center and Magnetic Resonance Imaging (MRI) Research Facility, Brigham Young University, UT, USA, ;Department of Psychiatry, University of Utah, Salt Lake City, UT, USA, Correspondence[email protected]

Paul B. JantzSchool Psychology Program, Texas State University, San Marcos, TX, USA,

Thomas J. FarrerDepartment of Psychology, Neuroscience Center and Magnetic Resonance Imaging (MRI) Research Facility, Brigham Young University, UT, USA, ;Department of Psychiatry, University of Utah, Salt Lake City, UT, USA,

Tracy J. AbildskovDepartment of Psychology, Neuroscience Center and Magnetic Resonance Imaging (MRI) Research Facility, Brigham Young University, UT, USA, ;Department of Psychiatry, University of Utah, Salt Lake City, UT, USA,

Maureen DennisDepartment of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada,

Cynthia A. GerhardtDepartment of Pediatrics, The Ohio State University, Columbus, OH, USA, ;The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA,

Kenneth H. RubinDepartment of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA,

Terry StancinDivision of Pediatric Psychology, Department of Pediatrics, Metro Health Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA,

H. Gerry TaylorDivision of Developmental/Behavioral Pediatrics and Psychology, University Hospitals/Rainbow Babies & Children's Hospital, Cleveland, OH, USA, and

Kathryn VannattaDepartment of Pediatrics, The Ohio State University, Columbus, OH, USA,

Keith Owen YeatesDepartment of Pediatrics, The Ohio State University, Columbus, OH, USA, ;The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA, ;Department of Pediatrics, University of Calgary, Calgary, Canada

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Abstract

Objectives: Complicated mild traumatic brain injury (mTBI) or cmTBI is based on the presence of visibly identifiable brain pathology on the day-of-injury computed tomography (CT) scan. In a paediatric sample the relation of DOI CT to late MRI findings and neuropsychological outcome was examined.

Methods: MRI (>12 months) was obtained in paediatric cmTBI patients and a sample of orthopaedically injured (OI) children. Those children with positive imaging findings (MRI+) were quantitatively compared to those without (MRI−) or with the OI sample. Groups were also compared in neurocognitive outcome from WASI sub-tests and the WISC-IV Processing Speed Index (PSI), along with the Test of Everyday Attention for Children (TEA-Ch) and a parent-rated behavioural functioning measure (ABAS-II).

Results: Despite the MRI+ group having significantly more DOI CT findings than the MRI− group, no quantitative differences were found. WASI Vocabulary and Matrix Reasoning scores were significantly lower, but not PSI, TEA-Ch or ABAS-II scores. MRI+ and MRI− groups did not differ on these measures.

Conclusions: Heterogeneity in the occurrence of MRI-identified focal pathology was not associated with uniform changes in quantitative analyses of brain structure in cmTBI. Increased number of DOI CT abnormalities was associated with lowered neuropsychological performance.

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Acknowledgements

We thank radiologists Barbara Bangert, MD (Cleveland), Jerome Rusin, MD (Columbus), and Susan Blaser, MD (Toronto), who assisted with the clinical interpretation of scans.

Declaration of interest

Erin D. Bigler does provide expert neuropsychological testimony in paediatric brain injury cases. No other conflicts of interest are declared by the other authors. The research presented in this manuscript was supported by NIH/NICHD Grant Numbers 5R01HD048946 and 3R01HD048946-05S1 titled ‘Social Outcomes of Pediatric Traumatic Brain Injury’. Funding was also provided in part by the Poelman Foundation which supports the Brain Imaging and Behavior Laboratory at Brigham Young University.

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Day of injury CT and late MRI findings: Cognitive outcome in a paediatric sample with complicated mild traumatic brain injury

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Day of injury CT and late MRI findings: Cognitive outcome in a paediatric sample with complicated mild traumatic brain injury

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