Does a computerized neuropsychological test predict prolonged recovery in concussed children presenting to the ED?

ABSTRACT

Computerized neuropsychological tests (CNTs) are widely used internationally in concussion management. Their prognostic value for predicting recovery post-concussion is poorly understood, particularly in pediatric populations. The aim of the present study was to examine whether cognitive functioning (measured by CogSport) has prognostic value for predicting rapid versus slow recovery. This is a prospective longitudinal observational cohort study conducted at a state-wide tertiary pediatric hospital. Data were collected at 1–4, 14, and 90 days post-injury. Eligible children were aged ≥5 and <18 years presenting to the Emergency Department having sustained a concussion within 48 h. Concussion was defined according to the Zurich/Berlin Consensus Statement on Concussion in Sport. Dependent variables were reaction times and error rates on the CogSport Brief Battery. In total, 220 cases were analyzed; 98 in a rapid recovery group (asymptomatic at 14 days post-injury, mean age 11.5 [3.2], 73.5% male) and 122 in a slow recovery group (symptomatic at 14 days post-injury, mean age 12.0 [3.1], 69.7% male). Longitudinal GEE analyses modeled the trajectories of both mean log₁₀-transformed reaction time and error rates between groups over time (1–4, 14 and 90 days). Both group main and interaction (time by group) terms for all models were non-significant (p > .05). Cognitive functioning, measured by CogSport and assessed within 1–4 days of concussion, does not predict prolonged recovery in a pediatric sample. Further, there were no significant group differences at any time point. Considering the widespread use and promotion of CNTs, it is important that clinicians understand the significant limitations of the CogSport battery.

KEYWORDS:

• Concussion
• CNT
• CogSport
• concussion recovery
• pediatrics

Contributor’s statement page

Vicki Anderson, Franz Babl, Stephen Hearps, and Michael Takagi:

Mr. Hearps and Drs. Anderson, Takagi, and Babl conceptualized and designed the study, drafted the initial manuscript, and analyzed the data.

Nicholas Anderson, Silvia Bressan, Gavin Davis, Kevin Dunne, Cathriona Clarke, Melissa Doyle, Chloe Lanyon, Vanessa Rausa, Emma Thompson:

Drs. Bressan, Davis, Dunne and Lanyon, Mr. Anderson, and Ms. Clarke, Doyle, Rausa, and Thompson made substantial contributions to the conception of the study, the acquisition of data, and critically revising the manuscript for important intellectual content.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplementary material

Supplemental data for this article can be accessed at https://doi.org/10.1080/09297049.2019.1639653.

Additional information

Funding

This study was funded by the Royal Children’s Hospital Research Foundation and the Victorian Government Operational Infrastructure Scheme. Hearps was funded by an Australian National Health and Medical Research Council (NHMRC) Development grant; Babl was funded by the Royal Children’s Hospital Research Foundation, an NHMRC Practitioner Fellowship, and a Melbourne Campus Clinician Scientist Fellowship; and Anderson by an NHMRC Senior Practitioner Fellowship. The funding organizations did not have a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.