Longitudinal neurocognitive trajectories and risk factors in the first three months following pediatric concussion

ABSTRACT

Objective

To identify differential trajectories of neurocognitive outcomes following pediatric concussion and investigate predictors associated with patterns of recovery up to 3 months.

Methods

74 participants aged 8–17 years completed attention/working memory, processing speed, and executive function measures at 2 weeks, 1 month, and 3 months post-injury. We used principal component analysis to generate a composite of information processing. Group-based trajectory modeling identified latent trajectories. Multinominal logistic regression was used to examine associations between risk factors and trajectory groups.

Results

We identified three trajectories of neurocognitive outcomes. The medium (54.6%) and high improving groups (35.8%) showed ongoing increase in information processing, while the low persistent group showed limited change 3 months post-injury. This group recorded below average scores on Digit Span Forward and Backward at 3 months. History of pre-injury headache was significantly associated with the persistent low scoring group, relative to the medium improving (p = 0.03) but not the high improving group (p = 0.09).

Conclusions

This study indicates variability in neurocognitive outcomes according to three differential trajectories, with groups partially distinguished by preexisting child factors (history of frequent headaches). Modelling that accounts for heterogeneity in individual outcomes is essential to identify clinically meaningful indices that are indicative of children requiring intervention.

KEYWORDS:

• mTBI
• neurocognitive outcomes
• principal component analysis
• group-based trajectory modeling
• pediatric concussion

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplemental material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/02699052.2024.2347553

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 inter-pretation of the data; preparation, review, or approval of the manuscript;or the decision to submit the manuscript for publication.