Persistent symptoms in mild pediatric traumatic brain injury.

Background

Traumatic brain injury (TBI) is the leading cause of morbidity and mortality for children in the US. The objective was to examine the epidemiology of self-reported neurologic and neuro-psychiatric symptoms in pediatric patients with mild TBI within 14 months post-injury.

Methods

A telephone based survey was conducted on all pediatric patients (aged<15 years) with a mild traumatic brain injury diagnosed at our urban level 1 adult/level 2 pediatric trauma center within 1 year. Subjects were identified by our trauma registry, and medical records were reviewed for demographic data and mechanism of injury. Parents or guardians were interviewed using a standardized questionnaire to collect data regarding the presence or absence of headaches, weakness, numbness, coordination impairment, speech impairment, nausea, vomiting, confusion, short-term memory impairment, sleep disturbances, anhedonia, depression, anxiety, fear, and agitation.

Results

Thirty-three parents of patients responded. The average age of the patients at time of TBI was 9.3±1.7 years. The age range was 3-14 years. The mechanisms of injury included pedestrian struck (54.5%), fall (39.4%), motor vehicle collision (3%), and assault (3%). The time from injury was stratified into 1-3 months (n=9), 4-6 months (n=9), 7-9 months (n=6), and 10-12 months (n=8), one patient surveyed was 14 months post-injury. Headaches (39.4%), anxiety (30.3%), fear (18.2%), and anhedonia (18.2%) were the most frequently reported symptoms. Less common were sleep disturbances (12.1%), depression (9.1%), nausea (6.1%), coordination impairment (6.1%), short-term memory impairment (6.1%), weakness (3%), numbness (3%), vomiting (3%), and agitation (3%). There were no instances of speech impairment.

Conclusions

Approximately 1/3 of patients complained of anxiety post-injury, and 1/5 reportedly experienced anhedonia and fear. Considering the ongoing neurologic and psychosocial development of the pediatric population, long-term follow-up and periodic screening examinations should be considered in patients diagnosed with TBI.