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Do Postconcussive Symptoms Discriminate Injury Severity in Pediatric Mild Traumatic Brain Injury?

Moran, Lisa M. MA; Taylor, H. Gerry PhD; Rusin, Jerome MD; Bangert, Barbara MD; Dietrich, Ann MD; Nuss, Kathryn E. MD; Wright, Martha MD; Yeates, Keith Owen PhD

Journal of Head Trauma Rehabilitation: September/October 2011 - Volume 26 - Issue 5 - p 348–354
doi: 10.1097/HTR.0b013e3181f8d32e
Original Articles

Objectives: To assess whether postconcussive symptoms (PCS) can be used to discriminate injury severity among children with mild traumatic brain injury (TBI).

Participants: One hundred eighty-six children with mild TBI, divided into high and low injury severity depending on whether the injury was associated with a loss of consciousness (LOC), and a comparison group of 99 children with orthopedic injuries (OI), all aged 8 to 15 years at the time of injury.

Main Measures: Parent-rated frequency and severity of PCS at initial assessment within 2 weeks postinjury and again at 3 and 12 months postinjury.

Results: Ratings of PCS obtained at the initial and 3-month assessments differentiated children with mild TBI from OI, although only ratings at the initial assessment discriminated among all 3 groups. Somatic PCS accounted for most of the discriminatory power.

Conclusions: Overall, the accuracy of group classification was relatively modest, with a large proportion of misclassifications of children in the mild-TBI groups. Although children with mild TBI have more PCS than children with OI, PCS do not permit sufficiently accurate discrimination of mild TBI and injury severity to warrant diagnostic decisions at this time.

Department of Psychology, Ohio State University (Ms Moran), Department of Pediatrics, Ohio State University College of Medicine (Drs Dietrich, Nuss, and Yeates), Department of Radiology, Nationwide Children's Hospital (Dr Rusin), Department of Emergency Medicine, Nationwide Children's Hospital (Drs Dietrich and Nuss), Research Institute at Nationwide Children's Hospital (Ms Moran and Dr Yeates), Columbus, Ohio; Department of Pediatrics, Case Western Reserve University (Drs Taylor and Wright), Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center (Drs Taylor and Wright), Departments of Radiology and Neurosurgery, University Hospitals Health System (Dr Bangert), Cleveland, Ohio.

Corresponding Author: Keith Owen Yeates, PhD, Department of Psychology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 432205 (keith.yeates@nationwidechildrens.org).

This work was supported by grants HD44099 and HD39834 from the National Institutes of Health to the senior author (K.O.Y.).

No competing financial interests exist. These data were submitted in partial fulfillment of the requirements for a master's degree for the first author (L.M.M.).

The authors declare no conflict of interest

© 2011 Lippincott Williams & Wilkins, Inc.