Neurocognitive Evaluation of Mild Traumatic Brain Injury in Children Treated and Released from the Emergency Department

Background: Mild traumatic brain injury (MTBI) is common in the pediatric population. A standardized approach to determine the need for structured follow-up and the optimal time to return to play is lacking. We tested the feasibility of neurocognitive testing and measured the degree of disability of children evaluated and discharged from the ED with MTBI. Methods: Pediatric blunt trauma patients (age 11-16 years) evaluated in the ED for MTBI were prospectively enrolled and administered a validated neurocognitive test (ImPACTŠ). Test results were compared against age/gender matched population norms using signed-rank tests. Results: 15 subjects were prospectively enrolled, tested and discharged from the ED (mean age=14 years; 53% male). 13.3% reported a prior concussion, 66.7% had amnesia for the current injury event, and 46.7% experienced loss of consciousness. Headache was the most common (93.3%) and severe (mean=3.2 on scale 0-6) symptom. Subjects' test results were uniformly abnormal relative to normative data. Compared to normative median values=50 for each neurocognitive domain score, the median values of patients' test results were verbal memory=30 (p=0.244), visual memory=15 (p=0.004), visual motor=22 (p=0.0006), reaction time=9 (p=0.003), and a median across the four domains=19 (p=0.0008). Compared to normative values of 0 to 8 for a total symptom score, the median value of patients' total symptom scores=17 (p=0.003). Conclusions: Acute neurocognitive testing of MTBI in children is feasible in the ED setting. Neurocognitive abnormalities were common and suggest that most children discharged from the ED with MTBI should be seen for follow-up with return to play recommendations deferred.