Systematic review of the clinical course, natural history, and prognosis for pediatric mild traumatic brain injury: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis

Ryan Hung; Linda J Carroll; Carol Cancelliere; Pierre Côté; Peter Rumney; Michelle Keightley; James Donovan; Britt-Marie Stålnacke; J David Cassidy

doi:10.1016/j.apmr.2013.08.301

Systematic review of the clinical course, natural history, and prognosis for pediatric mild traumatic brain injury: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis

Arch Phys Med Rehabil. 2014 Mar;95(3 Suppl):S174-91. doi: 10.1016/j.apmr.2013.08.301.

Authors

Ryan Hung¹, Linda J Carroll², Carol Cancelliere³, Pierre Côté⁴, Peter Rumney⁵, Michelle Keightley⁶, James Donovan⁷, Britt-Marie Stålnacke⁸, J David Cassidy⁹

Affiliations

¹ Department of Rehabilitation and Complex Continuing Care, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada. Electronic address: rhung@hollandbloorview.ca.
² School of Public Health and Alberta Centre for Injury Control and Research, University of Alberta, Edmonton, Alberta, Canada.
³ Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁴ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada.
⁵ Department of Rehabilitation and Complex Continuing Care, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
⁶ Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; Departments of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada.
⁷ Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada.
⁸ Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
⁹ Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark.

PMID: 24581904
DOI: 10.1016/j.apmr.2013.08.301

Abstract

Objective: To synthesize the best available evidence on prognosis after pediatric mild traumatic brain injury (MTBI).

Data sources: We searched MEDLINE, Embase, PsycINFO, CINAHL, and SPORTDiscus (2001-2012), as well as reference lists of eligible articles, and relevant systematic reviews and meta-analyses.

Study selection: Controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to have a minimum of 30 MTBI pediatric cases. After 77,914 records were screened for the entire review, 299 studies were eligible and assessed for scientific rigor.

Data extraction: Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Two reviewers independently reviewed each study and extracted data from accepted articles into evidence tables.

Data synthesis: Evidence from 25 accepted articles was synthesized qualitatively according to SIGN criteria, and prognostic information was prioritized according to design as exploratory or confirmatory. Most studies show that postconcussion symptoms and cognitive deficits resolve over time. Limited evidence suggests that postconcussion symptoms may persist in those with lower cognitive ability and intracranial pathology on neuroimaging. Preliminary evidence suggests that the risk of epilepsy is increased for up to 10 years after MTBI; however, there is insufficient high-quality evidence at this time to support this link.

Conclusions: Common post-MTBI symptoms and deficits in children are not specific to MTBI and appear to resolve with time; however, limited evidence suggests that children with intracranial pathology on imaging may experience persisting symptoms or deficits. Well-designed, long-term studies are needed to confirm these findings.

Keywords: Child; Craniocerebral trauma; Prognosis; Recovery of function; Rehabilitation.

Publication types

Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Brain Injuries / complications
Brain Injuries / diagnosis*
Child
Cognition Disorders / etiology
Disabled Children / statistics & numerical data
Epilepsy / etiology
Health Expenditures / statistics & numerical data
Humans
Pediatrics*
Post-Concussion Syndrome / etiology
Prognosis
Risk Factors
Sleep Wake Disorders / etiology
Time Factors
Trauma Severity Indices*
Triage