Research Reports - Identification and validation of prognostic criteria for persistence of mild traumatic brain injury-related impairment in the pediatric patient

Pediatr Emerg Care. 2012 Jun;28(6):498-502

Wiebe DJ, Collins MW, Nance ML

OBJECTIVES: This study aimed to develop and validate prognostic criteria to
identify children at risk for persistence of mild traumatic brain injury (MTBI)
impairment.
METHODS: A prospective cohort study was conducted among 11- to 17-year-old
emergency department (ED) patients admitted for MTBI. The Immediate
Postconcussion Assessment and Cognitive Testing neurocognitive test was
administered during hospitalization and at routine clinic follow-up (ImPACT).
Logistic regression and receiver operating characteristic (ROC) analyses were
used to develop prognostic criteria for MTBI-related impairment in 1 group and
validate the criteria in a second group. Mild traumatic brain injury-related
impairment was defined as any impairment (symptom score >8 or <25th percentile on
at least 1 of 4 neurocognitive composite domains) or severe impairment (symptom
score >12 or <25th percentile on at least 2 of 4 neurocognitive composite
domains) present on follow-up.
RESULTS: The derivation and validation cohorts were 42 and 21 patients (median
age, 14 years; 71.4% male). Using the mean of the validation cohort patients' 4
neurocognitive deficit composite percentiles at baseline, a cut point of less
than 39 percentile had high sensitivity (0.89) and specificity (0.80) and an area
under the ROC curve of 0.85 in predicting the presence of any impairment at
follow-up; it discriminated equally well in the validation cohort. A cut point of
less than 27 percentile had good sensitivity (0.67) and specificity (0.67) and
area under the ROC curve of 0.67 in predicting the presence of severe impairment
in the derivation cohort at follow-up; it discriminated equally well in the
validation cohort.
CONCLUSIONS: This is the first study demonstrating prognostic criteria that may
greatly help physicians identify patients who would benefit from structured
follow-up care after MTBI.

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