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. 2023 Jun;108(6):492-497.
doi: 10.1136/archdischild-2022-325202. Epub 2023 Mar 31.

Factors related to adverse long-term outcomes after mild traumatic brain injury in children: a scoping review

Sharea Ijaz  1 , Lauren Scott  2 , Sarah Dawson  2 , Rebecca Wilson  2 , Joni Jackson  2 , Kate Birnie  3 , Maria Theresa Redaniel  2 , Jelena Savović  2 , Ingram Wright  4 , Mark D Lyttle  5   6 , Julie Mytton  7
Affiliations

Factors related to adverse long-term outcomes after mild traumatic brain injury in children: a scoping review

Sharea Ijaz et al. Arch Dis Child. 2023 Jun.

Abstract

Objective: To identify demographic, premorbid and injury-related factors, or biomarkers associated with long-term (≥3 months) adverse outcomes in children after mild traumatic brain injury (mTBI).

Design: Scoping review of literature.

Patients: Children and adolescents with mTBI.

Risk factors: Any demographic, premorbid and injury-related factors, or biomarkers were included. We excluded genetic and treatment-related factors.

Main outcome measures: Postconcussion syndrome (PCS), recovery.

Results: Seventy-three publications were included, reporting 12 long-term adverse outcomes, including PCS in 12 studies and recovery in 29 studies. Additional outcomes studied were symptom scores/severity (n=22), quality of life (n=9) and cognitive function (n=9). Forty-nine risk factors were identified across studies. Risk factors most often assessed were sex (n=28), followed by age (n=23), injury mechanism = (n=22) and prior mTBI (n=18). The influence of these and other risk factors on outcomes of mTBI were inconsistent across the reviewed literature.

Conclusions: The most researched risk factors are sex, age and mechanism of injury, but their effects have been estimated inconsistently and did not show a clear pattern. The most studied outcomes are recovery patterns and symptom severity. However, these may not be the most important outcomes for clinicians and patients. Future primary studies in this area should focus on patient-important outcomes. Population-based prospective studies are needed that address prespecified hypotheses on the relationship of risk factors with given outcomes to enable reliable prediction of long-term adverse outcomes for childhood mTBI.

Keywords: adolescent health; child health; syndrome.

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Conflict of interest statement

Competing interests: SI, LS, RW, SD, JJ, MTR, and JS report grant funding from NIHR (NIHR ARC West) during the conduct of the study. JS reports personal fees from Core Models Limited, UK (for teaching introductory systematic review methods at an online course), unrelated to the submitted work.

Figures

Figure 1
Figure 1
Mild traumatic brain injury (mTBI) and how potential factors may affect symptoms after mTBI. PCS, postconcussion syndrome.
Figure 2
Figure 2
Map of long-term outcomes of childhood mTBI in literature. The size of the block indicates the relative size of literature on the outcome, with numbers of studies reporting each. mTBI, mild traumatic brain injury.
Figure 3
Figure 3
Risk factors for long-term outcomes of childhood mTBI in literature. mTBI, mild traumatic brain injury; PCS, postconcussion syndrome; 5P risk score.Predicting and Preventing Post-concussive Problems in Pediatrics risk score; SES, Socioeconomic status; A&E, Accident and Emergnecy; GCS, Glasgow coma scale; CT/MRI, Computerised tomography/Magnetic resonance imaging.
See this image and copyright information in PMC

References

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