Psychosocial consequences of mild traumatic brain injury in children: results of a systematic review by the International Collaboration on Mild Traumatic Brain Injury Prognosis

Michelle L Keightley; Pierre Côté; Peter Rumney; Ryan Hung; Linda J Carroll; Carol Cancelliere; J David Cassidy

doi:10.1016/j.apmr.2013.12.018

Psychosocial consequences of mild traumatic brain injury in children: results of a systematic review by the International Collaboration on Mild Traumatic Brain Injury Prognosis

Arch Phys Med Rehabil. 2014 Mar;95(3 Suppl):S192-200. doi: 10.1016/j.apmr.2013.12.018.

Authors

Michelle L Keightley¹, Pierre Côté², Peter Rumney³, Ryan Hung³, Linda J Carroll⁴, Carol Cancelliere⁵, J David Cassidy⁶

Affiliations

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

PMID: 24581905
DOI: 10.1016/j.apmr.2013.12.018

Abstract

Objective: To synthesize the best available evidence regarding psychosocial consequences of mild traumatic brain injury (MTBI) in children.

Data sources: MEDLINE, Embase, CINAHL, PsycINFO, and SPORTDiscus were searched (2001-2012). Inclusion criteria included published peer-reviewed reports in English, French, Norwegian, Spanish, Swedish, and Danish. References were also identified from relevant reviews and meta-analyses, and the bibliographies of eligible articles.

Study selection: This article presents an update of a previous review with a much larger scope, of which this topic is a small subset of the questions addressed by that review. Controlled trials and cohort and case-control studies were selected according to predefined criteria. Two independent reviewers used modified Scottish Intercollegiate Guidelines Network criteria to critically appraise eligible studies. A total of 77,914 records were screened; 101 of these articles were deemed scientifically admissible, of which 6 investigated the psychosocial consequences of MTBI in children.

Data extraction: Two reviewers independently extracted data from accepted studies into evidence tables.

Data synthesis: We conducted a best-evidence synthesis by linking our conclusions to the evidence tables. Most accepted studies were exploratory rather than confirmatory. Preliminary evidence suggests that most children recover within 3 months post-MTBI. After 1 year, the prevalence of postconcussion symptoms and syndrome is similar between children with MTBI and children with orthopedic injuries. The functional status of children with MTBI improves over a 30-month follow-up period, but further research is needed to investigate the possibility that children with MTBI experience greater rates of psychiatric illness during the 3 years after their injury.

Conclusions: The prognosis of MTBI is favorable in children. Most appear to recover functionally from a physical and psychological perspective. However, future research should investigate the risk for psychiatric illness.

Keywords: Brain injuries; Craniocerebral trauma; Pediatric; Psychological outcomes; Recovery of function; Rehabilitation.

Publication types

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

MeSH terms

Brain Injuries / complications
Brain Injuries / diagnosis*
Brain Injuries / psychology*
Humans
Mental Disorders / etiology
Mental Health Services / statistics & numerical data
Pediatrics*
Post-Concussion Syndrome / etiology
Prognosis
Trauma Severity Indices*