Neurocognition in the Emergency Department after a Mild Traumatic Brain Injury in Youth

Abstract The early cognitive effects from a mild traumatic brain injury (mTBI) are poorly understood in youth. The aim of this study was to examine acute neurocognitive functioning in children and adolescents who presented to the emergency department (ED) after an mTBI. Youth 8-17 years of age with an mTBI (n=77; mean age, 13.6 years; 95% confidence interval [CI], 13.0-14.2) and an orthopedic injury control (OIC) group (n=28; mean age, 13.9 years; 95% CI, 13.1-14.7) underwent a very brief computerized neurocognitive assessment (four subtests from CNS Vital Signs) in a pediatric trauma hospital ED. The mTBI and OIC groups were not significantly different on age, gender, handedness, computer familiarity, race, median family income, pain rating scales, or time from injury to assessment. There were no significant differences between the mTBI and OIC groups for accuracy on immediate memory, delayed memory, and measures of attention and executive functioning. However, the mTBI group performed significantly worse than the OIC on nearly all measures of psychomotor speed and reaction time. Further, cognitive functioning appears to worsen as more time passes since the mTBI. Neurocognitive deficits are detectable in youth with an mTBI who present to the ED, despite having a Glasgow Coma Scale score of 15/15 and normal neuroimaging (or their presentation does not warrant neuroimaging). Their profile appears to include preserved accuracy on cognitive measures, but at the expense of slower psychomotor speed and longer reaction time.