INS NYC 2024 Program

Poster	Poster Session 05 Program Schedule 02/15/2024 02:30 pm - 03:45 pm Room: Shubert Complex (Posters 1-60) Poster Session 05: Neuropsychiatry \| Addiction/Dependence \| Stress/Coping \| Emotional/Social Processes Final Abstract #31 Characteristics and Management of Traumatic Brain Injury in Young Children (0-5 years) Katherine Elwell, Children's MN, Minneapolis, United States Heather Sesma, Children's MN, St. Paul, United States Victoria Nguyen, Children's MN, Minneapolis, United States Riyana Parekh, Children's MN, Minneapolis, United States Katie Slifko, Children's MN, St. Paul, United States Jane Allen, Children's MN, St. Paul, United States Amy Linabery, Children's MN, Minneapolis, United States Category: Acquired Brain Injury (TBI/Cerebrovascular Injury and Disease - Child) Keyword 1: child brain injury Keyword 2: assessment Objective: Given the physical, neurocognitive, and psychological differences between children, adolescents, and adults, traumatic brain injury (TBI) management should reflect the developmental impact of injury across different age groups. The current study aimed to examine the characteristics and clinical management of young children with TBI seeking specialty care, particularly those referred for neuropsychological assessment. Participants and Methods: Medical record data for children aged 0-5 yrs with TBI initially seen in a multidisciplinary pediatric concussion clinic in 11/2016-1/2023 were abstracted. Trained abstracters recorded demographic, injury-related, patient history, imaging, and treatment data. Descriptive statistics were tabulated, overall and stratified by administration of neuropsychological assessment. Results: The cohort of 117 children (median age: 4.8 years, interquartile range: 3.9-5.6) experienced head injuries by various mechanisms (10% motor vehicle-related, 14% sports-related, 15% playground-related, 20% other occurrence of being struck/collisions, 41% other falls). Overall, 83% visited an emergency department and 97% underwent imaging, where 44% had no findings, 13% had skull fractures, 9% had intracranial hemorrhages, and the remainder had other (incidental) findings. Concussion clinic visits occurred a median of 16 (7-35.5) days post-injury. In structured clinical interviews regarding 29 common symptoms, parents endorsed few symptoms in the acute post-injury period (1, 1-10) and slightly more at the first clinic visit (4, 1-8). Eight patients (7%) underwent neuropsychological assessment due to observed changes in behavior and/or function following injury. This subset was similar to the overall group in demographics, injury mechanism, and management. Notably, a greater proportion sustained skull fractures (62.5%) and intracranial hemorrhages (62.5%). Patients were seen in the concussion clinic later in their recovery (75.5, 7-132 days post-injury) and parents endorsed more symptoms at the acute post-injury (7, 1-11) and first visit time points (9.5, 7-13). A few patterns emerged from the neuropsychological evaluations. With regard to executive function, 5/8 patients had clinically significant scores for most/all of the Behavior Rating Inventory of Executive Functioning (BRIEF-P, BRIEF-2) scales/indices. Adaptive functioning, as measured by the Adaptive Behavior Assessment System (ABAS-3), was reduced in at least one scale in 4/6. For emotional/behavioral functioning, 5/7 were at-risk and/or had clinically significant concerns on at least one Behavior Assessment System for Children (BASC-2, BASC-3) scale. Fine motor skills were impacted in at least one hand in 4/4 patients tested via Purdue Pegboard. Conversely, 7/7 displayed average functioning on the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI). Test results generally confirmed parental observations. Conclusions: Conclusions: Consistent with prior observations, parents of young children sustaining TBIs generally reported few symptoms. Together, these results suggest that more sensitive/objective symptom detection/surveillance measures are needed for younger children. If there is systematic underascertainment of TBI symptoms, this may compromise the quality of care younger patients receive. Although these results must be interpreted cautiously due to the modest number of patients referred for neuropsychological evaluation, they may inform clinical practice. Neuropsychological evaluations have a role in the clinical management of young children with complicated TBI and prolonged recovery to elucidate/confirm the extent of cognitive and functional difficulties, manage recovery expectations, and provide age-appropriate recommendations.

Poster

02/15/2024
02:30 pm - 03:45 pm
Room: Shubert Complex (Posters 1-60)

Poster Session 05: Neuropsychiatry | Addiction/Dependence | Stress/Coping | Emotional/Social Processes

Final Abstract #31

Characteristics and Management of Traumatic Brain Injury in Young Children (0-5 years)

Katherine Elwell, Children's MN, Minneapolis, United States
Heather Sesma, Children's MN, St. Paul, United States
Victoria Nguyen, Children's MN, Minneapolis, United States
Riyana Parekh, Children's MN, Minneapolis, United States
Katie Slifko, Children's MN, St. Paul, United States
Jane Allen, Children's MN, St. Paul, United States
Amy Linabery, Children's MN, Minneapolis, United States

Category: Acquired Brain Injury (TBI/Cerebrovascular Injury and Disease - Child)

Keyword 1: child brain injury
Keyword 2: assessment

Objective:

Given the physical, neurocognitive, and psychological differences between children, adolescents, and adults, traumatic brain injury (TBI) management should reflect the developmental impact of injury across different age groups. The current study aimed to examine the characteristics and clinical management of young children with TBI seeking specialty care, particularly those referred for neuropsychological assessment.

Participants and Methods:

Medical record data for children aged 0-5 yrs with TBI initially seen in a multidisciplinary pediatric concussion clinic in 11/2016-1/2023 were abstracted. Trained abstracters recorded demographic, injury-related, patient history, imaging, and treatment data. Descriptive statistics were tabulated, overall and stratified by administration of neuropsychological assessment.

Results:

The cohort of 117 children (median age: 4.8 years, interquartile range: 3.9-5.6) experienced head injuries by various mechanisms (10% motor vehicle-related, 14% sports-related, 15% playground-related, 20% other occurrence of being struck/collisions, 41% other falls). Overall, 83% visited an emergency department and 97% underwent imaging, where 44% had no findings, 13% had skull fractures, 9% had intracranial hemorrhages, and the remainder had other (incidental) findings. Concussion clinic visits occurred a median of 16 (7-35.5) days post-injury. In structured clinical interviews regarding 29 common symptoms, parents endorsed few symptoms in the acute post-injury period (1, 1-10) and slightly more at the first clinic visit (4, 1-8).

Eight patients (7%) underwent neuropsychological assessment due to observed changes in behavior and/or function following injury. This subset was similar to the overall group in demographics, injury mechanism, and management. Notably, a greater proportion sustained skull fractures (62.5%) and intracranial hemorrhages (62.5%). Patients were seen in the concussion clinic later in their recovery (75.5, 7-132 days post-injury) and parents endorsed more symptoms at the acute post-injury (7, 1-11) and first visit time points (9.5, 7-13).

A few patterns emerged from the neuropsychological evaluations. With regard to executive function, 5/8 patients had clinically significant scores for most/all of the Behavior Rating Inventory of Executive Functioning (BRIEF-P, BRIEF-2) scales/indices. Adaptive functioning, as measured by the Adaptive Behavior Assessment System (ABAS-3), was reduced in at least one scale in 4/6. For emotional/behavioral functioning, 5/7 were at-risk and/or had clinically significant concerns on at least one Behavior Assessment System for Children (BASC-2, BASC-3) scale. Fine motor skills were impacted in at least one hand in 4/4 patients tested via Purdue Pegboard. Conversely, 7/7 displayed average functioning on the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI). Test results generally confirmed parental observations.

Conclusions:

Conclusions: Consistent with prior observations, parents of young children sustaining TBIs generally reported few symptoms. Together, these results suggest that more sensitive/objective symptom detection/surveillance measures are needed for younger children. If there is systematic underascertainment of TBI symptoms, this may compromise the quality of care younger patients receive. Although these results must be interpreted cautiously due to the modest number of patients referred for neuropsychological evaluation, they may inform clinical practice. Neuropsychological evaluations have a role in the clinical management of young children with complicated TBI and prolonged recovery to elucidate/confirm the extent of cognitive and functional difficulties, manage recovery expectations, and provide age-appropriate recommendations.