Impact of Head CT Findings on the Post Concussive Symptom Inventory - Parental Report in Children after Traumatic Brain Injury
Christian Niedzwecki, DO, MS, FAAP, FAAPM&R, C-PRM, C-BI1; Zach Wirt, OTR/L, C/NDT, CKTP, CBIS2; Sarah Risen, MD3; Amee Moreno, NP4; Kim Davis, PhD5
1Baylor College of Medicine/ Texas Children's Hospital, Houston, TX; 2Texas Children's Hospital, Houston, TX; 3Baylor College of Medicine, Houston, TX; 4Texas Chidlren's Hospital, Houston, TX; 5Baylor College of Medicine and Texas Children's Hospital, Houston, TX
Objective: To describe deficits following an acute pediatric traumatic brain injury (TBI) utilizing a standardized tool in the subpopulations that receive head CT at time of injury.
Methods: Retrospective chart review on pediatric patients that attended a TBI follow-up clinic at a Level I trauma center. Inclusion criteria included having undergone CT brain imaging, age 3-21 years, and Post Concussive Symptom Inventory-Parent Rating (PCSI-PR) completion. 232 unique patients with PCSI data available for their first outpatient visit were identified. Of those, 6 were excluded for non-acute TBI greater than one year from injury), 4 were excluded for lack of imaging data, and 73 were excluded due to age <3years, for a total of 149 eligible records.
Results: Significant differences were noted between the subpopulations of children with and without head CT findings (CT negative and CT positive). These data indicated that those in the CT negative category had a significantly greater mean total PCSI-PR score than those in the CT positive category (Spearman Rho=.29, p>.001). This held true for physical, cognitive, emotional, and fatigue subscales. Correlation data revealed that LOS, LOC, PTA, and age at injury are significantly correlated with total PCSI-PR score. Seizure (y/n), GCS severity, and discharge to follow up time were not.
Conclusions: Although positive CT is often considered a risk factor for symptom persistence, these findings suggest that children who sustained a TBI without head CT findings may actually be at significant risk for increased symptomatology at follow-up. Reasons for this unanticipated finding will be discussed.
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