Almost half a million children 1 to 14 years old suffer from TBI each year in The United States. While these occur from various mechanisms, the most frequent causes are falls, being struck by a motor vehicle, or abusive injuries. Mild TBI is often accompaniedby long term behavioral and neuropsychological defects. Mild TBI usually occurs with head trauma due to contact and/or acceleration or deceleration forces. The type of mechanical forces may determine the nature of the resultant injury. What effect this injury has on the developing brain is unclear. Despite the fact that mild TBI seems to be associated with significant morbidity, there is very little data in the literature on long term sequelae related to mild traumatic injury unrelated to sports injuries. An interesting study by Manley et al reviewed potential long-term effects of sports related concussion looking at sequelae 10 years after injury. However, this was inclusive of professional athletes as well as high school athletes. It was also not specific regarding exact type of concussive injury. It did find that some former athletes in contact, collision, and combat sports suffer from depression and cognitive deficits later in life, and there is an association between these deficits and a history of multiple concussions. This would suggest that children with mild TBI would be at such risk with repetitive injury. The exact relationship with the repetitive injury and progression to chronic traumatic encephalopathy is unclear. Our review of the current literature did not show any article regarding children that was similar to this paper.
Our current study focused on TBI occurring from non-sports related injuries, and long-term sequelae related to TBI. In this study we extended our data to a period of time much further than our previous study which went only to 14 months' post injury. Weaknesses of our study are that we are unable to verify pre-existing mental conditions even though we asked about pre-existing issues, and as our survey was self-reported, we are unable to formally attach a diagnosis to our patients. With regard to pre-existing neurologic issues prior to the mild TBI, we were unable to find any such issues in our patient population. We found once again that persistent sequelae are present after seemingly innocuous TBI. Unlike our previous study which showed persistence of headaches, this study shows a persistence of anxiety and depression which once again suggest post-traumatic stress disorder (PTSD). As suggested in our previous paper, learning disabilities and memory loss are very problematic to patients and families. Since the persistence of neuropsychiatric issues beyond 5 years is significant in our population, perhaps routine neuro-psychiatric testing of all patients with mild TBI should be considered. Because we identified many patients with long term sequelae, we were able to guide them to our neurology colleagues to follow up and address these issues. Unfortunately, due to the retrospective and self-reported nature of our study no association between initial data and persistent sequelae was found. Further studies looking at non-sports related mild TBI are needed with specific data looking into objective data on neuro-psychological issues. Mild TBI clearly has a profound long-term impact on the developing brain. We also understand that comparing issues such as anxiety in a child aged 4 may not be comparable to a child of age 14. We made the assumption that, as the survey was being answered by the parent or guardian, we could make a general comparison. We also did a statistical analysis between each of the age groups (age 1-14) and because our numbers were small, we found no difference, hence we decided to combine age groups so as to look for any difference, which was also not present. The earlier identification and more detailed analysis of patients at risk may yield better outcomes in child with mild TBI. We conclude that significant sequelae are present in our pediatric patients that suffer, non-sports related, seemingly mild TBI.