Three-Month Psychiatric Outcome of Pediatric Mild Traumatic Brain Injury: A Controlled Study.

The objective was to clarify occurrence, phenomenology, and risk factors for novel psychiatric disorder (NPD) in the first 3-months after mild traumatic brain injury (mTBI) and orthopedic injury (OI). Children aged 8-15 years with mTBI (n=220) and with OI but no TBI (n=110) from consecutive admissions to an emergency department were followed prospectively at baseline and 3 months post-injury with semi-structured psychiatric interviews to document the number of NPDs that developed in each participant. Pre-injury child variables (adaptive, cognitive, and academic function, and psychiatric disorder), pre-injury family variables (socioeconomic status, family psychiatric history, and family function), and injury severity were assessed and analyzed as potential confounders and predictors of NPD. NPD occurred at a significantly higher frequency in children with mTBI versus OI in analyses unadjusted (mean ratio (MR) 3.647, CI95 (1.264, 15.405), p=0.014) and adjusted (MR=3.724, CI95 (1.264, 15.945), p=0.015) for potential confounders. In multi-predictor analyses, the factors besides mTBI that were significantly associated with higher NPD frequency after adjusting for each other were pre-injury lifetime psychiatric disorder, MR=2.284, CI95 (1.026, 5.305), p=0.043; high versus low family psychiatric history, MR=2.748, CI95 (1.201, 6.839), p=0.016, and worse socio-economic status, MR=0.618 per additional unit, CI95 (0.383, 0.973), p=0.037. These findings demonstrate that mild injury to the brain compared with an OI had a significantly greater deleterious effect on psychiatric outcome in the first three-months post-injury. This effect was present even after accounting for specific child and family variables which were themselves independently related to the adverse psychiatric outcome.