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Abstract
Background and Objectives This prospective, longitudinal cohort study examined trajectories of brain gray matter macrostructure after pediatric mild traumatic brain injury (mTBI).
Methods Children aged 8–16.99 years with mTBI or mild orthopedic injury (OI) were recruited from 5 pediatric emergency departments. Reliable change between preinjury and 1 month postinjury symptom ratings was used to classify mTBI with or without persistent symptoms. Children completed postacute (2–33 days) and/or chronic (3 or 6 months) postinjury T1-weighted MRI, from which macrostructural metrics were derived using automated segmentation. Linear mixed-effects models were used, with multiple comparisons correction.
Results Groups (N = 623; 407 mTBI/216 OI; 59% male; age mean = 12.03, SD = 2.38 years) did not differ in total brain, white, or gray matter volumes or regional subcortical gray matter volumes. However, time postinjury, age at injury, and biological sex-moderated differences among symptom groups in cortical thickness of the angular gyrus, basal forebrain, calcarine cortex, gyrus rectus, medial and posterior orbital gyrus, and the subcallosal area all corrected p < 0.05. Gray matter macrostructural metrics did not differ between groups postacutely. However, cortical thinning emerged chronically after mTBI relative to OI in the angular gyrus in older children (d [95% confidence interval] = −0.61 [−1.15 to −0.08]); and in the basal forebrain (−0.47 [−0.94 to −0.01]), subcallosal area (−0.55 [−1.01 to −0.08]), and the posterior orbital gyrus (−0.55 [−1.02 to −0.08]) in females. Cortical thinning was demonstrated for frontal and occipital regions 3 months postinjury in males with mTBI with persistent symptoms vs without persistent symptoms (−0.80 [−1.55 to −0.05] to −0.83 [−1.56 to −0.10]) and 6 months postinjury in females and younger children with mTBI with persistent symptoms relative to mTBI without persistent symptoms and OI (−1.42 [−2.29 to −0.45] to −0.91 [−1.81 to −0.01]).
Discussion These findings signal little diagnostic and prognostic utility of postacute gray matter macrostructure in pediatric mTBI. However, mTBI altered the typical course of cortical gray matter thinning up to 6 months postinjury, even after symptoms typically abate in most children. Collapsing across symptom status obscured the neurobiological heterogeneity of discrete clinical outcomes after pediatric mTBI. The results illustrate the need to examine neurobiology in relation to clinical outcomes and within a neurodevelopmental framework.
Glossary
- A-CAP=
- Advancing Concussion Assessment in Pediatrics;
- AIS=
- Abbreviated Injury Scale;
- ANTs=
- Advanced Normalization Tools;
- ED=
- emergency department;
- FDR=
- false discovery rate;
- mTBI=
- mild traumatic brain injury;
- OI=
- orthopedic injury;
- PERC=
- Pediatric Emergency Research Canada;
- TBV=
- total brain volume
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
The Pediatric Emergency Research Canada A-CAP Study Group coinvestigators are listed in the appendix at the end of the article.
Submitted and externally peer reviewed. The handling editor was Associate Editor Courtney Wusthoff, MD, MS.
- Received August 30, 2022.
- Accepted in final form April 24, 2023.
- © 2023 American Academy of Neurology
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