Neurocognitive Outcome after Pediatric Traumatic Brain Injury: Patient Subgroups with Diverging Outcome

Background and ObjectivesTraumatic brain injury (TBI) is the leading cause of acquired disability in children. Children with TBI are at risk of persistent deficits in neurocognitive functioning that affect daily life. However, neurocognitive outcomes are highly heterogenous and this heterogeneity is poorly understood. This study aims to investigate whether the heterogeneity in neurocognitive outcome can be reduced by distinguishing subgroups of children with distinct profiles of neurocognitive functioning, and to investigate whether these subgroups differ in demographic, premorbid and clinical characteristics. MethodsThis multicenter study included a consecutive cohort of children with mild to severe TBI and demographically matched neurologically healthy (NH) children. Seven neurocognitive domains were assessed six months post-TBI using computerized tests. The TBI and NH group were compared on the neurocognitive domains using t-tests. Results of the TBI group were subjected to cluster analysis to derive subgroups with distinct profiles of neurocognitive functioning. Resulting subgroups were compared on demographic, premorbid and clinical characteristics available at time of hospital visit. ResultsA total of 113 children with TBI and 113 NH children were included. The TBI group had lower performance than NH children on the neurocognitive domains Speed, Stability, Attention & Control, Verbal Working Memory and Visual Working Memory (.009[≤]ps[≤].047, -.42[≤]ds[≤]-.29). Cluster analysis revealed four subgroups of patients with diverging neurocognitive outcome profiles. One subgroup was characterized by good outcome, whereas three subgroups had adverse outcome characterized by weak global outcome, weak visual-processing outcome or weak executive functioning outcome. The subgroups did not differ in clinical characteristics but did differ in demographic and premorbid characteristics. The weak global outcome subgroup had more premorbid behavioral problems, while the good outcome subgroup had higher socio-economic status than the other subgroups. DiscussionThis study indicates that children with mild to severe TBI exhibit neurocognitive deficits compared to matched controls at six months post TBI, among which subgroups of children with distinct neurocognitive outcome profiles exist. The neurocognitive outcome subgroups represent children with diverging severity and configuration of neurocognitive weaknesses. The subgroups with the diverging neurocognitive outcome profiles did not differ in clinical characteristics, highlighting the importance to consider other factors for the prognosis of neurocognitive outcome.