Background and Aims
Traumatic brain injury (TBI) is the leading cause of disability in children and young adults. A majority of TBIs are considered mild TBIs (GCS 13-15), with complicated mild TBIs (c-mTBI) being a subset of mild TBI with the addition of intracranial abnormality on neuroimaging. Many patients with c-mTBI will make a full recovery, however a group of patients continue to have long-term adverse outcomes. Identifying prognostic factors at the time of injury can help clinicians choose therapies and medical interventions to optimize recovery. Despite a movement to identify prognostic factors that can predict long-term functional outcomes after TBI, there continues to be a paucity of research in this area. The aim of this study was to investigate the association between CT head findings at the time of injury and recovery of patients with c-mTBI.  We hypothesize that patients with isolated subarachnoid hemorrhage achieve the best outcome, extra-axial hematoma have better recovery than cortical contusion, subdural hemorrhage have worse outcomes than epidural hemorrhage, and that multiple imaging findings are associated the worst outcome.

Methods
A retrospective survey and chart review of pediatric TBI patients (age 5-18) and their parents were identified from 2010-2013 hospital data.  Of the 285 survey responses, 77 children were classified as c-mTBI, and were analyzed for this study.  Associations of imaging findings to degree (0-10 scale) and length (months) of recovery were analyzed using Fisher’s exact test.
 
Results
Overall, 48% (n = 37) of patients were reported to have completely recovered at the time of the survey. Close to half of patients (44%, n = 34) required more than three months for complete recovery, while 30% (n = 23) reported that they had yet to completely recover at the time of the survey. There were no significant differences in degree or length of recovery by extra-axial injury vs. cortical injury vs. subarachnoid hemorrhage, epidural vs. subdural hematoma, single hemorrhagic contusion size (≤ 5 mm vs. > 5 mm), single vs. multiple hemorrhagic contusions, depressed/complex vs. simple skull fractures, frontal contusions vs. contusions in other locations, and single vs. multiple findings (p > 0.05).

Conclusion
Contrary to our hypotheses, degree and length of recovery in pediatric patients with complicated mTBI may not be substantially influenced by imaging findings at the time of injury.

Relationship between CT head findings and long-term recovery in children with complicated mild traumatic brain injury