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Learning and Attention Deficit/Hyperactivity Disorders as Risk Factors for Prolonged Concussion Recovery in Children and Adolescents
Journal of the International Neuropsychological Society ( IF 2.6 ) Pub Date : 2021-03-22 , DOI: 10.1017/s1355617721000229
Alexia K Martin 1, 2 , Ashley J Petersen 2 , Heather W Sesma 1 , Mary B Koolmo 1 , Katherine M Ingram 1 , Katie B Slifko 1 , Victoria N Nguyen 1 , Robert C Doss 1 , Amy M Linabery 1, 2
Affiliation  

Objective:Examine pre-existing learning disorders (LD) and attention deficit/hyperactivity disorders (ADHD) as risk factors for prolonged recovery and increased symptomology following pediatric mild traumatic brain injury (mTBI).Methods:We conducted a retrospective cohort study of children/adolescents (5-17 years) with mTBI who presented to a Children’s Minnesota Concussion Clinic between April 2018 and March 2019. Differences across strata of pre-existing conditions (present vs. absent) in time to recovery measures were estimated via Kaplan–Meier and Cox proportional hazards analyses and differences in symptom trajectories were examined via linear mixed-effects regression models. Regression models were adjusted for age, sex and other confounders.Results:In our cohort of 680 mTBI patients, those with LD (n = 70) or ADHD (n = 107) experienced significantly longer median durations of symptoms (58 and 68 days, respectively) than those without (43 days). Accordingly, LD was significantly associated with delayed symptom recovery (adjusted hazard ratio (aHR) = 1.63, 95% CI: 1.16–2.29), return to school (1.47, 1.08–2.00), and return to physical activity (1.50, 1.10–2.04). Likewise, ADHD was associated with delayed recovery (1.69, 1.28–2.23), return to school (1.52, 1.17–1.97) and physical activity (1.55, 1.19–2.01). Further, patients with LD or ADHD reported, on average, significantly more concussion symptoms and higher vision symptom scores throughout recovery versus those without. There was no evidence that concussion or vision symptom recovery trajectories varied over time between those with/without LD or ADHD (joint P-interactions > 0.05).Conclusion:Pre-existing LD and ADHD are risk factors for prolonged and more symptomatic mTBI recovery in youth. These results can inform clinical concussion management and recovery expectations.

中文翻译:

学习和注意力缺陷/多动障碍是儿童和青少年脑震荡恢复时间延长的危险因素

目的:检查预先存在的学习障碍 (LD) 和注意力缺陷/多动障碍 (ADHD) 作为儿童轻度创伤性脑损伤 (mTBI) 后恢复时间延长和症状增加的危险因素。方法:我们对儿童 /在 2018 年 4 月至 2019 年 3 月期间到明尼苏达州儿童脑震荡诊所就诊的 mTBI 青少年(5-17 岁)。先前存在的疾病各阶层之间的差异(目前对比通过 Kaplan-Meier 和 Cox 比例风险分析估计恢复时间的测量值,并通过线性混合效应回归模型检查症状轨迹的差异。回归模型针对年龄、性别和其他混杂因素进行了调整。结果:在我们的 680 名 mTBI 患者队列中,患有 LD (n= 70) 或多动症 (n= 107) 的中位症状持续时间(分别为 58 天和 68 天)明显长于没有症状的人(43 天)。因此,LD 与延迟症状恢复显着相关(调整后的风险比 (aHR) = 1.63, 95% CI: 1.16–2.29)、重返学校 (1.47, 1.08–2.00) 和恢复体力活动 (1.50, 1.10– 2.04)。同样,ADHD 与延迟恢复 (1.69, 1.28–2.23)、返校 (1.52, 1.17–1.97) 和身体活动 (1.55, 1.19–2.01) 相关。此外,与没有的患者相比,患有 LD 或 ADHD 的患者在整个恢复过程中平均报告了更多的脑震荡症状和更高的视力症状评分。没有证据表明脑震荡或视力症状恢复轨迹在有/没有 LD 或 ADHD 的患者之间随时间而变化(关节-interactions > 0.05)。结论:预先存在的 LD 和 ADHD 是青少年 mTBI 恢复时间延长且症状较多的危险因素。这些结果可以为临床脑震荡管理和康复预期提供信息。
更新日期:2021-03-22
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