Severity of pediatric traumatic brain injury and early neurobehavioral outcome: a cohort study.

Traumatic brain injury (TBI) is a major cause of pediatric disability. Its neurobehavioral sequelae can often be difficult to distinguish from premorbid problems. To establish the early neurobehavioral consequences of TBI, we compared a cohort of brain injured children with controls, individually matched on premorbid characteristics. Ninety-eight children, aged 6 to 15 years, with mild, moderate, and severe closed head injuries, were consecutively identified on presentation to two regional medical centers. Individually selected controls were matched for age, gender, school grade, behavior, and academic performance. Intellectual, neuropsychologic, and academic assessments were undertaken 3 weeks after full orientation was achieved. No significant case-control differences were found on 20 variables measuring premorbid status. The pattern of decline in performance with increasing severity of brain injury was consistent for measures assessing intelligence, memory, speeded motor performance, adaptive problem solving, and academic performance. Moderately and severely injured patients performed at normal levels in reference to standardized intellectual norms, but they showed impairment when compared with their matched controls. The impairments uncovered in this study place moderately and severely brain injured children at risk for problems in the acquisition of academic skills and higher-order cognitive abilities.