Trajectories in health recovery in the 12 months following a mild traumatic brain injury in children: findings from the BIONIC Study

INTRODUCTION: There is growing consensus that adverse child outcomes may be evident in the early recovery phase following mild traumatic brain injury (TBI). However, controversy remains around the nature of children's longer-term recovery. AIM: To examine child cognitive, behavioural and quality-of-life outcomes over 12 months following mild injury, and to identify prognostic factors associated with outcomes. METHODS: A prospective sample of 222 children (aged 2-15 years at injury) with mild TBI was assessed using a cognitive testing battery and parent-report questionnaires at <= 14 days, 1, 6 and/or 12-months post-injury. RESULTS: Parents reported significant improvements in their child's behavioural adjustment between baseline and 6 months (P = 0.003), with further improvements at 12 months following injury (P = 0.001). Cognitive recovery and quality-of-life improvements were more gradual with minimal changes in the first month (P > 0.05), but significant improvements by 12-months post-injury (P = 0.03, P = 0.02, respectively). Time since injury, male gender, living rurally and parent anxiety were associated with extent of recovery beyond the acute period. CONCLUSIONS: Children's recovery from mild TBI continues beyond the initial 6 months following injury. Health-care providers need to be vigilant about the varying trajectories in children's recovery from TBI. On-going monitoring of children following injury will enable timely and proactive responses to persistent difficulties, with a view to minimising longer-term adverse consequences.