IQ After Pediatric Concussion

Ashley L Ware; Matthew J W McLarnon; Andrew P Lapointe; Brian L Brooks; Ann Bacevice; Barbara A Bangert; Miriam H Beauchamp; Erin D Bigler; Bruce Bjornson; Daniel M Cohen; William Craig; Quynh Doan; Stephen B Freedman; Bradley G Goodyear; Jocelyn Gravel; H Leslie K Mihalov; Nori Mercuri Minich; H Gerry Taylor; Roger Zemek; Keith Owen Yeates; Pediatric Emergency Research Canada A-CAP Study Group

doi:10.1542/peds.2022-060515

IQ After Pediatric Concussion

Pediatrics. 2023 Aug 1;152(2):e2022060515. doi: 10.1542/peds.2022-060515.

Authors

Ashley L Ware^{1

2

3

4}, Matthew J W McLarnon⁵, Andrew P Lapointe^{4

6}, Brian L Brooks^{4

7}, Ann Bacevice⁸, Barbara A Bangert⁸, Miriam H Beauchamp⁹, Erin D Bigler^{2

10}, Bruce Bjornson^{11

12}, Daniel M Cohen¹³, William Craig¹⁴, Quynh Doan¹², Stephen B Freedman¹⁵, Bradley G Goodyear⁶, Jocelyn Gravel¹⁶, H Leslie K Mihalov¹³, Nori Mercuri Minich^{8

17}, H Gerry Taylor¹³, Roger Zemek¹⁸, Keith Owen Yeates^#^{3

4}; Pediatric Emergency Research Canada A-CAP Study Group

Affiliations

¹ Department of Psychology, Georgia State University, Atlanta, Georgia.
² Department of Neurology, University of Utah, Salt Lake City, Utah.
³ Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
⁴ Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
⁵ Department of General Management and Human Resources, Bissett School of Business, Mount Royal University, Calgary, Alberta, Canada.
⁶ Department of Radiology, University of Calgary, Calgary, Alberta, Canada.
⁷ Neurosciences Program, Alberta Children's Hospital, Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Alberta, Canada.
⁸ Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio.
⁹ Department of Psychology, University of Montreal and CHU Sainte-Justine Hospital Research Center, Montréal, Québec, Canada.
¹⁰ Department of Psychology, Brigham Young University, Provo, Utah.
¹¹ Division of Neurology.
¹² Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
¹³ Abigail Wexner Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, The Ohio State University, Columbus, Ohio.
¹⁴ University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada.
¹⁵ Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹⁶ Department of Pediatric Emergency Medicine; CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Montréal, Québec, Canada.
¹⁷ Rainbow Babies & Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
¹⁸ Departments of Pediatrics and Emergency Medicine, University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.

^# Contributed equally.

Abstract

Objectives: This study investigated IQ scores in pediatric concussion (ie, mild traumatic brain injury) versus orthopedic injury.

Methods: Children (N = 866; aged 8-16.99 years) were recruited for 2 prospective cohort studies from emergency departments at children's hospitals (2 sites in the United States and 5 in Canada) ≤48 hours after sustaining a concussion or orthopedic injury. They completed IQ and performance validity testing postacutely (3-18 days postinjury; United States) or 3 months postinjury (Canada). Group differences in IQ scores were examined using 3 complementary statistical approaches (linear modeling, Bayesian, and multigroup factor analysis) in children performing above cutoffs on validity testing.

Results: Linear models showed small group differences in full-scale IQ (d [95% confidence interval] = 0.13 [0.00-0.26]) and matrix reasoning (0.16 [0.03-0.30]), but not in vocabulary scores. IQ scores were not related to previous concussion, acute clinical features, injury mechanism, a validated clinical risk score, pre- or postinjury symptom ratings, litigation, or symptomatic status at 1 month postinjury. Bayesian models provided moderate to very strong evidence against group differences in IQ scores (Bayes factor 0.02-0.23). Multigroup factor analysis further demonstrated strict measurement invariance, indicating group equivalence in factor structure of the IQ test and latent variable means.

Conclusions: Across multisite, prospective study cohorts, 3 complementary statistical models provided no evidence of clinically meaningful differences in IQ scores after pediatric concussion. Instead, overall results provided strong evidence against reduced intelligence in the first few weeks to months after pediatric concussion.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Bayes Theorem
Brain Concussion* / diagnosis
Brain Concussion* / epidemiology
Canada
Child
Humans
Post-Concussion Syndrome*
Prospective Studies
Risk Factors

Grants and funding

R01 HD076885/HD/NICHD NIH HHS/United States