METHODS
Participants
Participants were recruited from consecutive presentations to
the emergency departments of 2 major hospitals over a 30-month
period from 1995 to 1997. Human ethics approval was obtained.
The definition of mild TBI used was that adopted by the American
Congress of Rehabilitation Medicine.
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The children were re
-
cruited if they were 6 to 15 years old at the time of injury, spoke
English, and had a history of trauma or acceleration
–
deceleration
movement applied to the head, resulting in loss of consciousness
30 minutes, a period of posttraumatic amnesia (PTA)
24 hours,
and a Glasgow Coma Scale (GCS) score of 13 to 15 on presentation
to the emergency department. A GCS of 13 to 15 means that the
child would have had spontaneous eye opening, obeyed com-
mands, and responded verbally, but possibly in a disoriented,
confused, or inappropriate fashion or with inability to remember
ongoing events. Children with focal neurologic signs or for whom
there was any deterioration or concerns during the period of
observation were excluded from the study. The injuries were those
not considered sufficiently severe to warrant computed tomogra-
phy or magnetic resonance imaging. Children were recruited only
if they had no need for surgery under general anesthesia to avoid
any potential confounding effects of anesthesia. Children with a
history of previous head injury or other psychological or neuro-
logic problems or learning difficulties were not excluded because
these factors have been shown to be associated with poorer out-
comes in some previous studies of mild TBI in children.