***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE . We examined whether mild traumatic brain injuries in children and adolescents , especially when associated with acute clinical features reflecting more severe injury , result in different postinjury trajectories of postconcussive symptoms compared with mild orthopedic injuries . PARTICIPANTS AND METHODS . Participants in this prospect i ve and longitudinal cohort study were 8- to 15-year-old children , 186 with mild traumatic brain injuries and 99 with mild orthopedic injuries , who were recruited from consecutive admissions to emergency departments in 2 large children 's hospitals . Parents rated current postconcussive symptoms within 3 weeks of injury and at 1 , 3 , and 12 months after injury . At the initial assessment , parents also provided retrospective ratings of preinjury symptoms , and children with mild traumatic brain injuries received MRI of the brain . Clinical features examined as predictors of postconcussive symptoms included loss of consciousness , Glasgow Coma Scale score below 15 , other injuries , acute symptoms of concussion , and intracranial abnormalities on the MRI . RESULTS . Finite mixture modeling identified 4 longitudinal trajectories of postconcussive symptoms ( ie , no postconcussive symptoms , moderate persistent postconcussive symptoms , high acute/resolved postconcussive symptoms , high acute/persistent postconcussive symptoms ) . The mild traumatic brain injuries and orthopedic injuries groups demonstrated a different distribution of trajectories .  Children with mild traumatic brain injuries were more likely than those with orthopedic injuries to demonstrate high acute/resolved and high acute/persistent trajectories relative to the no postconcussive symptoms group . The 2 trajectories with high acute levels of postconcussive symptoms were especially likely among children with mild traumatic brain injuries whose acute clinical presentation reflected more severe injury . CONCLUSIONS . Mild traumatic brain injuries , particularly those that are more severe , are more likely than orthopedic injuries to result in transient or persistent increases in postconcussive symptoms in the first year after injury . Additional research is needed to eluci date the range of factors , both injury related and non – injury related , that place some children with mild traumatic brain injuries at risk for postconcussive symptoms OBJECTIVES This study of concussed adolescents sought to determine if a computer-based neurocognitive assessment ( Immediate Postconcussion Assessment and Cognitive Test [ ImPACT ] ) performed on patients who present to the emergency department ( ED ) immediately following head injury would correlate with assessment s performed 3 to 10 days postinjury and if ED neurocognitive testing would detect differences in concussion severity that clinical grading scales could not . METHODS A prospect i ve cohort sample of patients 11 to 17 years of age presenting to the ED within 12 hours of a head injury were evaluated using two traditional concussion grading scales and neurocognitive testing .  ED neurocognitive scores were compared to follow-up scores obtained at least 3 days postinjury . Postconcussive symptoms , outcomes , and complications were assessed via telephone follow-up for all subjects . RESULTS Sixty patients completed phone follow-up . Thirty-six patients ( 60 % ) completed follow-up testing a median of 6 days postinjury . Traditional concussion grading did not correlate with neurocognitive deficits detected in the ED or at follow-up . For the neurocognitive domains of verbal memory , processing speed , and reaction time , there was a significant correlation between ED and follow-up scores trending toward clinical improvement . By 2 weeks postinjury , 23 patients ( 41 % ) had not returned to normal activity . At 6 weeks , six patients ( 10 % ) still had not returned to normal activity . CONCLUSIONS Immediate assessment in the ED can predict neurocognitive deficits seen in follow-up and may be potentially useful to individualize management or test therapeutic interventions . Neurocognitive assessment in the ED detected deficits that clinical grading could not and correlated with deficits at follow-up Childhood traumatic brain injury ( TBI ) is a common , acquired disability , which has significant implication s for subsequent development , and for later quality of life . To date few studies have documented outcomes in these children into adolescence , when academic , social and personal dem and s increase . The objective of this study was to document functional outcomes at 10 years post-injury , and to identify predictors of outcome including injury , socio-demographic and pre-injury characteristics . The study employed consecutive recruitment to a prospect i ve , longitudinal study . Children with a diagnosis of TBI between 2 and 12 years were initially recruited and divided according to injury severity ( mild , moderate , severe ) . The sample was review ed at 10 years post-injury and intellectual , adaptive , executive and social domains were investigated . Results indicated that , at 10 years post child TBI , survivors ' functional abilities fell overall within the low average to average range regardless of injury severity , suggesting no extreme impairments at a group level for any of the domains under investigation . Significant group differences were identified , though , for adaptive abilities and for speed of processing , with more severe injury associated with poorer performances in each instance . Further , a similar trend was identified for measures of intellectual ability and executive functions . Individual rates of impairment were considerably higher than population expectations across all severity groups for these domains . Although rates of social impairment were also elevated , they were less related to injury factors , suggesting that cognitive/adaptive outcomes and social consequences of TBI may have different bases Primary objective : Comparison of healthcare costs for youth with mild traumatic brain injuries ( TBIs ) to costs in a matched cohort of children without TBI in the 3 years following injury . Research design : This study used a prospect i ve cohort design with 3-year follow-up . Costs were examined using the well-established two-step model and controlling for potential confounding variables . Methods and procedures : Four-hundred and ninety subjects from a large health maintenance organization , 14 years old or younger , who sustained a mild TBI in 1993 , were identified using computerized records . For each youth with mild TBI , three control subjects were selected ( n = 1470 ) , matched on age , sex and enrolment at the time of injury . Experimental interventions : Not applicable . Main outcomes and results : TBI exposure was associated with an increase in the proportion of subjects who had non-zero medical costs in all categories examined and a 75 % increase in mean total costs . Presence of psychological distress was also associated with increased proportion of subjects with costs in all categories examined and was associated with an approximate doubling of mean total costs . Conclusions : Mild TBI and psychological distress were each associated with significant increases in healthcare costs in an HMO setting Objective : To test the feasibility of  inpatient neurocognitive testing  and measure the degree of disability in children hospitalized with mild traumatic brain injury ( MTBI ) . Summary Background Data : MTBI is common in the pediatric population . A st and ardized approach to identify neurocognitive impairment and determine optimal time to return to exertional activities ( eg , school , sports ) is lacking . Methods : For a 2-year period , children ( age : 11–17 years ) hospitalized at a level 1 urban Pediatric Trauma Center with MTBI were prospect ively enrolled .  Neurocognitive performance was assessed utilizing previously vali date d computer-based tests ( Immediate Postconcussion Assessment and Cognitive Testing ) as inpatient and in follow-up clinic after discharge . The feasibility of inpatient testing and the degree neurocognitive impairment and symptomatology were assessed . This study was approved by the IRB and registered with clinical trials.gov ( NCT00715949 ) . Results : For the 2 years of study , 116 subjects were prospect ively enrolled and tested . The population had a mean age of 14 years and 69.8 % were male . On initial in-hospital testing , the overall population demonstrated considerable neurocognitive deficits ( mean values for all 4 subtests below 25th percentile , norm 50 % ) with at least one subtest score below 25 % in 95.7 % and an abnormal symptom score in 83.4 % of patients . In comparing initial testing to follow-up testing ( N = 63 ) , significant improvements were noted for all subtests ( verbal memory : 28.0 % vs. 37.5 % , respectively , norm 50 % , P = 0.02 ; visual memory : 24.9 % vs. 38.1 % , respectively , norm 50 % , P < 0.01 ; visual motor : 21.8 % vs. 31.1 % , respectively , norm 50 % , P = 0.01 ; reaction time : 21.8 % vs. 30.3 % , respectively , norm 50 % , P = 0.05 ) , with a decline in the symptom score ( 26.9 vs. 9.2 , respectively , norm 0 - 8 , P < 0.01 ) as well . Patients not seen in follow-up ( N = 53 ) did not differ demographically from those seen in clinic . Conclusions : Inpatient neurocognitive testing was feasible in pediatric MTBI patients .  Neurocognitive abnormalities were nearly universally present on initial evaluation with significant improvements demonstrated at the time of outpatient follow-up . Return to activity recommendations are thus best deferred for most hospitalized MTBI children until formal assessment can be performed after discharge The degree to which postinjury posttraumatic stress disorder ( PTSD ) and /or depressive symptoms in adolescents are associated with cognitive and functional impairments at 12 and 24 months after traumatic brain injury ( TBI ) is not yet known . The current study used a prospect i ve cohort design , with baseline assessment and 3- , 12- , and 24-month followup , and recruited a cohort of 228 adolescents ages 14 - 17 years who sustained either a TBI ( n = 189 ) or an isolated arm injury ( n = 39 ) . Linear mixed-effects regression was used to assess differences in depressive and PTSD symptoms between TBI and arm-injured patients and to assess the association between 3-month PTSD and depressive symptoms and cognitive and functional outcomes . Results indicated that patients who sustained a mild TBI without intracranial hemorrhage reported significantly worse PTSD ( Hedges g = 0.49 , p = .01 ; Model R(2 ) = .38 ) symptoms across time as compared to the arm injured control group . Greater levels of PTSD symptoms were associated with poorer school ( η(2 ) = .07 , p = .03 ; Model R(2 ) = .36 ) and physical ( η(2 ) = .11 , p = .01 ; Model R(2 ) = .23 ) functioning , whereas greater depressive symptoms were associated with poorer school ( η(2 ) = .06 , p = .05 ; Model R(2 ) = .39 ) functioning OBJECT The aim of this study was to determine whether the presence of intracranial pathophysiology on computed tomography ( CT ) scans obtained within 24 hours of  mild traumatic brain injury ( MTBI ) in children adversely affects neuropsychological outcome during the 1st year postinjury . METHODS A prospect i ve longitudinal design was used to examine the neuropsychological outcomes in children ( ages 5 - 15 years ) who had been treated for MTBI , which was defined as a loss of consciousness for up to 30 minutes and a lowest Glasgow Coma Scale ( GCS ) score of 13 - 15 . Exclusion criteria included any preinjury neurological disorder . Outcome assessment s were performed within 2 weeks and at 3 , 6 , and 12 months postinjury . Outcomes were compared between patients with MTBI  whose postinjury CT scans revealed complications of brain pathophysiology ( 32 patients , CMTBI group ) and those with MTBI but without complications ( 48 patients , MTBI group ) . RESULTS Significant interactions confirmed that the pattern of recovery over 12 months after injury differed depending on the intracranial pathology , presence and severity of injuries to body regions other than the head , preinjury attention-deficit hyperactivity disorder ( ADHD ) , and socioeconomic status . Children in the CMTBI group had significantly poorer episodic memory , slower cognitive processing , diminished recovery in managing cognitive interference , and poorer performance in calculating and reading than patients in the MTBI group . Among the patients with mild or no extracranial injury , visuomotor speed was slower in those in the CMTBI group ; and among patients without preinjury ADHD , working memory was worse in those in the CMTBI group . CONCLUSIONS Neuropsychological recovery during the 1st year following MTBI is related to the presence of radiographically detectable intracranial pathology . Children with intracranial pathology on acute CT performed more poorly in several cognitive domains when compared with patients whose CT findings were normal or limited to a linear skull fracture . Depending on the presence of preinjury ADHD and concomitant extracranial injury , working memory and visuomotor speed were also diminished in patients whose CT findings revealed complications following MTBI . Computed tomography within 24 hours postinjury appears to be useful for identifying children with an elevated risk for residual neuropsychological changes The occurrence of postconcussive symptoms ( PCS ) following mild traumatic brain injury ( TBI ) in children may depend on cognitive reserve capacity . This prospect i ve , longitudinal study examined whether the relationship between mild TBI and PCS is moderated by cognitive ability , which served as a proxy for cognitive reserve . Participants included 182 children with mild TBI and 99 children with orthopedic injuries ( OI ) , r 
    Output:
    
CONCLUSIONS The results suggest that not all children with mild or moderate TBI  recover without long-term problems .
Few studies followed children and adolescents with mild TBIs for extended periods of time , although it is clinical ly important to monitor patients over time