The association of pre-existing mental health conditions and patient outcomes after lower extremity orthopaedic trauma: a scoping review.

INTRODUCTION: Existing research has established a correlation between post-traumatic mental health conditions, including anxiety and depression, and various aspects of recovery, such as pain exacerbations, reduced functional recovery, and lowered patient satisfaction. However, the influence of pre-existing mental health conditions on orthopaedic trauma outcomes has not been thoroughly investigated. The objective of this study was to systematically review literature addressing the association between pre-existing mental health conditions and patient outcomes following surgical interventions for lower extremity fractures in non-geriatric populations. METHODS: A systematic literature review was conducted using Medline, Embase, and Scopus databases following PRISMA-ScR guidelines to select studies that examined lower extremity orthopaedic trauma outcomes in relation to pre-existing mental health conditions. Studies that evaluated patients with surgically treated lower extremity fractures and a history of mental health conditions such as anxiety, depression, or mood disorders were included. Studies with a mean patient age above 65 years of age were excluded to focus on non-geriatric injury patterns. RESULTS: The systematic review identified 12 studies investigating the relationship between surgical outcomes of orthopaedic lower extremity fractures and pre-existing mental health disorders in non-geriatric populations. Studies included patients with pelvis, femur, tibia, and ankle fractures. A majority (83%) of these studies demonstrated that patients with pre-existing mental health diagnoses had inferior functional outcomes, heightened pain levels, or an increase in postoperative complications. DISCUSSION: The presence of pre-existing mental health conditions, particularly anxiety and depression, may predispose orthopaedic trauma patients to an elevated risk of suboptimal functional outcomes, increased pain, or complications after surgical intervention for lower extremity fractures. Future research should focus on interventions that mitigate the impact of mental health conditions on orthopaedic outcomes and patient wellness in this population.

ASQ3 and/or the Bayley-III to support clinicians' decision making.

BACKGROUND: Appropriate tools are essential to support a clinician's decision to refer very preterm infants to developmental resources. Streamlining the use of developmental assessment or screening tools to make clinical decisions offers an alternative methodology to help to choose the most effective way to assess this very high-risk population. OBJECTIVE: To examine the influence of the Ages and Stages Questionnaire-3rd edition (ASQ3) and the Bayley Scales of Infant Development-3rd edition (Bayley-III) scores within a clinically-based decision-making process. METHODS: This retrospective cohort study includes children born at less than 29 weeks gestation who had completed both psychologist-administered Bayley-III and physician-observed ASQ3 assessments at 18 months corrected age. Theoretical referral decisions (TRDs) based on each assessment results were formulated, using cut-off scores between the lower first and second standard deviation values and below the lower second standard deviation values. TRDs to refer to developmental resources were evaluated in light of the multidisciplinary team's actual final integrated decisions (FID). RESULTS: Complete data was available for 67 children. The ASQ3 and the Bayley-III had similar predictive value for the FID, with comparable kappa values. Comparisons of the physicians' and psychologists' TRDs with the FIDs demonstrated that the ASQ3 in conjunction with the medical and socio-familial findings predicted 93% of referral decisions. CONCLUSION: Taking into consideration potential methodological biases, the results suggest that either ASQ3 or Bayley-III, along with socio-environmental, medical and neurological assessment, are sufficient to guide the majority of clinicians' decisions regarding referral for specialty services. This retrospective study suggests that the physician-supervised ASQ3 may be sufficient to assess children who had been extremely preterm infants for referral purposes. The findings need to be confirmed in a larger, well-designed prospective study to minimize and account for potential sources of bias.

Serum Biomarkers Help Predict Attention Problems in Critically Ill Children With Traumatic Brain Injury.

OBJECTIVE: To evaluate the association between acute serum biomarkers, and the changes in attention at 1 year following traumatic brain injury. DESIGN AND SETTING: A prospective observational and laboratory study conducted in PICUs at five Canadian children's hospitals. STUDY POPULATION AND MEASUREMENTS: Fifty-eight patients aged 5 to 17 years with traumatic brain injury were enrolled in the study. Nine brain-specific and inflammatory serum protein biomarkers were measured multiple times over the first week following injury. Attention was measured at "baseline" to represent pre-injury function and at 1 year following injury using the Conners Third Parent Rating Scale. RESULTS: Compared with baseline, there were significantly more clinical symptoms of inattention at 1 year post injury. The Glasgow Coma Scale score, age at injury, baseline levels of inattention, and highest levels of serum biomarkers were used to estimate the probability of developing inattention. These independent variables were first evaluated individually followed by combinations of the best predictors using area under the receiver operating characteristic curve analyses. A combination of high baseline levels of inattention and high serum levels of the biomarker neuron-specific enolase was the best predictor for inattention. Glasgow Coma Scale and age at injury were not associated with inattention at 1 year post injury. CONCLUSIONS: Combining baseline assessment of attention with measurement of serum biomarkers shows promise as reliable, early predictors of long-term attention after childhood traumatic brain injury.

Continuities and changes in the friendships of children with and without ADHD: a longitudinal, observational study.

We examined how the real-life dyadic friendships of 87 children with ADHD and 46 comparison children (76 % boys) aged 7-13 years evolved during a 6-month follow-up period. The methods included friendship quality self-report measures and direct observation of friends' dyadic behaviors in three structured analogue tasks. At Time 2, the friends of the participants with ADHD reported less positive friendship quality and more conflict with their friends than at Time 1. They were also considerably less satisfied with their friendship than 6 months prior. In contrast, the friends of comparison children reported fewer negative friendship features, more positive friendship features and a slightly greater friendship satisfaction than at Time 1. In sharp contrast with the invited friends' reports, referred children with ADHD did not report deterioration in their friendship quality over time. Unlike comparison children who significantly reduced violations of game rules between Time 1 and Time 2, children with ADHD broke more game rules during the same period. In negotiating with friends, comparison children, but not children with ADHD, reduced the number of self-centered and insensitive proposals at Time 2. Controlling for Time 1 variance, violations of game rules and a self-centered, insensitive negotiation approach predicted deterioration in friendship quality for children with and without ADHD over time.

How do children with ADHD (mis)manage their real-life dyadic friendships? A multi-method investigation.

This multimethod study provides detailed information about the friendships of 87 children (76% boys) with ADHD and 46 comparison children aged 7-13 years. The methods included parent and teacher ratings, self-report measures and direct observation of friends' dyadic behaviors in three structured analogue tasks. Results indicated that, in contrast with comparison children, children with ADHD had friends with high levels of ADHD and oppositional symptoms; they perceived fewer positive features and more negative features, and were less satisfied in their friendships. Observational data indicated that children with ADHD performed both more legal and more illegal maneuvers than comparison children in a fast-paced competitive game. While negotiating with their friends, children with ADHD made more insensitive and self-centered proposals than comparison children. In dyads consisting of one child with ADHD and one typically developing child, children with ADHD were often more dominant than their friends.

Cognitive changes in children treated for acute lymphoblastic leukemia with chemotherapy only according to the Pediatric Oncology Group 9605 protocol.

The purpose of this study was to examine cognitive functioning and neuroimaging in children with leukemia treated with the Pediatric Oncology Group 9605 protocol at the Children's Hospital of Eastern Ontario. Mean age at diagnosis was 4.88 +/- 2.54 years. The mean (n = 24) Wechsler Verbal and Performance IQ fell in the low-average range (87.33 +/- 15.69 and 84.83 +/- 19.11, respectively). Mean (n = 20) Verbal and Visual Memory Indexes of 82.95 +/- 15.46 and 88.30+/- 10.80, respectively, were obtained. The proportion of scores on measures of intelligence and memory falling > 1 SD below the normative mean was substantially higher than expected. Paired t-test suggested that Wechsler Verbal IQ and memory remained stable, whereas Wechsler Performance IQ declined significantly. The results of growth curve analyses replicated these findings and suggested a significant adverse effect of cumulative dosage of intrathecal methotrexate on estimated Wechsler Performance IQ. Although only two children experienced seizures, 78% of the group showed leukoencephalopathy on at least one magnetic resonance image. Reliance on seizures as a predictor of leukoencephalopathy might underestimate the incidence of neurotoxicity.

Medical and cognitive outcome in children with traumatic brain injury.

BACKGROUND: Head injury is an important cause of morbidity and mortality in pediatrics. Comprehensive studies on outcome are scarce despite significant clinical concern that multiple areas of functioning may be impaired following moderate to severe head injury. The literature suggests that sequelae include not only medical problems but also impairments in cognitive functioning. METHODS: A retrospective medical and psychology chart review of patients, age 1-18 years, admitted to the Children's Hospital of Eastern Ontario with moderate (Glasgow Coma Scale [GCS] 9-12) or severe head injury (GCS < or = 8) from November 1, 1993 until December 31, 1998 was conducted. Correlations were performed between medical variables (i.e., GCS, Pediatric Risk of Mortality [PRISM] III score, duration of ICU and hospital stay) and measures of intelligence and memory functioning. RESULTS: Eighty-three children age 1 to 18 were included. Seventy percent of the children were classified as having a severe head injury. There was a mortality rate of thirteen percent. Younger age at injury, lower GCS, and higher PRISM III scores predicted higher mortality. Medical complications were documented systematically. Forty-four patients underwent at least one cognitive assessment and 17 of these children had intelligence testing at three points in time: baseline (< four months), early recovery (five to 15 months) and follow-up (16 to 38 months). The mean intelligence and memory scores fell within the average range at the latest point in follow-up. For those children who underwent three serial assessments, the mean verbal and performance IQ fell within the low average range at baseline improving significantly to fall within the average range by early recovery. Continued improvements were apparent in verbal memory beyond early recovery, with the mean obtained at follow-up falling within 1 SD of the normative mean. Despite the return to normal ranges for the group means the proportion of scores falling below 1.5 standard deviations from the mean was greater than population norms for verbal IQ, performance IQ and verbal memory. Lower GCS scores and longer duration of stay in ICU or hospital were predictive of lower nonverbal intelligence. Lower GCS was also predictive of lower visual memory scores. CONCLUSIONS: This study describes a population of Canadian children who suffered moderate or severe traumatic brain injury. Initial GCS was the best predictor of mortality and cognitive outcome. These children demonstrated a temporal improvement in intelligence and memory functioning, with their mean performance on these cognitive measures falling within the average range at 16 to 38 months postinjury, although there was considerable variability in the outcomes between individuals.

Predictors of intellectual function after a unilateral cortical lesion: study of 635 patients from infancy to adulthood.

This study investigated potential predictors of intellectual outcome in 417 children and 218 adults who had sustained a unilateral cortical lesion. Of these, 295 cases were collected from the scientific literature and 340 from medical records at seven hospitals in Canada Different sets of predictors emerged for the Wechsler Verbal and Performance IQ values, accounting for differing variances (i.e., 12.4% and 20.1%, respectively). The volume of the lesion was the factor that explained the most variance (i.e., 4.95% and 11.7%, respectively). Age at lesion onset was significantly and positively correlated with verbal intelligence scores. This variable, considered independently or in interaction with other predictors, did not account for a large portion of the variance explained in intelligence. This refutes the commonly held notion that early onset of the insults results in a better prognosis.

Psychosocial functioning following surgical treatment for intractable epilepsy in childhood.

METHODS: Psychosocial functioning was examined in 13 children who had undergone surgical treatment for intractable epilepsy. The ratings of each child's social, emotional and behavioural problems were obtained via parent and teacher reports made an average of 2 years post-operatively. RESULTS: Parents viewed their children as having greater social difficulties than reported in standardisation samples. Although the overall level of difficulty fell below clinically significant cut-offs, the proportion of children who were rated as having clinically significant levels of difficulties approached significance. Teachers rated these children as displaying more symptoms of anxiety and depression, although the levels remained subclinical. DISCUSSION: These results are discussed in view of the complex interaction between neurological and environmental variables involved in social-emotional functioning following surgical treatment for epilepsy.

Cognitive sequelae in children with posterior fossa tumors.

Late effects of radiotherapy on intellectual functioning have been well documented in children treated for posterior fossa tumors. Other aspects of cognitive functioning, such as memory, have not been adequately assessed in this population. This retrospective review reports on 15 children diagnosed with medulloblastoma or cerebellar astrocytoma who were administered a norm-referenced standardized test of memory functioning (i.e., Wide Range Assessment of Memory and Learning) an average of 3.5 years after treatment. Analyses revealed that sample means of IQ and memory were significantly lower than those of the normative population. No significant differences were found between the verbal and nonverbal IQ, or verbal and visual memory. Age at diagnosis accounted for a significant proportion of variability in the intelligence ratings but not in the memory indexes. The IQ scores of children less than 6 years of age at diagnosis were significantly lower than those of children diagnosed when over 6 years of age. Given the substantial variability within the older age group, there was insufficient power to detect true differences between memory index means for children by age at diagnosis. Follow-up assessments over 5 years may better identify the long-term effects of radiotherapy on memory functioning.

Are there changes in intelligence and memory functioning following surgery for the treatment of refractory epilepsy in childhood?

MATERIALS AND METHODS: A retrospective review of the neuropsychological and medical variables of 26 children who underwent a cortical resection as part of the management of their medically refractory epilepsy was conducted. Neuropsychological variables included pre- and postoperative measures of intelligence (Wechsler Scales) and memory functioning (Wide Range Assessment of Memory and Learning). Medical variables included age at onset of seizures, age at surgery, site of resection, and degree of seizure control postoperatively. RESULTS: Twenty patients had temporal resections (13 left-sided). Six had extratemporal resections. In this series, cortical resection as treatment of epilepsy in children did not result in a significant change in performance on measures of intelligence or memory functioning. No significant correlation was found between the medical variables and the neuropsychological outcome.