Paediatrics (RCH) - Theses
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ItemAnosmia in paediatric traumatic brain injury( 2015)Objective: Paediatric traumatic brain injury (TBI) is a leading cause of childhood disability, and is associated with significant physical, sensory, psychosocial and neuropsychological sequelae. While our knowledge of outcomes after paediatric TBI has expanded over the past 20-30 years little is known about olfactory function outcomes. This is despite the fact that olfactory dysfunction (OD) is known to be common after adult TBI, has poor prognosis for recovery and is associated with significant functional implications in health, safety, and activities of daily living. In adults with TBI, OD has been linked to injury variables including severity, site of impact, neuropathology and skull fracture and to deficits in executive function (EF), with OD suggested as a potential marker of EF deficits following TBI, though little is known about these relationships in paediatric TBI. The overall aim of this thesis was to address the dearth of research in paediatric OD. The study investigated the frequency with which OD occurs following paediatric TBI, and the relationship between OD and injury variables such as severity, fracture, and injury impact. The relationship between olfactory function and EF was examined and recovery of OD documented up to 18 months post injury. Overall, it was hypothesised that children with moderate/severe TBI would demonstrate poorer olfactory function than those with mild TBI and that children with TBI and OD would perform more poorly on measures of EF than those without OD. Method: Thirty-seven children aged 8-16 years with TBI were recruited to our prospective longitudinal study. Olfactory assessment using the University of Pennsylvania Smell Identification Test was conducted at 0-3 months (T1), 8 months (T2) and 18 months (T3) post injury. Children completed EF tests at T2 and parents completed ratings of behavioural EF at T2 and T3. Results: At T1 19% of participants demonstrated impaired olfaction, with 5% classified as anosmic. OD was significantly related to injury severity at T1, with those with moderate/severe TBI showing poorer olfactory function than those with mild TBI. Longitudinal follow-up indicated evidence of recovery in olfactory function at T2, however, only 16% of those with the most severe OD showed recovery to normal olfactory function, with the remainder demonstrating ongoing OD at T3. Occipital site of impact was a significant predictor of olfactory performance at T3. Children with OD showed significantly poorer performance on a single EF measure of fluency at T2 compared to those with normal olfaction. Acute olfactory function did not significantly predict EF outcomes at either 8 or 18 months post injury. Conclusions: OD appears to be relatively common after paediatric TBI, with limited prospects for recovery, consistent with previous adult research. Acute OD was significantly related to injury severity, though those children at greatest risk of poor later olfactory function were those with an occipital site of impact. Evidence for a link between OD and EF was limited and in particular, acute olfactory function did not appear to be an accurate predictor of later EF deficits. Our findings indicate the need for a focus on OD in clinical practice with routine screening and implementation of education and management strategies recommended. There is a need for further longitudinal research in larger cohorts to elucidate further the links between OD and injury variables, identify clinical predictors of OD, and investigate the functional implications for children and adolescents with TBI.