Research Reports - Perception of recovery after pediatric mild traumatic brain injury is influenced by the "Good Old Days" bias

Arch Clin Neuropsychol. 2013 Nov 5

Brooks BL, Kadoura B, Turley B, Crawford S, Mikrogianakis A, Barlow KM

Recovery from mild traumatic brain injury (mTBI) is primarily based on the
resolution of post-concussive symptoms back to a premorbid level. However, the
"good old days" bias means fewer premorbid symptoms are retrospectively recalled,
thus skewing the determination of recovery relative to pre-injury. The objectives
of this study were to investigate the "good old days" bias in pediatric mTBI and
demonstrate the implications of this bias on perceived recovery. Children and
adolescents 2-18 years old (mean = 10.9, SD = 4.4, N = 412) were recruited after
sustaining an mTBI. Ratings of premorbid symptoms were provided: (a) in the
Emergency Department (ED; by parents), (b) retrospectively at a 1-month follow-up
(by parents and adolescents), and (c) retrospectively at a 3-month follow-up (by
parents and adolescents). Parent ratings of premorbid symptoms decreased by 80%
from the ED to 1-month post-injury (p < .001) but were stable from 1 to 3 months
post-injury (p < .05). Adolescents premorbid ratings declined from 1 to 3 months
post-injury. Slow recovery did not have a differential impact on premorbid
reporting. Using premorbid ratings obtained in the ED, instead of retrospective
symptom reporting at the time of follow-up, suggests that a significant minority
of patients believed to be "not recovered" actually have the "same or lower"
symptom ratings at 1 (29%) and 3 months (41%) post-injury compared with before
the injury. The "good old days" bias is present in pediatric mTBI by 1-month
post-injury, influences retrospective symptom reporting, and has measureable
implications for determining recovery in research and clinical practice.

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