Natural Progression of Symptom Change and Recovery From Concussion in a Pediatric Population

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Abstract

The natural progression of symptom change and recovery remains poorly defined in children after concussion.

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Most cited references 39

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Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED.

Roger Zemek, Nick Barrowman, Stephen B. Freedman … (2016)

Approximately one-third of children experiencing acute concussion experience ongoing somatic, cognitive, and psychological or behavioral symptoms, referred to as persistent postconcussion symptoms (PPCS). However, validated and pragmatic tools enabling clinicians to identify patients at risk for PPCS do not exist.

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Epidemiology of postconcussion syndrome in pediatric mild traumatic brain injury.

K M Barlow, S. Crawford, A. Stevenson … (2010)

Much disagreement exists as to whether postconcussion syndrome (PCS) is attributable to brain injury or to other factors such as trauma alone, preexisting psychosocial problems, or medicolegal issues. We investigated the epidemiology and natural history of PCS symptoms in a large cohort of children with a mild traumatic brain injury (mTBI) and compared them with children with an extracranial injury (ECI). This investigation was a prospective, consecutive controlled-cohort study of 670 children who presented to a tertiary referral emergency department with mTBI and 197 children who presented with ECI. For all participants, data were collected by use of a telephone interview of a parent 7 to 10 days after injury. If a change from preinjury symptoms was reported by a parent, follow-up continued monthly until symptom resolution. Outcomes were measured by using the Post Concussion Symptom Inventory, Rivermead Postconcussion Symptom Questionnaire, Brief Symptom Inventory, and Family Assessment Device. There was a significant difference between the mTBI and ECI groups in their survival curves for time to symptom resolution (log rank [Mantel-Cox] 11.15, P < .001). Three months after injury, 11% of the children in the mTBI group were symptomatic (13.7% of children older than 6 years) compared with 0.5% of the children in the ECI group. The prevalence of persistent symptoms at 1 year was 2.3% in the mTBI group and 0.01% in the ECI group. Family functioning and maternal adjustment did not differ between groups. Among school-aged children with mTBI, 13.7% were symptomatic 3 months after injury. This finding could not be explained by trauma, family dysfunction, or maternal psychological adjustment. The results of this study provide clear support for the validity of the diagnosis of PCS in children.

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The role of age and sex in symptoms, neurocognitive performance, and postural stability in athletes after concussion.

Tracey Covassin, R.J. Elbin, William Harris … (2012)

Researchers have begun to focus on age and sex differences in concussion outcomes. Results suggest that younger athletes and female athletes may take longer to recover from a concussion. However, little is known about the interactive effects of age and sex on symptoms, neurocognitive testing (NCT), and postural stability. The purpose of the study was to examine sex and age differences in symptoms, NCT, and postural stability following concussion. We hypothesized that high school and female athletes would have worse symptoms, NCT, and postural stability than college and male athletes, respectively. Cohort study; Level of evidence, 2. A total of 296 concussed athletes from a multistate, 2-year study were enrolled in this study. Participants completed the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) and Post-Concussion Symptom Scale (PCSS) at baseline and again at 2, 7, and 14 days after concussion. Participants completed the Balance Error Scoring System (BESS) at 1, 2, and 3 days after concussion. Female athletes performed worse than male athletes on visual memory (mean, 65.1% and 70.1%, respectively; P = .049) and reported more symptoms (mean, 14.4 and 10.1, respectively) after concussion (P = .035). High school athletes performed worse than college athletes on verbal (mean, 78.8% and 82.7%, respectively; P = .001) and visual (mean, 65.8% and 69.4%, respectively; P = .01) memory. High school athletes were still impaired on verbal memory 7 days after concussion compared with collegiate athletes (P = .001). High school male athletes scored worse on the BESS than college male athletes (mean, 18.8 and 13.0, respectively; P = .001). College female athletes scored worse on the BESS than high school female athletes (mean, 21.1 and 16.9, respectively; P = .001). The results of the current study supported age differences in memory and sex differences in memory and symptoms and an interaction between age and sex on postural stability after concussion that warrant consideration from clinicians and researchers when interpreting symptoms, specific components of NCT, and postural stability tests. Future research should develop and assess interventions tailored to age and sex differences and include younger (<14 years) participants.

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Author and article information

Journal

Title: JAMA Pediatrics

Abbreviated Title: JAMA Pediatr

Publisher: American Medical Association (AMA)

ISSN (Print): 2168-6203

Publication date (Electronic): November 05 2018

Page: e183820

Affiliations

[1 ]Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada

[2 ]Department of Psychology, University of Calgary, Calgary, Alberta, Canada

[3 ]Department of Pediatrics, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada

[4 ]Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada

[5 ]Department of Emergency Medicine, New York University School of Medicine, New York

[6 ]Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada

[7 ]Department of Pediatrics, Stollery Children’s Hospital, Edmonton, Alberta, Canada

[8 ]Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada

[9 ]Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Center, Montreal, Quebec, Canada

[10 ]Children’s National Health System, George Washington University School of Medicine, Rockville, Maryland

[11 ]Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada

Article

DOI: 10.1001/jamapediatrics.2018.3820

PMC ID: 6583432

PubMed ID: 30398522

SO-VID: bd93f1d9-df0e-4566-8ee6-dd0aa1a646a9

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Natural Progression of Symptom Change and Recovery From Concussion in a Pediatric Population

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Pediatric Pulse: Advancing Neonatal and Child Health

Most cited references 39

Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED.

Epidemiology of postconcussion syndrome in pediatric mild traumatic brain injury.

The role of age and sex in symptoms, neurocognitive performance, and postural stability in athletes after concussion.

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