Persistent Postconcussion Symptoms After Injury

PCSs failed to resolve in a striking number of children with mTBI; 40%, especially girls, continued to act differently 1 year after injury. BrightcoveDefaultPlayer10.1542/6138657590001PEDS-VA_2018-0939 Video Abstract OBJECTIVES: We examined whether preinjury, demographic, and family factors influenced vulnerability to postconcussion symptoms (PCSs) persisting the year after mild traumatic brain injury (mTBI). METHODS: Children with mTBI (n = 119), complicated mild traumatic brain injury (cmTBI) (n = 110), or orthopedic injury (OI) (n = 118), recruited from emergency departments, were enrolled in a prospective, longitudinal cohort study. Caregivers completed retrospective surveys to characterize preinjury demographic, child, and family characteristics. PCSs were assessed using a validated rating scale. With multivariable general linear models adjusted for preinjury symptoms, we examined predictors of PCSs 3, 6, and 12 months after injury in children ages 4 to 8, 9 to 12, and 13 to 15 years at injury. With logistic regression, we examined predictors of chronic PCSs 1 year after traumatic brain injury. RESULTS: Postinjury somatic, emotional, cognitive, and fatigue PCSs were similar in the mTBI and cmTBI groups and significantly elevated compared with the OI group. PCS trajectories varied with age and sex. Adolescents had elevated PCSs that improved; young children had lower initial symptoms and less change. Despite similar preinjury PCSs, girls had elevated symptoms across all time points compared with boys. PCS vulnerability factors included female sex, adolescence, preinjury mood problems, lower income, and family discord. Social capital was a protective factor. PCSs persisted in 25% to 31% of the traumatic brain injury group and 18% of the OI group at 1 year postinjury. The odds of chronic PCSs were almost twice as high in girls as in boys and were >4 times higher in young children with cmTBI than in those with mTBI. CONCLUSIONS: A significant minority of children with mTBI and OI have PCSs that persisted 1 year after injury.

[1]  G. Gioia,et al.  Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children , 2018, JAMA pediatrics.

[2]  Likang Xu,et al.  The Epidemiology of Pediatric Head Injury Treated Outside of Hospital Emergency Departments , 2017, Epidemiology.

[3]  M. Vavilala,et al.  Racial Disparities in Outpatient Mental Health Service Use Among Children Hospitalized for Traumatic Brain Injury , 2017, The Journal of head trauma rehabilitation.

[4]  T. Covassin,et al.  Sex differences in sport-related concussion long-term outcomes. , 2017, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[5]  Paul J. Gubanich,et al.  Structural Connectivity Related to Persistent Symptoms After Mild TBI in Adolescents and Response to Aerobic Training: Preliminary Investigation , 2017, The Journal of head trauma rehabilitation.

[6]  L. Ewing-Cobbs,et al.  Altered stress system reactivity after pediatric injury: Relation with post-traumatic stress symptoms , 2017, Psychoneuroendocrinology.

[7]  A. Zeleznik,et al.  Association of Concussion With Abnormal Menstrual Patterns in Adolescent and Young Women , 2017, JAMA pediatrics.

[8]  F. Babl,et al.  Trajectories and Risk Factors for Post-Traumatic Stress Symptoms following Pediatric Concussion. , 2017, Journal of neurotrauma.

[9]  B. Albanese,et al.  Anxiety sensitivity mediates gender differences in post-concussive symptoms in a clinical sample , 2017, Psychiatry Research.

[10]  Allen K. Sills,et al.  Predictors of clinical recovery from concussion: a systematic review , 2017, British Journal of Sports Medicine.

[11]  A. Mayer,et al.  What is the physiological time to recovery after concussion? A systematic review , 2017, British Journal of Sports Medicine.

[12]  M. Vavilala,et al.  Utilization of Mental Health Services After Mild Pediatric Traumatic Brain Injury , 2017, Pediatrics.

[13]  G. Gioia,et al.  Association of Persistent Postconcussion Symptoms With Pediatric Quality of Life. , 2016, JAMA pediatrics.

[14]  F. Rivara,et al.  Collaborative Care for Adolescents With Persistent Postconcussive Symptoms: A Randomized Trial , 2016, Pediatrics.

[15]  A. McKinlay,et al.  Predictors of Post-concussive Symptoms in Young Children: Injury versus Non-injury Related Factors , 2016, Journal of the International Neuropsychological Society.

[16]  E. Juarez-Colunga,et al.  Psychological Factors Associated with Delayed Symptom Resolution in Children with Concussion. , 2016, The Journal of pediatrics.

[17]  F. Rivara,et al.  Sports- and Recreation-Related Concussions in US Youth , 2016, Pediatrics.

[18]  Council on Sports Medicine and Fitness , 2016, Pediatric Clinical Practice Guidelines & Policies.

[19]  Blaine Hoshizaki,et al.  Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED. , 2016, JAMA.

[20]  K. Barlow,et al.  The Incidence of Postconcussion Syndrome Remains Stable Following Mild Traumatic Brain Injury in Children. , 2015, Pediatric neurology.

[21]  R. Zafonte,et al.  Factors Associated With Concussion-like Symptom Reporting in High School Athletes. , 2015, JAMA pediatrics.

[22]  James J. McCarthy,et al.  Prevalence and Predictors of Poor Recovery from Mild Traumatic Brain Injury. , 2015, Journal of neurotrauma.

[23]  Matthew T. McCarthy,et al.  Clinical features and biomarkers of concussion and mild traumatic brain injury in pediatric patients , 2015, Annals of the New York Academy of Sciences.

[24]  S. Chapman,et al.  Psychiatric disorders in children and adolescents 24 months after mild traumatic brain injury. , 2015, The Journal of neuropsychiatry and clinical neurosciences.

[25]  Youth Board on Children,et al.  Sports-related concussions in youth: improving the science, changing the culture. , 2014, Military medicine.

[26]  G. Gioia,et al.  Psychometric characteristics of the postconcussion symptom inventory in children and adolescents. , 2014, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[27]  Matthew A. Eisenberg,et al.  Duration and Course of Post-Concussive Symptoms , 2014, Pediatrics.

[28]  T. Koepsell,et al.  Prevalence of and risk factors for poor functioning after isolated mild traumatic brain injury in children. , 2014, Journal of neurotrauma.

[29]  K. Barlow,et al.  Perception of recovery after pediatric mild traumatic brain injury is influenced by the "good old days" bias: tangible implications for clinical practice and outcomes research. , 2014, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[30]  M. Keightley,et al.  Systematic review of the clinical course, natural history, and prognosis for pediatric mild traumatic brain injury: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis. , 2014, Archives of physical medicine and rehabilitation.

[31]  Emmanuel Lagarde,et al.  Specificity of Postconcussion Symptoms at 3 Months After Mild Traumatic Brain Injury: Results From a Comparative Cohort Study , 2014, The Journal of head trauma rehabilitation.

[32]  M. Halstead,et al.  Returning to Learning Following a Concussion , 2013, Pediatrics.

[33]  T. Koepsell,et al.  Disparities in Disability After Traumatic Brain Injury Among Hispanic Children and Adolescents , 2013, Pediatrics.

[34]  M. Sampson,et al.  Prognosticators of persistent symptoms following pediatric concussion: a systematic review. , 2013, JAMA pediatrics.

[35]  Lynn Babcock,et al.  Predicting postconcussion syndrome after mild traumatic brain injury in children and adolescents who present to the emergency department. , 2013, JAMA pediatrics.

[36]  A. Dietrich,et al.  Injury versus noninjury factors as predictors of postconcussive symptoms following mild traumatic brain injury in children. , 2013, Neuropsychology.

[37]  A. Dietrich,et al.  Quality of life in pediatric mild traumatic brain injury and its relationship to postconcussive symptoms. , 2012, Journal of pediatric psychology.

[38]  R. Asarnow,et al.  The UCLA Longitudinal Study of Neurocognitive Outcomes Following Mild Pediatric Traumatic Brain Injury , 2011, Journal of the International Neuropsychological Society.

[39]  Deborah Dewey,et al.  Epidemiology of Postconcussion Syndrome in Pediatric Mild Traumatic Brain Injury , 2010, Pediatrics.

[40]  F. Penedo,et al.  Resiliency in the face of disadvantage: do Hispanic cultural characteristics protect health outcomes? , 2009, Journal of personality.

[41]  D. Nagin,et al.  Longitudinal Trajectories of Postconcussive Symptoms in Children With Mild Traumatic Brain Injuries and Their Relationship to Acute Clinical Status , 2009, Pediatrics.

[42]  Linda Ewing-Cobbs,et al.  Prediction of cognitive sequelae based on abnormal computed tomography findings in children following mild traumatic brain injury. , 2008, Journal of neurosurgery. Pediatrics.

[43]  H. Belanger,et al.  The neuropsychological impact of sports-related concussion: A meta-analysis , 2005, Journal of the International Neuropsychological Society.

[44]  J. Borg,et al.  Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. , 2004, Journal of rehabilitation medicine.

[45]  J. Suhr,et al.  “Expectation as etiology” versus “the good old days”: Postconcussion syndrome symptom reporting in athletes, headache sufferers, and depressed individuals , 2001, Journal of the International Neuropsychological Society.

[46]  C Willmott,et al.  Cognitive and behavioral outcome following mild traumatic head injury in children. , 1999, The Journal of head trauma rehabilitation.

[47]  Desmond K. Runyan,et al.  Children Who Prosper in Unfavorable Environments: The Relationship to Social Capital , 1998, Pediatrics.

[48]  W. Mittenberg,et al.  Postconcussion syndrome occurs in children. , 1997, Neuropsychology.

[49]  Mj Kuiken,et al.  38TH ANNUAL PROCEEDINGS - ASSOCIATION FOR THE ADVANCEMENT OF AUTOMOTIVE MEDICINE , 1994 .

[50]  T. Achenbach.  Manual for the child behavior checklist/4-18 and 1991 profile , 1991 .

[51]  G. Keitner,et al.  THE McMASTER FAMILY ASSESSMENT DEVICE: RELIABILITY AND VALIDITY* , 1985 .

[52]  B. F. Chatterjee,et al.  Abbreviated Injury Scale , 1983 .

[53]  B. Jennett,et al.  Assessment of coma and impaired consciousness. A practical scale. , 1974, Lancet.