Concussive Symptoms Following Pediatric Mild Traumatic Brain Injury

Abstract

Objectives: To determine the proportion of children with postconcussive symptoms (PCSs) and to explore the influence of noninjury and injury factors on parents' PCS report at 3 months postinjury. Design: A cross-sectional analysis of the 3-month postinjury data from a larger, prospective, longitudinal study. Methods: Parents and their child aged 2 to 12 years who presented at the emergency department with either a mild traumatic brain injury (mTBI) or a superficial injury to the head (SIH) were recruited. Parents reported their child's symptoms at the time of injury and at 3 months postinjury. Child, family/parent, and injury characteristics were considered as potential predictors. Logistic regression was conducted to determine which factors increase the likelihood of parents' PCS report. Results: At 3 months postinjury, 30% and 13% of children in the mTBI and SIH groups exhibited 1 or more symptoms, respectively. On the other hand, 18% (mTBI) and 8% (SIH) continued to have ongoing problems when 2 or more symptoms were considered at follow-up. The final model, which included child's sex, injury group, number of symptoms at the time of injury, and parental stress, had a significant predictive utility in determining parents' report of 1 or more symptoms at follow-up. Only parental stress continued to be a significant predictor when considering 2 or more symptoms at 3 months postinjury. Conclusions: Children with mTBI have worse outcomes than children with SIH at follow-up, with parents more likely to report 1 or more ongoing symptoms if their children had an mTBI. Postinjury assessment of parental stress and ongoing symptom monitoring in young children with mTBI will allow for timely provision of support for the family.

Characteristics of Pediatric Mild Traumatic Brain Injury and Recovery in a Concussion Clinic Population

“…Studying children and adolescents from outpatient subspecialty concussion clinics captures a different sample of patients than those from the ED 4,17 or athletics. 18,19 A 2013 multisite study of mild TBI based in the ED 20 recruited patients with more severe or highly symptomatic initial injuries, 5,6,20,[22][23][24] Another important characteristic of the 4CYC cohort was that a substantial proportion of patients were preadolescent, while many earlier studies, particularly in sports-related TBI, have focused primarily on high school-aged youth. 18,[25][26][27] The inclusion of younger children with mild TBI can help us determine age-specific differences in symptom presentation and recovery.…”

“…Studies in ED patients and youths with sports-related mild TBI have reported a relatively rapid recovery in most individuals, with a much smaller proportion of patients reporting ongoing symptoms at 1 month 7,21 or 3 months. 5,6,20,[22][23][24] Another important characteristic of the 4CYC cohort was that a substantial proportion of patients were preadolescent, while many earlier studies, particularly in sports-related TBI, have focused primarily on high school-aged youth. 18,[25][26][27] The inclusion of younger children with mild TBI can help us determine age-specific differences in symptom presentation and recovery.…”

“…Conversely, a 2010 study of youth sport-related mild TBI acquired data through school-based athletic trainers, resulting in patients with injuries who often do not present for care at an outpatient concussion clinic or ED. Studies in ED patients and youths with sports-related mild TBI have reported a relatively rapid recovery in most individuals, with a much smaller proportion of patients reporting ongoing symptoms at 1 month or 3 months …”

Applicability and clinical utility of the German rivermead post-concussion symptoms questionnaire in proxies of children after traumatic brain injury: an instrument validation study

“…While proxy ratings are commonly used to assess children's mental health status and neuropsychiatric outcomes after pTBI, parent-child agreement for PCS are modest, with children generally reporting more severe symptoms [39]. In fact, research has suggested that parents' proxy ratings of persistent PCS after pTBI were more strongly associated with parental stress than with the severity of the children's injuries [67]. Since RPQ self-report assessments were found to have excellent properties in adult [14,15] and adolescent [25] populations, the use of RPQ self-reports with age-appropriate item wordings for younger children should be preferred.…”

MR Elastography demonstrates reduced white matter shear stiffness in early-onset hydrocephalus

“…Looking at the different findings from our two models, it is clear that the sex effect sizes were significantly increased when considering patients only, so this sex difference may be specific to our patient population. Within the general context of brain injury, it is generally accepted that women are more susceptible to injury and worse outcome ( Cogan et al, 2020 , Merritt et al, 2019 , Yue et al, 2019 , Manley et al, 2017 , Cheng et al, 2019 , Yumul et al, 2020 ), although a number of recent studies have begun to question this conclusion ( Mollayeva et al, 2018 , Choleris et al, 2018 ). Of course, these results have to be viewed with caution given the relatively small size of our study.…”