Duration and Course of Post-Concussive Symptoms

Abstract

OBJECTIVES: To examine the incidence, duration, and clinical course of individual post-concussive symptoms in patients presenting to a pediatric emergency department (ED) with a concussion. METHODS: We conducted secondary analysis of a prospective cohort study of patients 11 to 22 years old presenting to the ED of a children’s hospital with an acute concussion. The main outcome measure was duration of symptoms, assessed by the Rivermead Post-Concussion Symptoms Questionnaire (RPSQ). Patients initially completed a questionnaire describing mechanism of injury, associated symptoms, past medical history, and the RPSQ, then were serially administered the RPSQ for 3 months after the concussion or until all symptoms resolved. RESULTS: Headache, fatigue, dizziness, and taking longer to think were the most common symptoms encountered at presentation, whereas sleep disturbance, frustration, forgetfulness, and fatigue were the symptoms most likely to develop during the follow-up period that had not initially been present. Median duration of symptoms was the longest for irritability (16 days), sleep disturbance (16 days), frustration (14 days), and poor concentration (14 days), whereas nausea, depression, dizziness, and double-vision abated most quickly. One month after injury, nearly a quarter of children still complained of headache, >20% suffered from fatigue, and nearly 20% reported taking longer to think. CONCLUSIONS: Among patients presenting to a pediatric ED after a concussion, physical symptoms such as headache predominate immediately after the injury, emotional symptoms tend to develop later in the recovery period, and cognitive symptoms may be present throughout.

Psychiatric outcomes after pediatric sports-related concussion

“…In 1 study conducted at a tertiary pediatric concussion clinic, emotional symptoms, including depression, frustration, irritability, and restlessness, were reported by 22.9%-27.7% of the patients evaluated less than 72 hours after injury. 7 Emotional symptoms peaked 7 days after injury and decreased to 8.3%-14.7% among patients who remained symptomatic at 28 days. Together, these findings confirm that emotional symptoms are reported in a substantial proportion of pediatric patients with SRC, can Ours is the first study to examine the prevalence, clinical features, risk factors, and management of postinjury psychiatric outcomes among pediatric patients with SRC referred to a multidisciplinary pediatric concussion program.…”

“…Although many pediatric patients will recover to their neurological baseline within 1-4 weeks with an appropriate amount of physical and cognitive rest, 21%-73% of patients will experience symptoms that last longer than 1 month and will be diagnosed with postconcussion syndrome (PCS). 1,2,5,6,11,56 Although the impact of pediatric SRC on physical and cognitive functioning has been well documented in previous clinical research studies, 1,2,[5][6][7]11,37,56 there has been little attention paid to the emotional and psychiatric manifestations of this condition. Previous studies have observed novel psychiatric disorders (NPDs) occurring in 10%-100% of children and adolescents with TBI of various severities, including personality changes, attention-deficit hyperactivity disorder (ADHD), behavioral disorders, depression, and anxiety disorders.…”

Social norms theory and concussion education

“…Symptoms from most concussions resolve in <2 weeks [8]; however, for some athletes the symptoms can persist for longer than 1 month [9]. In that intervening period, athletes may experience a combination of cognitive, somatic and emotional symptoms [9,10] that can impair their ability to complete school or work obligations [11].…”

“…In that intervening period, athletes may experience a combination of cognitive, somatic and emotional symptoms [9,10] that can impair their ability to complete school or work obligations [11]. Athletes who sustain more concussions are more likely to experience prolonged symptoms [12][13][14].…”

Aggressive Rehabilitation Pathway Targeting Concussion Symptoms: Illustration with a Case Study

“…It is often recommended to wait for resolution of symptoms before initiating a structured rehabilitation program [3,4,23], but based on our patient's circumstances the symptoms needed to be addressed more directly [24]. Our program regularly engages symptoms in rehabilitation designed to work around and address them so improvement can be achieved.…”