Persistent Postconcussion Symptoms After Injury

Abstract

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.

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.…”

Persistent alterations in cerebrovascular reactivity in response to hypercapnia following pediatric mild traumatic brain injury

“…These findings are consistent with previous reports in pmTBI by both our group 40 and others 41,42 and represent a prolonged course of recovery for some symptoms not typically observed in adult populations. 43…”

Academic outcomes following adolescent sport-related concussion or fracture injury: A prospective cohort study

“…Additional work is required to obtain a more sensitive measure of school performance, such as individual assignments, quiz or test scores, or teacher evaluations. Lastly, children and adolescents with orthopaedic injuries have also been found to experience concussion-like symptoms that may impact school performance and participation [27]. Concussion symptoms were not assessed among SRF patients in this study and this should be considered in future studies.…”