Post-concussive Signs and Symptoms in Preschool Children: A Systematic Review

Yumul, Joy Noelle; Crowe, Louise; Catroppa, Cathy; Anderson, Vicki; McKinlay, Audrey

doi:10.1007/s11065-021-09518-z

Cited by 9 publications

(6 citation statements)

References 63 publications

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“…Several behavioral manifestations of comfort-seeking (eg, wants to be held, gets upset if separated from parent) and poor mood and motivation (eg, cries a lot, is withdrawn and isolated), which are not included in other PCS questionnaires, were also reported. These findings strengthen the evidence from smaller or retrospective studies showing that early childhood concussion is associated with behavioral manifestations unique to this developmental period, including more fussiness, wanting to be cuddled more, increased crying, and poor feeding . Given their limited verbal and cognitive abilities, behavioral manifestations, such as regression, comfort-seeking, or excessive crying, may be the only ways a young child can convey that they feel unwell after injury.…”

Section: Discussionsupporting

confidence: 55%

“…These findings strengthen the evidence from smaller or retrospective studies showing that early childhood concussion is associated with behavioral manifestations unique to this developmental period, including more fussiness, wanting to be cuddled more, increased crying, and poor feeding. 11,[17][18][19] Given their limited verbal and cognitive abilities, behavioral manifestations, such as regression, comfort-seeking, or excessive crying, may be the only ways a young child can convey that they feel unwell after injury. Documenting these behavioral JAMA Network Open | Pediatrics manifestations through direct observation could be the key to tracking PCS and facilitating concussion diagnosis in young children.…”

Section: Discussionmentioning

confidence: 99%

“…Discrepancies across studies may be related to methodological limitations. For example, using adaptations of questionnaires validated in older children may overlook manifestations that are unique to young children . When caregivers are provided with specific, tangible examples of how PCS could manifest in young children, they tend to report behavioral changes (eg, excessive crying, tantrums, clinginess) that are thought to reflect underlying symptoms due to the child’s inability to verbally communicate abstract sensations and concepts (eg, dizziness, feeling foggy) .…”

Section: Introductionmentioning

confidence: 99%

“…For example, using adaptations of questionnaires validated in older children may overlook manifestations that are unique to young children. 18 When caregivers are provided with specific, tangible examples of how PCS could manifest in young children, they tend to report behavioral changes (eg, excessive crying, tantrums, clinginess) that are thought to reflect underlying symptoms due to the child's inability to verbally communicate abstract sensations and concepts (eg, dizziness, feeling foggy). 14,17 In response to the need for a more developmentally appropriate approach, the Report of Early Childhood Traumatic Injury Observations & Symptoms (REACTIONS) inventory provides examples of observable manifestations and behaviors related to PCS.…”

Section: Introductionmentioning

confidence: 99%

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Postconcussive Symptoms After Early Childhood Concussion

Dupont,

Tang,

Beaudoin

et al. 2024

JAMA Netw Open

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ImportanceResearch on postconcussive symptoms (PCS) following early childhood concussion has been hindered by a lack of measures suitable for this age group, resulting in a limited understanding of their evolution in young children.ObjectiveTo document PCS in the first 3 months after early childhood concussion using a developmentally appropriate measure.Design, Setting, and ParticipantsThis cohort study used data collected at 3 Canadian and 1 US urban pediatric emergency departments (EDs) and 8 Canadian daycares from December 2018 to December 2022 as part of the Kids’ Outcomes and Long-Term Abilities (KOALA) project, a prospective, multicenter, longitudinal cohort study. Participants included children aged 6 to 72 months with early childhood concussion or orthopedic injury (OI) or uninjured children from the community to serve as controls. Data were analyzed from March 2023 to January 2024.ExposureConcussion sustained between ages 6 and 72 months.Main Outcomes and MeasuresPrimary outcomes were cognitive, physical, behavioral and total PCS assessed prior to injury (retrospectively), acutely (within 48 hours), and at 10 days, 1 month, and 3 months after injury or recruitment through caregiver observations using the Report of Early Childhood Traumatic Injury Observations &amp; Symptoms inventory. Group comparisons were analyzed using ordinal regression models.ResultsThe study included 303 children (mean [SD] age, 35.8 [20.2] months; 152 [50.2%] male). Of these, 174 children had a concussion (mean [SD] age, 33.3 [19.9] months), 60 children had an OI (mean [SD] age, 38.4 [19.8] months) and 69 children were uninjured controls (mean [SD] age, 39.7 [20.8] months). No meaningful differences were found between the concussion and comparison groups in retrospective preinjury PCS. Significant group differences were found for total PCS at the initial ED visit (concussion vs OI: odds ratio [OR], 4.33 [95% CI, 2.44-7.69]; concussion vs control: OR, 7.28 [95% CI, 3.80-13.93]), 10 days (concussion vs OI: OR, 4.44 [95% CI, 2.17-9.06]; concussion vs control: OR, 5.94 [95% CI, 3.22-10.94]), 1 month (concussion vs OI: OR, 2.70 [95% CI, 1.56-4.68]; concussion vs control: OR, 4.32 [95% CI, 2.36-7.92]), and 3 months (concussion vs OI: OR, 2.61 [95% CI, 1.30-5.25]; concussion vs control: OR, 2.40 [95% CI, 1.36-4.24]). Significant group differences were also found for domain-level scores (cognitive, physical, behavioral) at various time points.Conclusions and RelevanceIn this early childhood cohort study, concussion was associated with more PCS than OIs or typical development up to 3 months after injury. Given the limited verbal and cognitive abilities typical of early childhood, using developmentally appropriate manifestations and behaviors is a valuable way of tracking PCS and could aid in concussion diagnosis in young children.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Postconcussive Symptoms After Early Childhood Concussion

Dupont,

Tang,

Beaudoin

et al. 2024

JAMA Netw Open

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“…We found 15 systematic reviews of one or more risk factors for various mTBI outcomes. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Eligibility criteria for these reviews varied and follow-up was not well defined, leading to diverse findings. For example, two reported older children had poorer outcomes 15 16 ; however, these included different age ranges (>20 years vs 2-18 years), outcomes (PCS vs quality of life) and methods, so comparisons are more nuanced.…”

Section: Comparison With Other Reviewsmentioning

confidence: 99%

Factors related to adverse long-term outcomes after mild traumatic brain injury in children: a scoping review

et al. 2023

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ObjectiveTo identify demographic, premorbid and injury-related factors, or biomarkers associated with long-term (≥3 months) adverse outcomes in children after mild traumatic brain injury (mTBI).DesignScoping review of literature.PatientsChildren and adolescents with mTBI.Risk factorsAny demographic, premorbid and injury-related factors, or biomarkers were included. We excluded genetic and treatment-related factors.Main outcome measuresPostconcussion syndrome (PCS), recovery.ResultsSeventy-three publications were included, reporting 12 long-term adverse outcomes, including PCS in 12 studies and recovery in 29 studies. Additional outcomes studied were symptom scores/severity (n=22), quality of life (n=9) and cognitive function (n=9). Forty-nine risk factors were identified across studies. Risk factors most often assessed were sex (n=28), followed by age (n=23), injury mechanism = (n=22) and prior mTBI (n=18). The influence of these and other risk factors on outcomes of mTBI were inconsistent across the reviewed literature.ConclusionsThe most researched risk factors are sex, age and mechanism of injury, but their effects have been estimated inconsistently and did not show a clear pattern. The most studied outcomes are recovery patterns and symptom severity. However, these may not be the most important outcomes for clinicians and patients. Future primary studies in this area should focus on patient-important outcomes. Population-based prospective studies are needed that address prespecified hypotheses on the relationship of risk factors with given outcomes to enable reliable prediction of long-term adverse outcomes for childhood mTBI.

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