Predicting Wellness After Pediatric Concussion

Abstract

Objective: Concussion in children and adolescents is a prevalent problem with implications for subsequent physical, cognitive, behavioral, and psychological functioning, as well as quality of life. While these consequences warrant attention, most concussed children recover well. This study aimed to determine what pre-injury, demographic, and injury-related factors are associated with optimal outcome (“wellness”) after pediatric concussion. Method: A total of 311 children 6–18 years of age with concussion participated in a longitudinal, prospective cohort study. Pre-morbid conditions and acute injury variables, including post-concussive symptoms (PCS) and cognitive screening (Standardized Assessment of Concussion, SAC), were collected in the emergency department, and a neuropsychological assessment was performed at 4 and 12 weeks post-injury. Wellness, defined by the absence of PCS and cognitive inefficiency and the presence of good quality of life, was the main outcome. Stepwise logistic regression was performed using 19 predictor variables. Results: 41.5% and 52.2% of participants were classified as being well at 4 and 12 weeks post-injury, respectively. The final model indicated that children who were younger, who sustained sports/recreational injuries (vs. other types), who did not have a history of developmental problems, and who had better acute working memory (SAC concentration score) were significantly more likely to be well. Conclusions: Determining the variables associated with wellness after pediatric concussion has the potential to clarify which children are likely to show optimal recovery. Future work focusing on wellness and concussion should include appropriate control groups and document more extensively pre-injury and injury-related factors that could additionally contribute to wellness. (JINS, 2019, 25, 375–389)

Systematic Review of Pre-injury Migraines as a Vulnerability Factor for Worse Outcome Following Sport-Related Concussion

“…Additionally, a similar proportion of those with migraines had symptoms at 28 days post injury (35%) compared to the entire sample (32%; p = 0.72) ( 16 ). A different prospective study that examined sports concussions in patients ages 12–17 who presented to an emergency department did not show a higher likelihood of prolonged recovery ( 46 ). In contrast, another study examined youth ages 5–18 who presented to emergency departments across Canada and found a higher portion of the migraine group (42.6%) had symptoms at 28 days post injury, compared to 28.1% of the group without migraines ( 10 ).…”

“…It is essential to appreciate that only one study was designed specifically to examine migraine as a risk factor ( 45 ). All other studies included migraine as a secondary or exploratory variable; some studies discussed their rationale for examining pre-injury migraines ( 10 , 20 , 34 – 37 , 41 – 43 , 46 ), while others did not ( 13 , 14 , 16 – 19 , 21 , 30 , 32 , 33 , 38 – 40 , 44 ). Most studies ( n = 19/25, 76%) did not find a statistically significant association between having pre-injury migraines and a prolonged recovery or worse clinical outcome following concussion, two studies had both significant and null findings, and four studies showed only significant findings.…”

Post-concussion symptoms in sports-related mild traumatic brain injury compared to non-sports-related mild traumatic brain injury

“…A recent study carried out by Beauchamp et al among children aged 6-18 years also highlighted that those who sustained sports or recreationalrelated concussions had a better quality of life and were less likely to experience persistent post-concussion symptoms and cognitive impairment. [11] Both studies suggest that these differences could be explained by particular biomechanical characteristics (velocity of impact, distribution of the forces, location and speed) which potentially differ between motor vehicle collision, bicycle accidents or falls and sports injury. As recently shown, brain tissue stresses and strains are related to the impact force of the injury [31].…”

“…There are numerous available studies regarding mild TBI pathophysiology [7], diagnosis [5,8], treatments [5,9,10], predictors of wellness [11,12] and symptom evolution [13]. Since about 24% of mild TBI patients remain significantly impaired by persistent symptoms such as headaches, dizziness and fatigue at 3-month follow-up [14], many studies have analyzed the impact of mechanisms of injury on persistent post-concussion symptoms while evaluating other risk factors [11,[15][16][17][18]. However, sport as the mechanism of injury has an impact on the recovery and return to normal activities.…”

“…Only a few studies have attempted to compare the recovery of patients who sustained a sports-related mild TBI with the recovery of patients who sustained other types of injuries [11,19]. However, most of these studies have focused on high school athletes [19,20], elite collegiate athletes [21,22] or professional athletes [23,24].…”