The Course of Concussion Recovery in Children 6‐12 Years of Age: Experience From an Interdisciplinary Rehabilitation Clinic

Abstract

Background Current concussion evidence is largely derived from teenagers and adults. Concussion in younger children occurs within the context of neuro-maturation, with differing age-based pathophysiological responses to injury. Therefore our current understanding of concussion in older children and adults is unlikely to directly apply to younger children. Objective To describe patient variables, clinical course, and factors associated with time to discharge from concussion care in children 6 – 12 years of age with concussion treated in an interdisciplinary rehabilitation-based concussion clinic. Design Retrospective chart review. Setting Interdisciplinary concussion clinic at an academically-affiliated rehabilitation center. Patients Children aged 6 – 12 years (n= 105; mean 10.8 years of age, 70% male) seen within 60 days of concussive injury. Main Outcome Measurements Descriptive statistics explored demographic, injury, and clinical features. The primary outcome measure, time to discharge from concussion care, was estimated using survival-analysis methods based on the date of discharge from the clinic. Multivariate models were used to examine factors associated with longer time to discharge. Results Median time to discharge was 34 days post-injury (range 5–192 days); 75% of children were discharged within 60 days of injury. A minority reported persisting symptoms at discharge. Younger age and increased symptom burden at initial evaluation predicted longer time to discharge. Conclusions While children 6–12 years old treated in a specialty concussion clinic show variability in time to discharge from concussion care, most were discharged within 2 months following injury. Risk factors for prolonged recovery, such as younger age and higher symptom burden at initial visit, can be used when counseling families and planning interventions. There may be varying contributions, including psychosocial stressors, to ongoing symptoms in children who experience persisting symptoms after other concussion-related concerns have resolved. Future work focused on the subset of children who report persisting symptoms will be useful for developing an evidence base related to their care.

Screening for Orthostatic Intolerance in Symptomatic Children Presenting for Concussion Care

“…6 Symptoms of concussion, such as headaches, dizziness, fatigue, and difficulty concentrating, are often nonspecific and overlap with symptoms of other commonly diagnosed pediatric conditions, including migraines, mental health disorders, attention deficit hyperactivity disorder, and orthostatic intolerance (OI). 7 The new Centers for Disease Control and Prevention guideline on the Diagnosis and Management of mTBI Among Children highlights the benefit of multidisciplinary evaluation for patients with persisting symptoms (ie, still present 4-6 weeks after injury) 8 in order to identify etiologies of and optimal treatment for these symptoms.…”

Participation in Physical Activity at Time of Presentation to a Specialty Concussion Clinic Is Associated With Shorter Time to Recovery

“…A robust analytic strategy was employed to account for many potential confounding variables between exercise groups, many of which have been identified in previous literature. 3,[5][6][7]9,12,[30][31][32][33][34][35][36] After controlling for these variables, and conducting several sensitivity analyses, physical activity remained a significant predictor of recovery time following concussion. This work is distinct from prior work examining effects of exercise after concussion because this population of children referred to a rehabilitation-based clinic represents a unique heterogeneous subgroup of children who are not rapidly recovering and/or have comorbidities complicating evaluation and management.…”

“…6 Endorsement of post-concussion symptoms as listed on the ACE 26 were extracted from the visit notes as described previously. 6 Symptom variables were (1) total number of symptoms (maximum of 22) and (2) number of symptom domains (physical, cognitive, emotional, sleep) endorsed in the days prior to the clinic visit.…”

Sleep Symptoms Predict School Attendance After Pediatric Concussion

“…The clinic and data collection model and criteria for evaluating appropriateness for discharge from clinic have been previously described. 10 All children participated in brief neuropsychological testing at the first clinic visit, which included validity (effort) testing; we excluded children who did not show reliable effort for testing (n = 11), yielding a final sample of 88 children.…”