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Postconcussive symptoms in hospitalized pediatric patients after mild traumatic brain injury
Thane A Blinman1, Eileen Houseknecht, Caitlin Snyder
1Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. blinman@email.chop.edu
Insights
Pediatric mild traumatic brain injury (MTBI) symptoms are common upon hospitalization, with headache most frequent and fatigue most severe. Most children recover significantly by follow-up, indicating the need for careful assessment.
Area of Science:
- Pediatric neurology
- Trauma care
- Clinical symptomology
Background:
- Mild traumatic brain injury (MTBI) is a prevalent condition in children.
- The spectrum of symptoms following pediatric MTBI is not well-defined.
- This study aimed to document concussive symptoms in hospitalized pediatric MTBI patients.
Purpose of the Study:
- To clarify the frequency and severity of concussive symptoms in children hospitalized with MTBI.
- To analyze symptom changes from hospitalization to outpatient follow-up.
- To identify the most common and most severe symptoms in this population.
Main Methods:
- Prospective enrollment of pediatric blunt trauma patients (ages 11-17) with MTBI (GCS 14-15).
- Administration of a 22-question Likert-based concussion symptom scale at hospitalization and follow-up.
- Analysis of symptom frequency and severity at both time points.
Main Results:
- 116 children participated; 63 completed follow-up. Mean age was 14.1 years, 69.8% male.
- Mean symptom scores decreased from 27.9 at hospitalization to 9.2 at follow-up.
- Abnormal symptom scores (>8) were present in 83.6% at hospitalization, reducing to 38.1% at follow-up. Headache was the most common initial symptom; fatigue was most severe. Excess sleep was most common at follow-up.
Conclusions:
- Concussive symptoms are frequent in hospitalized pediatric MTBI patients.
- Symptom scores generally normalize by outpatient follow-up.
- Headache and fatigue are key symptoms requiring attention in pediatric MTBI management.
Background:
Mild traumatic brain injury (MTBI) is common in the pediatric population. The symptom complex that might be expected in children after MTBI is not well documented. We sought to clarify the frequency and severity of concussive symptoms reported by children who required hospitalization for MTBI.
Methods:
Pediatric blunt trauma patients (age, 11-17 years) admitted for treatment of MTBI (GCS 14-15) were prospectively enrolled over a 2-year period. Consented patients were administered a 22-question Likert-based concussion symptom scale (normal, total score 0-8). The symptom scale was repeated at the time of routine follow-up trauma clinic visit. The frequency and severity of concussive symptoms were analyzed at both time-points.
Results:
For the 2-year period, 116 children participated in the study including 63 who returned for clinic follow-up. The overall population had mean age of 14.1 years (median 14) and was 69.8% male. The mean symptom score (sum of Likert scores [scale 0-6] for 22 questions) was 27.9 (median, 23.5) at hospitalization and 9.2 (median, 4.0) at follow-up. An abnormal symptom score (>8) was reported in 83.6% of hospitalized patients and 38.1% at follow-up. Girls had a significantly higher mean symptom score at initial testing than boys (33.9 vs 25.3, respectively; P < .05). This difference disappeared by the time of follow-up (girls 9.2 vs boys 9.1, P = .98) The most common initial symptom was headache (71.5% of patients) and most severe (highest mean score) was fatigue (mean, 2.0; median, 2.0). At follow-up, the most common symptom was excess sleep (38.1%) and most severe symptom falling asleep (mean, 1.0; median, 0). There were no significant differences in initial scores based on reported loss of consciousness, prior concussion history, or GCS 14 vs 15.
Conclusions:
Symptoms after MTBI are quite common at the time of hospitalization. Symptom scores improve to near normal for most by outpatient follow-up. The most common symptom was headache, but the most severe was fatigue, in this hospitalized pediatric population. Thoughtful assessment and follow-up of this patient population are warranted.
