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Published on: September 25, 2014
Epidemiology of postconcussion syndrome in pediatric mild traumatic brain injury
Karen Maria Barlow1, Susan Crawford, Andrea Stevenson
1Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada. karen.barlow@albertahealthservices.ca
Insights
Postconcussion syndrome (PCS) in children is often linked to mild traumatic brain injury (mTBI), not just trauma or psychosocial factors. This study validates PCS as a diagnosis in pediatric mTBI cases.
Area of Science:
- Pediatric neurology
- Neuroscience
- Trauma research
Background:
- Disagreement exists on the causes of postconcussion syndrome (PCS), with debates on whether it stems from brain injury or other factors like trauma, psychosocial issues, or medicolegal concerns.
- This study investigates the epidemiology and natural history of PCS symptoms in children with mild traumatic brain injury (mTBI) compared to those with extracranial injury (ECI).
Purpose of the Study:
- To determine the incidence and duration of postconcussion syndrome (PCS) symptoms in children following mild traumatic brain injury (mTBI).
- To differentiate PCS causes by comparing outcomes in children with mTBI versus extracranial injury (ECI).
- To validate the diagnosis of PCS in pediatric populations.
Main Methods:
- A prospective, controlled-cohort study involving 670 children with mTBI and 197 with ECI.
- Data collected via parent telephone interviews 7-10 days post-injury, with monthly follow-ups until symptom resolution.
- Utilized standardized questionnaires including the Post Concussion Symptom Inventory and Family Assessment Device.
Main Results:
- Significant differences in symptom resolution time between mTBI and ECI groups (P < .001).
- Three months post-injury, 13.7% of children with mTBI remained symptomatic, compared to 0.5% with ECI.
- One-year prevalence of persistent symptoms was 2.3% for mTBI and 0.01% for ECI; family functioning and maternal adjustment did not differ between groups.
Conclusions:
- A significant portion of school-aged children with mTBI experience persistent symptoms, supporting the validity of postconcussion syndrome (PCS) diagnosis.
- These findings indicate PCS in children is linked to the brain injury itself, not solely trauma, family dysfunction, or maternal psychological adjustment.
Background:
Much disagreement exists as to whether postconcussion syndrome (PCS) is attributable to brain injury or to other factors such as trauma alone, preexisting psychosocial problems, or medicolegal issues. We investigated the epidemiology and natural history of PCS symptoms in a large cohort of children with a mild traumatic brain injury (mTBI) and compared them with children with an extracranial injury (ECI).
Methods:
This investigation was a prospective, consecutive controlled-cohort study of 670 children who presented to a tertiary referral emergency department with mTBI and 197 children who presented with ECI. For all participants, data were collected by use of a telephone interview of a parent 7 to 10 days after injury. If a change from preinjury symptoms was reported by a parent, follow-up continued monthly until symptom resolution. Outcomes were measured by using the Post Concussion Symptom Inventory, Rivermead Postconcussion Symptom Questionnaire, Brief Symptom Inventory, and Family Assessment Device.
Results:
There was a significant difference between the mTBI and ECI groups in their survival curves for time to symptom resolution (log rank [Mantel-Cox] 11.15, P < .001). Three months after injury, 11% of the children in the mTBI group were symptomatic (13.7% of children older than 6 years) compared with 0.5% of the children in the ECI group. The prevalence of persistent symptoms at 1 year was 2.3% in the mTBI group and 0.01% in the ECI group. Family functioning and maternal adjustment did not differ between groups.
Conclusions:
Among school-aged children with mTBI, 13.7% were symptomatic 3 months after injury. This finding could not be explained by trauma, family dysfunction, or maternal psychological adjustment. The results of this study provide clear support for the validity of the diagnosis of PCS in children.
