Detailed concussion symptom analysis in a paediatric ED population
Joseph A Grubenhoff1, Michael W Kirkwood, Sara Deakyne
1University of Colorado School of Medicine, Department of Pediatrics, Section of Emergency Medicine, Aurora, CO, USA. grubenhoff.joe@tchden.org
Insights
Children with head injuries show more symptoms than others. Specific symptoms like headache and nausea are key indicators of mild traumatic brain injury (mTBI) in children with altered mental status.
Area of Science:
- Pediatric emergency medicine
- Neuroscience
- Clinical Traumatology
Background:
- Mild traumatic brain injury (mTBI) is a common injury in children.
- Accurate and efficient diagnosis of mTBI is crucial for appropriate management.
- Identifying specific symptom patterns can aid in mTBI diagnosis.
Purpose of the Study:
- To determine the frequency of acute mTBI symptoms in children.
- To identify which symptoms are most effective in diagnosing mTBI.
- To compare symptom frequency between children with head injuries and those with orthopedic injuries.
Main Methods:
- Prospective case-control study in a pediatric trauma emergency department.
- Enrolled children aged 6-18 with head injury or extremity injury.
- Utilized a graded symptom checklist and logistic regression to analyze symptom associations with altered mental status (AMS).
Main Results:
- Children with head injuries reported significantly more symptoms than controls.
- Head-injured children with AMS had the highest frequency and severity of symptoms.
- Headache, nausea, dizziness, blurred/double vision, and feeling "not sharp" were strongly associated with AMS.
Conclusions:
- mTBI symptoms are more prevalent in children with head injuries.
- Altered mental status exacerbates symptom presentation in pediatric mTBI.
- A concise symptom inventory can be effective for mTBI evaluation in children.
Primary Objective:
To examine the frequency of acute mild traumatic brain injury (mTBI) symptoms in children using a concussion symptom inventory and to identify which symptoms are most useful in identifying mTBI. It was hypothesized that symptoms associated with mTBI are more common in children with head injury than orthopaedic injury and certain symptoms are more useful than others in identifying mTBI.
Research Design:
Prospective case-control study conducted in a paediatric trauma centre emergency department.
Methods And Procedures:
Children of 6-18 years old with head injury or a minor extremity injury were enrolled. Symptoms were assessed using a graded symptom checklist. Symptom frequency was compared using a chi-square test. The association between individual symptoms with AMS was evaluated with logistic regression analysis.
Main Outcomes And Results:
Children with head injury displayed more frequent symptoms than controls. Head-injured cases with altered mental status (AMS) demonstrated the most frequent and severe symptoms (median symptom scores: control = 1, cases without AMS = 5, cases with AMS = 10; p < 0.001). Headache, nausea, dizziness, blurred/double vision and not feeling 'sharp' were associated with AMS.
Conclusions:
Symptoms associated with mTBI are more frequent in children with head injury. AMS magnifies this effect. A symptom inventory is integral to the evaluation of mTBI in children; a smaller set of dichotomized symptoms may be as useful as and more easily administered than lengthier symptom scales.
