Subacute concussion-related symptoms and postconcussion syndrome in pediatrics

Millions of youth sustain concussion each year; although most fully recover following an isolated concussion, a significant minority develop prolonged symptoms and disability following concussion. This article reviews recent data regarding the epidemiology of postconcussion syndrome (PCS) and recommendations for the evaluation and management of postconcussive symptoms in pediatrics.

PCS is a constellation of symptoms related to head injury including somatic symptoms, sleep dysregulation, cognitive deficits and emotional disturbance. Postconcussive symptoms affect 1.5-11% of concussed youth for more than 1 month after injury, depending on the population studied. Girls have a higher risk of postconcussive headache but it is not clear if cognitive recovery differs between the sexes. Advanced neuroimaging techniques demonstrate a correlation between postconcussive symptoms and functional neurological changes. However, pre-existing and psychosocial factors also affect risk for prolonged PCS. Current treatment strategies are based mainly on expert opinion and studies of related syndromes.

Although a minority of concussed youth develop prolonged PCS, those who are affected can develop significant disability. Prolonged postconcussive symptoms are likely due to interactions between the biological injury, pre-existing risk factors and psychosocial issues. Further research is essential to improve outcomes for this vulnerable population.