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Related Experiment Video

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A Neuroscientific Approach to the Examination of Concussions in Student-Athletes
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Acute concussion symptom severity and delayed symptom resolution.

Joseph A Grubenhoff1, Sara J Deakyne2, Lina Brou3

  • 1Departments of Pediatrics, andEmergency Department, and joe.grubenhoff@childrenscolorado.org.

Pediatrics
|June 25, 2014
PubMed
Summary

Initial concussion symptom severity in children does not predict delayed symptom resolution. However, higher scores are linked to post-concussion syndrome, highlighting the need for careful monitoring of cognitive symptoms.

Keywords:
acutebrain concussionbrain injuryemergency medicinepost-concussion symptomspost-concussion syndrometraumatic

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Area of Science:

  • Pediatric emergency medicine
  • Neurology
  • Sports medicine

Background:

  • Up to 30% of pediatric concussion cases present with delayed symptom resolution (DSR).
  • Initial symptom severity is a potential, easily quantifiable predictor of DSR.

Purpose of the Study:

  • To test the hypothesis that greater acute symptom severity after concussion increases the risk for DSR.
  • To explore the association between initial symptom severity and post-concussion syndrome (PCS).

Main Methods:

  • Prospective longitudinal cohort study of 234 children (8-18 years) presenting to the ED with concussion.
  • Acute symptom severity assessed via graded symptom inventory; DSR assessed at 1 month.
  • Sensitivity analysis for DSR and PCS association; hierarchical cluster analysis for symptom characteristics.

Main Results:

  • Initial symptom severity did not significantly predict DSR (21% of subjects).
  • Post-concussion syndrome (PCS) affected 12% of subjects; scores >10 associated with increased PCS risk (RR, 3.1).
  • Cognitive symptoms were more characteristic of DSR, while some DSR symptoms overlapped with early resolution.

Conclusions:

  • Acute symptom severity at ED presentation does not predict DSR in pediatric concussion.
  • Initial symptom severity is associated with PCS, indicating risk stratification depends on symptom definition.
  • Cognitive symptoms warrant attention; follow-up is recommended for all pediatric concussion patients.