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A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
Published on: September 25, 2014
Association of Persistent Postconcussion Symptoms With Pediatric Quality of Life
Zuzana Novak1, Mary Aglipay2, Nick Barrowman2
1Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Insights
Children with persistent postconcussion symptoms (PPCS) experience significantly lower health-related quality of life (HRQoL). These deficits persist for months, impacting physical, emotional, social, and school functioning, even after symptom resolution.
Area of Science:
- Pediatric emergency medicine
- Neurology
- Quality of life research
Background:
- Persistent postconcussion symptoms (PPCS) present long-term challenges affecting children's health-related quality of life (HRQoL).
- Limited large-scale studies have comprehensively investigated the association between PPCS and HRQoL in pediatric populations.
Purpose of the Study:
- To determine the association between HRQoL and PPCS at 4 weeks post-concussion.
- To assess the extent of HRQoL impairment in children over the subsequent 12 weeks.
Main Methods:
- Prospective, multicenter cohort study (Predicting Persistent Postconcussive Problems in Pediatrics [5P]) involving 2006 children aged 5-18 years.
- PPCS defined as 3+ persistent symptoms at 4 weeks using the Post-Concussion Symptom Inventory.
- HRQoL measured using the Pediatric Quality of Life Inventory (PedsQL-4.0) at 4, 8, and 12 weeks; analyzed using linear mixed effects models.
Main Results:
- Children with PPCS (30.6%) had significantly lower total PedsQL-4.0 scores (mean 70.0) compared to those without PPCS (mean 80.3).
- PPCS group showed lower physical, emotional, social, and school PedsQL-4.0 subscores at all time points.
- Children with PPCS had substantially lower HRQoL than healthy norms, with deficits persisting up to 12 weeks.
Conclusions:
- Children with PPCS exhibit significantly reduced HRQoL compared to recovered peers.
- HRQoL deficits are widespread across all domains and can persist for months, even after symptom resolution.
- Further research should focus on interventions addressing concussion's impact on pediatric HRQoL.
Importance:
Persistent postconcussion symptoms (PPCS) pose long-term challenges and can negatively affect patients' health-related quality of life (HRQoL). To date, no large comprehensive study has addressed the association between PPCS and HRQoL.
Objectives:
To determine the association between HRQoL and PPCS at 4 weeks after concussion and assess the degree of impairment of HRQoL in the subsequent 12 weeks.
Design, Setting, And Participants:
In a prospective, multicenter cohort study (Predicting Persistent Postconcussive Problems in Pediatrics [5P]) from August 14, 2013, to September 30, 2014, children aged 5 to 18 years who presented to the emergency department within 48 hours after head injury and were considered to have an acute concussion were enrolled across 9 pediatric emergency departments within the Pediatric Emergency Research Canada Network. Persistent postconcussion symptoms were defined as 3 or more persistent symptoms on the validated Post-Concussion Symptom Inventory at 4 weeks. Linear mixed effects random coefficients models evaluated the association between PPCS and HRQoL, adjusting for potential confounders including age, sex, prior concussions, migraine, anxiety, learning disability, depression, and sleep disorder.
Main Outcomes And Measures:
The primary outcome was HRQoL assessed with the validated Pediatric Quality of Life Inventory version 4.0 (PedsQL-4.0) at 4, 8, and 12 weeks after head injury.
Results:
Of 2006 children enrolled (median age, 11.8 years [interquartile range, 8.9-14.6 years]; 1241 boys and 765 girls), 1667 (83.1%) completed the PedsQL-4.0 at all 3 time points. Of these 1667 children, the 510 with PPCS (30.6%) had lower total PedsQL-4.0 scores (mean, 70.0) than did those without PPCS (mean, 80.3; mean difference, -10.3; 95% CI, -9.4 to -11.2). Patients with PPCS also had significantly lower physical, emotional, social, and school PedsQL-4.0 subscores at 4, 8, and 12 weeks. Patients with PPCS had lower HRQoL than published healthy norms at 4 weeks (mean difference, 13.89; 95% CI, 11.55-16.23), 8 weeks (mean difference, 11.63; 95% CI, 9.34-13.93), and 12 weeks (mean difference, 9.38; 95% CI, 7.01-11.75; P < .001). Patients who recovered from concussion also had lower HRQoL than norms at 4 weeks (mean difference, 3.56; 95% CI, 1.28-5.85) and 8 weeks (mean difference, 2.75; 95% CI, 0.48-5.02; P < .05). School functioning PedsQL-4.0 subscores were significantly lower for all children regardless of PPCS status at all time points.
Conclusions And Relevance:
Children with PPCS have lower HRQoL compared with those who have recovered from concussion, yet deficits in HRQoL are pervasive across all domains and may persist for months even in children whose symptoms have resolved. Future interventional research should target the effect of concussion on HRQoL.
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