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Do Concussive Symptoms Really Resolve in Young Children?
Coco O Bernard1, Jennie L Ponsford, Audrey McKinlay
1School of Psychological Sciences (Ms Bernard and Dr Ponsford) and Epworth HealthCare & School of Public Health and Preventive Medicine (Dr McKenzie), Monash University, Melbourne, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Australia (Dr McKinlay); and Sunshine Hospital Emergency Department, Melbourne, Australia (Mr Krieser).
Insights
Young children with mild traumatic brain injury (mTBI) often experience persistent postconcussive symptoms (PCSs) and behavioral changes for up to three months. Assessment methods can influence how parents report these symptoms in younger children.
Area of Science:
- Pediatric neurology
- Neuroscience
- Child psychology
Background:
- Mild traumatic brain injury (mTBI) is common in children.
- Understanding postconcussive symptoms (PCSs) and behavioral changes is crucial for recovery.
- Younger children may present unique challenges in symptom reporting.
Purpose of the Study:
- To investigate the frequency and nature of PCSs and behavioral outcomes in children aged 2-12 after mTBI.
- To compare outcomes in children with mTBI to a control group with minor bodily injury.
- To analyze symptom progression over three months post-injury.
Main Methods:
- Parental ratings of PCSs using a comprehensive checklist at multiple time points (72 hours, 1 week, 1, 2, 3 months).
- Assessment of pre-injury and post-injury behavior using the Clinical Assessment of Behavior at baseline, 1 month, and 3 months.
- Inclusion of a control group with minor bodily injury for comparison.
Main Results:
- PCS burden peaked acutely but significantly decreased from 1 week to 1 month post-mTBI.
- Children with mTBI showed more persistent PCSs, particularly behavioral and sleep issues, up to 3 months compared to controls.
- Problematic behaviors showed subtle, non-clinically significant increases from baseline to 3 months post-mTBI.
Conclusions:
- A notable proportion of young children experience lasting PCSs and behavioral issues after mTBI.
- Careful consideration of assessment methods is necessary to accurately capture PCSs in young children.
- Findings highlight the importance of longitudinal monitoring of both symptoms and behavior.
Objectives:
To examine the frequency and nature of postconcussive symptoms (PCSs) and behavioral outcomes in young children following mild traumatic brain injury (mTBI) or concussion.
Setting:
Emergency department.
Participants:
Children aged 2 to 12 years presenting with either a concussion or minor bodily injury (control).
Outcome Measurement:
Parent ratings of PCS were obtained within 72 hours of injury, at 1 week, and 1, 2, and 3 months postinjury using a comprehensive PCS checklist. Preinjury behavior was examined at baseline using the Clinical Assessment of Behavior, which was readministered 1 and 3 months postinjury.
Results:
PCS burden following mTBI peaked in the acute phase postinjury but reduced significantly from 1 week to 1 month postinjury. Parents of children with mTBI reported more persistent PCSs up to 3 months postinjury than trauma controls, characterized mostly by behavioral and sleep-related symptoms. Subtle increases in problematic behaviors were observed from baseline (preinjury) to 1 month postinjury and persisted at 3 months postinjury; however, scores were not classified as clinically "at risk."
Conclusions:
A significant minority of young children experienced persistent PCS and problematic behavior following mTBI. Care must be taken when assessing PCS in younger children as method of PCS assessment may influence parental reporting.