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Comparison of Methods for Classifying Persistent Post-Concussive Symptoms in Children.

Andrew R Mayer1,2,3,4, David D Stephenson1, Andrew B Dodd1

  • 1The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA.

Journal of Neurotrauma
|January 23, 2020
PubMed
Summary

Defining persistent post-concussive symptoms (PPCS) in pediatric mild traumatic brain injury (pmTBI) is challenging due to varying methods and symptom overlap in healthy children. Current definitions show significant variability, questioning their clinical utility.

Keywords:
pediatric mild traumatic brain injurypersistent post-concussive symptoms

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Area of Science:

  • Neuroscience
  • Pediatric Medicine
  • Psychology

Background:

  • Pediatric mild traumatic brain injury (pmTBI) is a growing public health concern, particularly for children with persistent post-concussive symptoms (PPCS).
  • Existing clinical and scientific literature presents multiple, often inconsistent, methods for defining PPCS.
  • Healthy children frequently exhibit symptoms similar to those experienced after a concussion, complicating diagnosis.

Purpose of the Study:

  • To examine the inter-method agreement, misclassification rates, and psychometric properties of six different PPCS definition methods.
  • To compare these methods in adolescent patients with pmTBI and age/sex-matched healthy controls (HC).
  • To assess the reliability and potential biases in symptom reporting over time.

Main Methods:

  • Six published PPCS methods were categorized into Simple Change and Standardized Change algorithms.
  • Adolescent pmTBI patients (n=162) and HC (n=117) were assessed 1 week and 4 months post-injury.
  • Test-retest reliability, inter-rater reliability, and misclassification rates were analyzed.

Main Results:

  • Healthy children showed fair to good test-retest reliability over 4 months, but with evidence of rating bias.
  • Simple Change algorithms resulted in higher misclassification rates (>30%) in HC and poor inter-rater reliability.
  • A wide variation (49% spread) in PPCS diagnosis was observed among pmTBI patients at 4 months, with better agreement for Standardized Change algorithms.

Conclusions:

  • Self-reported symptoms in adolescents have modest reliability over 4 months, with systematic bias in both self and parental ratings.
  • The variability in identifying PPCS challenges the accurate estimation of its incidence in published research.
  • The clinical utility of commonly used Simple Change scores for diagnosing PPCS is questionable.