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Published on: September 25, 2014
Trajectories and Risk Factors for Pediatric Postconcussive Symptom Recovery
Katie Truss1,2, Stephen J C Hearps1, Franz E Babl1,2,3
1Murdoch Children's Research Institute, Melbourne, Australia.
Insights
Children exhibit diverse recovery patterns after concussion, with some experiencing persistent symptoms. Identifying these distinct trajectories and associated factors like internalizing behaviors and parental distress is key for targeted interventions.
Area of Science:
- Pediatric neurology
- Child psychology
- Longitudinal studies
Background:
- Persistent postconcussive symptoms (PCS) in children are not well understood.
- Previous research often treated children with concussion as a uniform group, overlooking individual recovery differences.
Purpose of the Study:
- To identify distinct postconcussive recovery trajectories in children.
- To determine injury-related and psychosocial factors linked to these recovery patterns.
Main Methods:
- Prospective, longitudinal study of 169 children (ages 5-18) reporting PCS over 3 months post-concussion.
- Group-based trajectory modeling, multinomial logistic regression, and chi-squared tests analyzed data.
- Assessed injury-related, demographic, pre-injury, and mental health factors for child and parent.
Main Results:
- Identified 5 distinct PCS recovery trajectories: Low Acute Recovered (26.6%), Slow to Recover (13.6%), High Acute Recovered (29.6%), Moderate Persistent (18.3%), and Severe Persistent (11.8%).
- Severe Persistent PCS was associated with higher child internalizing behaviors and greater parental distress compared to the Low Acute Recovered group.
Conclusions:
- Childhood concussion recovery is variable, with 5 identified trajectories.
- Trajectories differ in symptom number, child internalizing behaviors, and parental distress.
- Recognizing these trajectories can enable targeted early interventions for at-risk children.
Background:
Persistent postconcussive symptoms (PCS) are poorly understood in children. Research has been limited by an assumption that children with concussion are a homogenous group.
Objective:
To identify (i) distinctive postconcussive recovery trajectories in children and (ii) injury-related and psychosocial factors associated with these trajectories.
Methods:
This study is part of a larger prospective, longitudinal study. Parents of 169 children (5-18 yr) reported their child's PCS over 3 mo following concussion. PCS above baseline levels formed the primary outcome. Injury-related, demographic, and preinjury information, and child and parent mental health were assessed for association with trajectory groups. Data were analyzed using group-based trajectory modeling, multinomial logistic regression, and chi-squared tests.
Results:
We identified 5 postconcussive recovery trajectories from acute to 3 mo postinjury. (1) Low Acute Recovered (26.6%): consistently low PCS; (2) Slow to Recover (13.6%): elevated symptoms gradually reducing; (3) High Acute Recovered (29.6%): initially elevated symptoms reducing quickly to baseline; (4) Moderate Persistent (18.3%): consistent, moderate levels of PCS; (5) Severe Persistent (11.8%): persisting high PCS. Higher levels of child internalizing behaviors and greater parental distress were associated with membership to the Severe Persistent group, relative to the Low Acute Recovered group.
Conclusion:
This study indicates variability in postconcussive recovery according to 5 differential trajectories, with groups distinguished by the number of reported symptoms, levels of child internalizing behavior problems, and parental psychological distress. Identification of differential recovery trajectories may allow for targeted early intervention for children at risk of poorer outcomes.
