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Post-concussion symptom burden in children following motor vehicle collisions
Angela Lumba-Brown1, Ken Tang2, Keith Owen Yeates3
1Department of Emergency Medicine Stanford University Palo Alto California.
Insights
Children with concussions from motor vehicle collisions report fewer initial symptoms but experience slower recovery at one month compared to other injury types. This suggests a unique patient group for emergency department counseling.
Area of Science:
- Pediatric Emergency Medicine
- Neuroscience
- Traumatology
Background:
- Motor vehicle collisions (MVCs) are a significant cause of traumatic brain injuries in children.
- Post-concussive symptoms following pediatric concussion require further investigation, particularly concerning injury mechanisms.
- No large-scale studies have specifically analyzed post-concussive symptom burden in children injured in MVCs.
Purpose of the Study:
- To compare the acute post-concussive symptom burden in children who sustained concussions from MVCs versus other injury mechanisms.
- To analyze the recovery trajectories of post-concussive symptoms in pediatric concussion patients based on the mechanism of injury.
Main Methods:
- Secondary analysis of the Predicting Persistent Post-concussive Problems in Pediatrics study cohort (n=3029).
- Prospective recruitment of children aged 5-17 presenting to emergency departments with concussion (2013-2015).
- Utilized the Post-Concussion Symptom Inventory (PCSI) to measure symptom severity and recovery over 12 weeks, comparing post-injury scores to perceived pre-injury scores.
Main Results:
- A small proportion (1.8%, n=56) of concussions were attributed to MVCs.
- Children with MVC-related concussions presented with lower initial symptom burden compared to other injury mechanisms (mean difference -0.36).
- The MVC group exhibited a slower decline in symptom burden at one month post-injury (mean difference -0.54).
Conclusions:
- Pediatric concussion patients injured in MVCs may present with less severe initial symptoms but experience prolonged recovery.
- These findings suggest MVC-related pediatric concussions represent a distinct population requiring tailored prognostic counseling in emergency departments.
- Further research is warranted to understand the unique characteristics and long-term outcomes of this patient group.
Objective:
Motor vehicle collisions generate considerable transmitted forces resulting in traumatic brain injury in children presenting to emergency departments (EDs). To date, no large study has examined post-concussive symptoms in children sustaining concussions in motor vehicle collisions. This study aimed to compare trends in acute post-concussive symptom burden in children with concussion following motor vehicle collisions as compared to other injury mechanisms.
Methods:
The study is a secondary analysis of the Predicting Persistent Post-concussive Problems in Pediatrics study, which prospectively recruited a multicenter cohort of 3029 children 5-17 years of age presenting to the ED with concussion from 2013-2015. Post-concussive symptom ratings were obtained at pre-specified time points for 12 weeks post-injury, using the validated Post-Concussion Symptom Inventory (PCSI). Symptom severity and recovery trajectories were measured using delta scores on the PCSI (mean post-injury symptom score minus perceived pre-injury score). A multivariable, longitudinal model evaluated the adjusted effect of mechanism of injury (motor vehicle collisions vs other mechanisms) on mean symptom scores, compared to perceived pre-injury reports, and the temporal change in mean scores over during recovery.
Results:
Of 3029 study participants, 56 (1.8%) sustained concussion from motor vehicle collisions. Children sustaining concussion in a motor vehicle collision had lower post-concussive symptom scores upon ED presentation, measured as differences from their perceived pre-injury reports, as compared to other injury mechanisms (-0.36 [95% confidence interval (CI) = -0.58, -0.15]). However, the motor vehicle collisions group showed the smallest decline in symptom burden over 1 month following injury (-0.54 [95% CI = -0.81, -0.27]).
Conclusions:
Children sustaining concussions in motor vehicle collisions may have lower initial symptom burdens but slower symptom recovery at 1 month compared to other mechanisms of injury and may represent a distinct population for prognostic counseling in the ED requiring further research.
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