Paediatric post-concussive symptoms: symptom clusters and clinical phenotypes

Area of Science:

• Pediatric neurology
• Clinical psychology
• Epidemiology

Background:

• Post-concussive symptoms (PCS) are common in children after acute concussion.
• Understanding symptom co-occurrence and patient heterogeneity is crucial for effective management.
• Previous research has not fully elucidated distinct PCS clusters and associated patient phenotypes in pediatric populations.

Purpose of the Study:

• To investigate the co-occurrence and clustering patterns of post-concussive symptoms in children.
• To identify and characterize distinct patient phenotypes based on the type and severity of persistent symptoms.
• To inform tailored treatment strategies for pediatric concussion recovery.

Main Methods:

• Secondary analysis of the prospective, multicenter Predicting and Preventing Post-concussive Problems in Pediatrics (5P) cohort study.
• Inclusion of children aged 5-17 years presenting within 48 hours of acute concussion.
• Hierarchical cluster analyses of symptom severity ratings from the Post-Concussion Symptom Inventory at 28 days post-injury were used to identify symptom and patient clusters.

Main Results:

• 3063 children were included; median age 12.1 years, 60.6% male.
• Fatigue was the most frequent persistent symptom (21.7%); headache frequently co-occurred.
• Distinct clusters emerged: vestibular-ocular and headache for physical symptoms; emotional and cognitive symptoms clustered together with higher severity. Five patient phenotypes were identified: resolved/minimal, mild, moderate, severe, and profound.

Conclusions:

• Post-concussive symptoms in children exhibit distinct clustering patterns.
• These clusters facilitate the identification of specific patient phenotypes based on symptom type and severity.
• Comprehensive care systems are needed to identify and treat these distinct pediatric post-concussion phenotypes effectively.