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Published on: September 25, 2014
Persistent post-concussive syndrome in children after mild traumatic brain injury is prevalent and vastly
Eli Fried1, Uri Balla1, Merav Catalogna2
1Pediatric Division, Kaplan Medical Center, Rehovot, Israel.
Insights
Persistent post-concussion syndrome (PPCS) affects 25% of children after mild traumatic brain injury (mTBI). Adolescence and motor vehicle accidents are key risk factors, highlighting the need for better screening and treatment for pediatric concussion.
Area of Science:
- Pediatric Neurology
- Traumatology
- Epidemiology
Background:
- Persistent post-concussion syndrome (PPCS) following mild traumatic brain injury (mTBI) in children is not well understood.
- Limited data exists on the prevalence and predictors of PPCS in the pediatric population.
Purpose of the Study:
- To determine the prevalence of PPCS in children aged 8-15 years after mTBI.
- To identify clinical variables associated with a higher risk of developing PPCS in this age group.
Main Methods:
- A multicenter, retrospective matched cohort study.
- Inclusion of 205 children with mTBI and 205 controls (radius fracture).
- Evaluation of PPCS symptoms using the Rivermead Post-Concussion Questionnaire 6-60 months post-injury; multivariable logistic regression for predictor identification.
Main Results:
- PPCS prevalence was 25.3% in the mTBI group versus 2.4% in the control group (p < 0.001).
- Time elapsed since injury did not significantly influence PPCS prevalence within the 6-60 month period.
- Motor vehicle accidents and adolescence emerged as significant risk factors for PPCS in children with mTBI.
Conclusions:
- PPCS is significantly underdiagnosed in children following mTBI.
- Approximately 25% of pediatric mTBI cases presenting to the emergency department may develop PPCS.
- Implementation of screening guidelines is crucial for early identification and management of PPCS in children.
Abstract:
Data on epidemiology and prognosticators of persistent post-concussion syndrome (PPCS) after mild traumatic brain injury (mTBI) in the pediatric population is scarce. The aim of this study was to evaluate the prevalence of PPCS in children after mTBI and to identify clinical variables in children who are at high risk for developing PPCS. A multicenter, retrospective matched cohort in which PPCS symptoms were evaluated in children 8-15-year-old, 6-60 months after being admitted to the emergency department because of mTBI. The control group included children admitted to the emergency department because of uncomplicated distal radius fractures. The children's guardians were interviewed for the presence of PPCS symptoms using the "Rivermead Post-Concussion Questionnaire". A multivariable logistic regression model was used to identify predictors of PPCS. Two-hundred and five children were included in the mTBI group and 205 in the control. The median time from the injury was 33.5 months in the mTBI group and 33.8 in the control. The prevalence of PPCS in the mTBI group was 25.3% and PPCS like symptoms in the control was 2.4%, p < 0.001. Within the 6-60 months period, the PPCS prevalence was not influenced by the time that elapsed from the injury. In the mTBI group, motor vehicle accidents and adolescence were found to be risk factors for PPCS. PPCS is underdiagnosed in the pediatric population and 25% of children admitted to the ED due to mTBI may suffer from PPCS. Screening guidelines should be implemented to identify and properly treat these children.
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