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Classification Criteria and Rates of Persistent Postconcussive Symptoms in Children: A Systematic Review and
Leah Chadwick1, Manu J Sharma2, Sheri Madigan3
1Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
Insights
Persistent postconcussive symptoms (PPCS) affect about one-third of children after a concussion or mild traumatic brain injury. Older age, being female, and seeking care at concussion clinics are associated with higher PPCS prevalence.
Area of Science:
- Pediatric neurology
- Neuroscience
- Public health
Background:
- Persistent postconcussive symptoms (PPCS) are a significant concern following pediatric concussion.
- Understanding the prevalence and predictors of PPCS is crucial for effective management.
Purpose of the Study:
- To systematically review studies on the proportion of children experiencing PPCS.
- To identify potential moderators influencing the prevalence of PPCS in pediatric populations.
Main Methods:
- A comprehensive literature search was conducted across major databases (MEDLINE, Embase, PsycINFO, Scopus, Cochrane).
- Studies included children (<18 years) with concussion/mild TBI, assessed for PPCS ≥4 weeks post-injury, and reported prevalence data.
- Study quality was assessed using the Newcastle-Ottawa Scale.
Main Results:
- Thirteen studies comprising 5307 participants were analyzed.
- The overall weighted average prevalence of PPCS was 35.1% (95% CI, 26.3%-45.0%).
- Higher PPCS prevalence was observed in older children, females, those treated at concussion clinics, and in more recent publications.
Conclusions:
- Approximately one-third of children with concussion/mild TBI develop persistent postconcussive symptoms.
- Key factors such as age, sex, and the point of care can help identify children at higher risk for PPCS.
Objective:
To provide a systematic review of studies examining the proportion of children with persistent postconcussive symptoms (PPCS) and to examine potential moderators of prevalence.
Study Design:
Searches were conducted in MEDLINE, Embase, PsycINFO, Scopus, and Cochrane Central Register of Controlled Trials on April 16, 2020. Criteria for study inclusion were children aged <18 years with concussion or mild traumatic brain injury, operational definition of PPCS, assessment of postconcussive symptoms at least 4 weeks postinjury, sample sizes and proportion with PPCS available, and study published in English. Definition of PPCS, sample size, proportion of participants identified with PPCS, child sex and age at injury, time postinjury, premorbid symptoms, diagnosis (concussion or mild traumatic brain injury), and study publication year were extracted from each article. Study quality was assessed using the Newcastle-Ottawa Scale.
Results:
Thirteen studies, with a total of 5307 participants, were included in our analysis. The proportion of children identified with PPCS was 35.1% (weighted average; 95% CI, 26.3%-45.0%). The prevalence of PPCS was higher in older and female children who presented for care at concussion clinics, and in more recent publications.
Conclusions:
Approximately one-third of children with concussion/mild traumatic brain injury will experience PPCS. Age, sex, and point of care could help identify children at high risk for PPCS.
