A Prospective Cohort Study of the Association Between Preinjury Psychosocial Function and Postconcussive Symptoms in
Quynh Doan1, Leah Chadwick, Ken Tang
1Department of Pediatrics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada (Dr Doan); Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada (Ms Chadwick and Dr Yeates); Independent Statistical Consultant, Vancouver, Canada (Dr Tang); Departments of Pediatrics, Clinical Neurosciences, and Psychology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada (Dr Brooks); Department of Psychology, University of Montreal & Ste-Justine Hospital Research Center, Montreal, Canada (Dr Beauchamp); Department of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada (Dr Zemek); Department of Pediatrics, University of Alberta, and Stollery Children's Hospital, Edmonton, Alberta, Canada (Dr Craig); and Department of Pediatric Emergency Medicine, CHU Sainte-Justine, Université de Montréal, Montreal, Canada (Dr Gravel).
Insights
Preinjury psychosocial function impacts postconcussion symptoms in children with mild traumatic brain injury (mTBI). Assessing psychosocial factors is crucial for understanding symptom severity and recovery trajectories.
Area of Science:
- Pediatric neurology
- Neuropsychology
- Child psychology
Background:
- Mild traumatic brain injury (mTBI) is common in children, with symptoms potentially influenced by pre-existing factors.
- Understanding factors that moderate symptom presentation is vital for effective clinical management.
Purpose of the Study:
- To investigate the moderating effect of preinjury psychosocial function on postconcussion symptoms in children with mTBI.
- To compare symptom trajectories between children with mTBI and orthopedic injury (OI).
Main Methods:
- Prospective cohort study of 633 children with mTBI and 334 with OI, aged 8-16 years.
- Assessed preinjury psychosocial function using PedsQL and SDQ; measured postconcussion symptoms via HBI and PCS-I.
- Longitudinal regression models analyzed interactions between preinjury function and injury group.
Main Results:
- Preinjury psychosocial function significantly moderated postconcussion symptoms over 6 months.
- Higher emotional/conduct problems correlated with more severe symptoms in mTBI vs. OI.
- Conversely, milder hyperactivity/peer problems and higher social functioning were linked to greater symptom differences between mTBI and OI groups.
Conclusions:
- Preinjury psychosocial function is a key moderator of postconcussion symptoms in pediatric mTBI.
- Routine assessment of preinjury psychosocial status is recommended for children with mTBI to predict and manage symptoms.
Objective:
We evaluated the moderating effect of preinjury psychosocial function on postconcussion symptoms for children with mild traumatic brain injury (mTBI).
Design, Setting, And Population:
We conducted a prospective cohort study of children ages 8.0 to 16.9 years with mTBI ( n = 633) or orthopedic injury (OI; n = 334), recruited from 5 pediatric emergency departments from September 2016 to December 2018.
Main Measures:
Participants completed baseline assessments within 48 hours of injury, and postconcussion symptoms assessments at 7 to 10 days, weekly to 3 months, and biweekly to 6 months post-injury. Preinjury psychosocial function was measured using parent ratings on the Pediatric Quality of Life Inventory (PedsQL) and the Strengths and Difficulties Questionnaire (SDQ), retrospectively evaluating their child's status prior to the injury. Parent and child ratings on the Health and Behavior Inventory (HBI) (cognitive and somatic subscales) and the Post-Concussion Symptom Interview (PCS-I) were used as measures of postconcussion symptoms. We fitted 6 longitudinal regression models, which included 747 to 764 participants, to evaluate potential interactions between preinjury psychosocial function and injury group as predictors of child- and parent-reported postconcussion symptoms.
Results:
Preinjury psychosocial function moderated group differences in postconcussion symptoms across the first 6 months post-injury. Higher emotional and conduct problems were significantly associated with more severe postconcussion symptoms among children with mTBI compared with OI. Wald's χ 2 for interaction terms (injury group × SDQ subscales) ranged from 6.3 to 10.6 ( P values <.001 to .043) across parent- and child-reported models. In contrast, larger group differences (mTBI > OI) in postconcussion symptoms were associated with milder hyperactivity (Wald's χ 2 : 15.3-43.0, all P < .001), milder peer problems (Wald's χ 2 : 11.51, P = .003), and higher social functioning (Wald's χ 2 : 12.435, P = .002).
Conclusions:
Preinjury psychosocial function moderates postconcussion symptoms in pediatric mTBI, highlighting the importance of assessing preinjury psychosocial function in children with mTBI.
