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Published on: September 25, 2014
Assessment of post-concussion emotional symptom load using PCSS and PROMIS instruments in pediatric patients
Gina M Johnson1, Jacob T Wild1, Jamie K Burgess1
1Division of Orthopedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Insights
Adding PROMIS anxiety and depressive symptom surveys to concussion evaluations helps identify more pediatric patients with emotional symptoms. This aids in directing treatment and providing necessary psychological support for better recovery.
Area of Science:
- Pediatric neurology
- Clinical psychology
- Neuroscience
Background:
- Concussion can lead to emotional symptoms in children.
- Current assessment tools may not fully capture the emotional burden.
- Early identification of emotional distress is crucial for effective management.
Purpose of the Study:
- Evaluate the utility of Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depressive symptom domains.
- Assess the effectiveness of PROMIS in conjunction with the Post-Concussion Symptom Scale (PCSS) for identifying emotional symptoms in pediatric concussion patients.
- Identify predictors of higher emotional symptom severity following concussion.
Main Methods:
- Recruited 458 pediatric patients (8-17 years) at a concussion clinic (2014-2018).
- Collected demographic and clinical data, including PCSS, injury history, and Vestibular/Ocular-Motor Screen (VOMS).
- Administered PROMIS Pediatric anxiety and depressive symptom surveys at the initial visit; used multivariable linear regression to find predictors of emotional symptom load.
Main Results:
- Over 92% of patients reported at least one emotional symptom on PROMIS or PCSS.
- Abnormal VOMS, female sex, prior anxiety/depression history, and longer time since injury predicted higher emotional symptom loads.
- PROMIS identified a significant number of emotional symptoms in pediatric concussion patients.
Conclusions:
- Integrating PROMIS anxiety and depressive symptom surveys into pediatric concussion evaluations can improve the identification of emotional symptoms.
- This enhanced identification allows for more targeted post-concussion treatment and psychological support.
- Future research should investigate if early symptom detection with PROMIS facilitates recovery and improves psychological outcomes.
Objectives:
The purpose of this study is to evaluate the utility of the Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depressive symptom domains in conjunction with the Post-Concussion Symptom Scale (PCSS)for identifying pediatric patients with emotional symptoms following a concussion, and to identify predictors of higher emotional symptom loads.
Methods:
We recruited English-speaking patients aged 8-17 years presenting to a tertiary-care concussion clinic from 2014 to 2018 (n = 458). Demographics and clinical data including PCSS, injury date, previous history of anxiety/depression, and Vestibular/Ocular-Motor Screen (VOMS) were collected from patients' electronic medical records. Participants completed surveys in the PROMISTM Pediatric Item Bank v1.1-Anxiety and Depressive Symptoms domains at their initial clinic visit. Multivariable linear regression identified predictors of higher emotional symptom loads.
Results:
Overall, 425 (92.8%) reported ≥1 emotional symptom on either PROMIS or PCSS. Predictors of higher emotional symptom loads were abnormal VOMS, female sex, history of anxiety or depression, and longer time since injury.
Conclusion:
Our results suggest that adding PROMIS anxiety and depressive symptom surveys to pediatric concussion evaluations may identify more children with emotional symptoms, allowing clinicians to better direct post-concussion treatment and incorporate psychological support for patients if necessary. Future studies should examine whether earlier identification of emotional symptoms with these tools facilitates recovery and improves short- and/or long-term psychological outcomes in pediatric concussion.
