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Published on: December 8, 2014
Postconcussive Symptoms After Early Childhood Concussion
Dominique Dupont1,2, Ken Tang3, Cindy Beaudoin1,2
1Department of Psychology, Université de Montréal, Montreal, Quebec, Canada.
Insights
Early childhood concussion is linked to more postconcussive symptoms (PCS) for up to 3 months compared to orthopedic injuries or typical development. Using age-appropriate measures aids in tracking PCS and diagnosing concussion in young children.
Area of Science:
- Pediatric neurology
- Developmental psychology
- Traumatic brain injury research
Background:
- Research on postconcussive symptoms (PCS) in early childhood is limited by a lack of age-appropriate assessment tools.
- Understanding the evolution of PCS in young children is crucial for timely diagnosis and management.
Purpose of the Study:
- To document PCS in the first 3 months after early childhood concussion using a developmentally appropriate measure.
- To compare PCS in young children with concussion to those with orthopedic injuries and uninjured controls.
Main Methods:
- A prospective, multicenter, longitudinal cohort study involving children aged 6 to 72 months.
- Caregiver observations using the Report of Early Childhood Traumatic Injury Observations & Symptoms inventory assessed PCS at multiple time points.
- Ordinal regression models were used for group comparisons.
Main Results:
- Children with concussion showed significantly higher rates of PCS compared to orthopedic injury and control groups up to 3 months post-injury.
- Significant differences were observed in total PCS and domain-level scores (cognitive, physical, behavioral) at various assessment points.
- No significant differences in pre-injury PCS were found between the concussion and comparison groups.
Conclusions:
- Concussion in early childhood is associated with a higher burden of PCS compared to orthopedic injuries or typical development.
- The use of developmentally appropriate measures is valuable for tracking PCS and supporting concussion diagnosis in young children.
- Findings highlight the importance of specialized assessment tools for evaluating concussion outcomes in this vulnerable population.
Importance:
Research on postconcussive symptoms (PCS) following early childhood concussion has been hindered by a lack of measures suitable for this age group, resulting in a limited understanding of their evolution in young children.
Objective:
To document PCS in the first 3 months after early childhood concussion using a developmentally appropriate measure.
Design, Setting, And Participants:
This cohort study used data collected at 3 Canadian and 1 US urban pediatric emergency departments (EDs) and 8 Canadian daycares from December 2018 to December 2022 as part of the Kids' Outcomes and Long-Term Abilities (KOALA) project, a prospective, multicenter, longitudinal cohort study. Participants included children aged 6 to 72 months with early childhood concussion or orthopedic injury (OI) or uninjured children from the community to serve as controls. Data were analyzed from March 2023 to January 2024.
Exposure:
Concussion sustained between ages 6 and 72 months.
Main Outcomes And Measures:
Primary outcomes were cognitive, physical, behavioral and total PCS assessed prior to injury (retrospectively), acutely (within 48 hours), and at 10 days, 1 month, and 3 months after injury or recruitment through caregiver observations using the Report of Early Childhood Traumatic Injury Observations & Symptoms inventory. Group comparisons were analyzed using ordinal regression models.
Results:
The study included 303 children (mean [SD] age, 35.8 [20.2] months; 152 [50.2%] male). Of these, 174 children had a concussion (mean [SD] age, 33.3 [19.9] months), 60 children had an OI (mean [SD] age, 38.4 [19.8] months) and 69 children were uninjured controls (mean [SD] age, 39.7 [20.8] months). No meaningful differences were found between the concussion and comparison groups in retrospective preinjury PCS. Significant group differences were found for total PCS at the initial ED visit (concussion vs OI: odds ratio [OR], 4.33 [95% CI, 2.44-7.69]; concussion vs control: OR, 7.28 [95% CI, 3.80-13.93]), 10 days (concussion vs OI: OR, 4.44 [95% CI, 2.17-9.06]; concussion vs control: OR, 5.94 [95% CI, 3.22-10.94]), 1 month (concussion vs OI: OR, 2.70 [95% CI, 1.56-4.68]; concussion vs control: OR, 4.32 [95% CI, 2.36-7.92]), and 3 months (concussion vs OI: OR, 2.61 [95% CI, 1.30-5.25]; concussion vs control: OR, 2.40 [95% CI, 1.36-4.24]). Significant group differences were also found for domain-level scores (cognitive, physical, behavioral) at various time points.
Conclusions And Relevance:
In this early childhood cohort study, concussion was associated with more PCS than OIs or typical development up to 3 months after injury. Given the limited verbal and cognitive abilities typical of early childhood, using developmentally appropriate manifestations and behaviors is a valuable way of tracking PCS and could aid in concussion diagnosis in young children.
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