Different trajectories of post-concussive symptom subscales after pediatric mild traumatic brain injury: Data from a
Martina Studer1, Lara Mischler2, Fabrizio Romano3
1Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital Basel (UKBB), Basel, Switzerland; Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland.
Insights
Children with mild traumatic brain injury (mTBI) experience persistent sleep-related post-concussive symptoms (PCS) for months. These symptoms impact participation, highlighting a need for targeted interventions in pediatric mTBI recovery.
Area of Science:
- Pediatric neurology
- Neuroscience
- Rehabilitation medicine
Background:
- Mild traumatic brain injury (mTBI) is common in children, with potential long-term effects.
- Understanding the recovery trajectory of post-concussive symptoms (PCS) and functional outcomes is crucial for effective management.
Purpose of the Study:
- To investigate the longitudinal course of parent-rated PCS, attentional performance, and participation in children following mTBI.
- To compare these outcomes between children with mTBI and healthy controls over a 6-month period.
Main Methods:
- Prospective longitudinal study involving 64 children post-mTBI and 57 healthy controls (ages 8-16).
- Parent-rated PCS (Post-Concussion Symptom Inventory) assessed immediately, 1 week, and 3-6 months post-injury.
- Attentional performance (Test of Attentional Performance) and participation (Child and Adolescent Scale of Participation) measured at follow-up points.
Main Results:
- Somatic and cognitive PCS remained elevated at 1 week post-injury, while emotional PCS normalized.
- Sleep-related PCS were significantly elevated at 3-6 months post-injury.
- Children with mTBI showed reduced participation at school compared to controls, despite similar attentional performance; PCS correlated negatively with home participation.
Conclusions:
- Sleep-related PCS persist for weeks to months after pediatric mTBI and warrant specific attention.
- Parental ratings of participation are affected, particularly in the school setting, suggesting functional deficits beyond cognitive or attentional impairments.
- Targeted interventions for sleep disturbances may be beneficial in the recovery process for children after mTBI.
Purpose:
The aim of this study was to investigate the trajectory of parent-rated post-concussive symptoms (PCS), attentional performance and participation within 6 months in children after mild traumatic brain injury (mTBI).
Methods:
For this prospective longitudinal study, we included data on 64 children after mTBI and 57 healthy control children (age 8-16 years). Parents rated PCS using the Post-Concussion Symptom Inventory (PCSI) immediately (T0), 1 week (T1), and 3-6 months after injury (T2). Attentional performance (alertness, selective and divided attention) was measured using the Test of Attentional Performance (TAP) at T1 and T2 and participation was measured using the Child and Adolescent Scale of Participation (CASP) at T2.
Results:
Friedman tests showed different trajectories of PCS subscales over time: Compared to pre-injury level, the amount of somatic and cognitive PCS was still elevated at T1, while emotional PCS at T1 were already comparable to pre-injury level. The rating of sleep-related PCS at T2 was significantly elevated compared to the pre-injury rating. Quade ANCOVAs indicated group differences in PCS subscales between patients and controls at T1, but not at T2. Patients and controls showed a similar performance in tests of attention at T1 and T2, but parental rating of participation at school was significantly reduced. Although cognitive PCS and attention were not correlated, there were significantly negative Spearman correlations between participation at home and pre-injury and concurrent PCS at T2.
Conclusions:
Our data imply that sleep-related PCS are still elevated weeks after injury and are thus a target for interventions after mTBI.
