Incidence, risk factors and outcomes of persistent post-concussion symptoms in Singaporean school-going children

Concussion and its sequalae of persistent post-concussion symptoms (PPCS) are significant healthcare burdens in the paediatric population. For affected patients, PPCS significantly impacts their academic performance, social interactions, and quality of life. This study is undertaken to investigate the prevalence of PPCS, identify associated risk factors and outcomes, and evaluate the applicability of the Post-Concussion Symptom Scale (PCSS) in school-going children diagnosed with concussive head injury.

This is a single-institution, retrospective study conducted from January 2020 to April 2023 (40 months). All patients aged 5 to 18 years diagnosed with concussion at the KK Women's and Children's Hospital, Singapore, are included. Subsequently, they are stratified into 2 groups: non-PPCS (symptom resolution within 4 weeks) and PPCS (symptoms persisting beyond 4 weeks). Data on patient demographics, clinical history, mechanism of head injury, symptomatology, PCSS scores, and recovery times are analyzed. Multivariable logistic regression is performed to identify independent predictors of PPCS.

A total of 220 patients were recruited for this study. Eighty-seven (39.5%) patients had PPCS. Sports-related injuries were the most common cause of concussion. Higher PCSS scores were significantly associated with PPCS (p < 0.01). Independent predictors of PPCS included female gender (p = 0.01), history of psychiatric illness (p < 0.01), and childhood headaches (p = 0.01).

To our knowledge, this is the first longitudinal study focused on PPCS in a Southeast Asian paediatric population. Early identification of high-risk patients and clinical predictors is crucial to initiate time-sensitive interventions for optimal outcomes.