Symptom Burden, School Function, and Physical Activity One Year Following Pediatric Concussion

Jacquie van Ierssel; Andrée-Anne Ledoux; Ken Tang; Rhonda Correll; Keith Owen Yeates; Gerald Gioia; Stephen B Freedman; Gurinder Sangha; Kathy Boutis; Darcy Beer; William Craig; Emma Burns; Angelo Mikrogianakis; Alexander S Dubrovsky; Isabelle Gagnon; Jocelyn Gravel; Candice McGahern; Martin H Osmond; Roger Zemek; Pediatric Emergency Research Canada (PERC) Concussion Team

doi:10.1016/j.jpeds.2020.08.061

Symptom Burden, School Function, and Physical Activity One Year Following Pediatric Concussion

J Pediatr. 2021 Jan:228:190-198.e3. doi: 10.1016/j.jpeds.2020.08.061. Epub 2020 Aug 25.

Authors

Jacquie van Ierssel¹, Andrée-Anne Ledoux², Ken Tang³, Rhonda Correll³, Keith Owen Yeates⁴, Gerald Gioia⁵, Stephen B Freedman⁶, Gurinder Sangha⁷, Kathy Boutis⁸, Darcy Beer⁹, William Craig¹⁰, Emma Burns¹¹, Angelo Mikrogianakis¹², Alexander S Dubrovsky¹³, Isabelle Gagnon¹⁴, Jocelyn Gravel¹⁵, Candice McGahern³, Martin H Osmond², Roger Zemek²; Pediatric Emergency Research Canada (PERC) Concussion Team

Affiliations

¹ Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada. Electronic address: jminnes@cheo.on.ca.
² Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada.
³ Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
⁴ Department of Psychology, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, Calgary, Canada.
⁵ Children's National Health System, George Washington University School of Medicine, Rockville, MD.
⁶ Alberta Children's Hospital Research Institute, Calgary, Canada; Department of Paediatrics, Alberta Children's Hospital, Calgary, Canada.
⁷ Children's Hospital of Western Ontario, London, Canada.
⁸ Department of Pediatrics, Hospital for Sick Children, Toronto, Canada.
⁹ Department of Pediatrics, Winnipeg Children's Hospital, Winnipeg, Canada.
¹⁰ Department of Pediatrics, Stollery Children's Hospital, Edmonton, Canada.
¹¹ Department of Pediatrics, IWK Health Sciences Centre, Halifax, Canada.
¹² Department of Pediatrics, McMaster University, Hamilton, Canada; Department of Pediatrics, McMaster Children's Hospital & St Joseph's Healthcare, Hamilton, Canada.
¹³ Department of Pediatrics, Montreal Children's Hospital, Montreal, Canada; Department of Pediatrics, McGill University, Montreal, Canada.
¹⁴ Department of Pediatrics, Montreal Children's Hospital, Montreal, Canada; School of Physical and Occupational Therapy, McGill University, Montreal, Canada.
¹⁵ Department of Pediatrics, Hôpital Ste. Justine, Montreal, Canada.

PMID: 32858032
DOI: 10.1016/j.jpeds.2020.08.061

Abstract

Objectives: To characterize symptom burden, school function, and physical activity in youth 1 year following acute concussion and those with subsequent repeat concussion.

Study design: Secondary analysis of Predicting Persistent Postconcussive Problems in Pediatrics prospective, multicenter cohort study conducted in 9 Canadian emergency departments. Participants were children between ages 5 and 18 years who presented consecutively ≤48 hours of concussion and agreed to participate in a post hoc electronic survey 1 year after injury. Outcomes were assessed using a standardized 25-question symptom scale derived from the Post-Concussion Symptom Inventory-Parent; school function and physical activity outcomes were queried. The primary outcome was total symptom score 1 year following concussion, defined as the number of symptoms experienced more than before injury.

Results: Of 3052 youth enrolled in the Predicting Persistent Postconcussive Problems in Pediatrics study, 432 (median [IQR] age, 11.5 [9,14] years; 266 [62%] male) completed the 1-year survey; 34 respondents reported a repeat concussion. Following acute concussion, youth were more likely to be symptom-free than following repeat concussion (75% vs 50%; difference = 25% [95% CI 8-41]; P = .002) and to have recovered fully (90% vs 74%; difference = 17% [95% CI 5-34]; P = .002) after 1 year. Although physical symptoms were less 1 year after initial emergency department presentation for both groups (P < .001), youth with a repeat concussion reported greater headache persistence (26% vs 13%; difference = 13% [95% CI 1,31]; P = .024). Both groups returned to their normal school routine (100% vs 95%; difference = 5% [95% CI -5 to 8; P = .618). Youth without repeat concussion more frequently returned to normal physical activities (98% vs 85%; difference = 13% [95% CI 4-28]; P < .0001) and sport (95% vs 82%; difference = 13% [95% CI 3-29]; P = .009).

Conclusions: Most youth are symptom-free and fully recovered 1 year following concussion. Some children with repeat concussion have worse outcomes and have delays in returning to normal school routines and sport.

Keywords: concussion; physical activity; recovery; symptoms; youth.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Brain Concussion / psychology*
Child
Child, Preschool
Exercise / physiology*
Female
Humans
Learning*
Male
Prognosis
Prospective Studies
Recovery of Function / physiology*
Schools*
Time Factors

Abstract

Publication types

MeSH terms

Grants and funding