Frequency and Predictors of Persisting Symptoms 1 Year After Early Childhood Concussion
What did they do?
In this cohort study (KOALA – Kids’ Outcomes And Long-term Abilities after early childhood concussion study) they looked at children 6 months to 6 years old presenting with concussions or orthopedic injury. They wanted to see how often these children had persistent symptoms after concussion (PSaC). Had the parents fill out a retrospective, before the injury questionnaire while in the ED. They had subsequent in person follow up at 10 days, 1 months, and 3 months after the injury and one last questionnaire at 12 months post injury. They looked at 17 symptoms over time, including affected attention/concentration, memory, thinking or moving slowly, headache, nausea, balance, fatigue, sleep, vision, sensitivity to light/noise/touch, irritability, mood/motivation, anxiety, regression, and comfort seeking.
What did they find?
In young children presenting to the ED with concussion, 28% experience PSaC 1 month after injury, which tended to diminish with time. Importantly, PSaC was more common in children who had more severe symptoms in the ED. Loss of consciousness and need for brain imaging by PECARN, were the two most important predictors. Interestingly, attending school or daycare and higher parental education levels were correlated with lower levels of PSaC.
Relevance?
In school age children other studies have found PSaC in 35% at 1 month after injury. This study shows a similar rate in younger children. This becomes important in our discussions with parents at discharge. Especially in younger children, with more severe symptoms, they have a pretty good chance of having concussion symptoms for the month after discharge.
The Bottom Line:
Persisting symptoms at 1 month after concussion happen in about a 3rd of pediatric patients down to 6 months old. It’s way more common if they are more symptomatic in the ED. Diagnosing these patients with concussion and giving the parents good expectant management and follow-up, will really help the families out and hopefully keep them from returning. Encouraging early return to school seems to help mitigate symptoms.
In this cohort study (KOALA – Kids’ Outcomes And Long-term Abilities after early childhood concussion study) they looked at children 6 months to 6 years old presenting with concussions or orthopedic injury. They wanted to see how often these children had persistent symptoms after concussion (PSaC). Had the parents fill out a retrospective, before the injury questionnaire while in the ED. They had subsequent in person follow up at 10 days, 1 months, and 3 months after the injury and one last questionnaire at 12 months post injury. They looked at 17 symptoms over time, including affected attention/concentration, memory, thinking or moving slowly, headache, nausea, balance, fatigue, sleep, vision, sensitivity to light/noise/touch, irritability, mood/motivation, anxiety, regression, and comfort seeking.
What did they find?
In young children presenting to the ED with concussion, 28% experience PSaC 1 month after injury, which tended to diminish with time. Importantly, PSaC was more common in children who had more severe symptoms in the ED. Loss of consciousness and need for brain imaging by PECARN, were the two most important predictors. Interestingly, attending school or daycare and higher parental education levels were correlated with lower levels of PSaC.
Relevance?
In school age children other studies have found PSaC in 35% at 1 month after injury. This study shows a similar rate in younger children. This becomes important in our discussions with parents at discharge. Especially in younger children, with more severe symptoms, they have a pretty good chance of having concussion symptoms for the month after discharge.
The Bottom Line:
Persisting symptoms at 1 month after concussion happen in about a 3rd of pediatric patients down to 6 months old. It’s way more common if they are more symptomatic in the ED. Diagnosing these patients with concussion and giving the parents good expectant management and follow-up, will really help the families out and hopefully keep them from returning. Encouraging early return to school seems to help mitigate symptoms.
