Format

Send to

Choose Destination
JAMA. 2016 Mar 8;315(10):1014-25. doi: 10.1001/jama.2016.1203.

Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED.

Author information

1
Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada.
2
Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
3
Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.
4
Department of Pediatrics, Hospital Ste Justine, University of Montreal, Montreal, Quebec, Canada.
5
Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
6
Department of Pediatrics, Children's Hospital of Western Ontario, Western University, London, Canada.
7
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
8
Department of Pediatrics, Manitoba Children's Hospital, Winnipeg, Canada.
9
Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada.
10
Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada.
11
Department of Pediatrics, Alberta Children's Hospital, Calgary, Canada.
12
Department of Pediatrics and Clinical Neurosciences, Alberta's Children's Hospital, University of Calgary, Calgary, Canada.
13
Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
14
Department of Neuropsychology, Children's National Health System, George Washington University School of Medicine, Rockville, Maryland.
15
Sports Concussion Clinic, Boston Children's Hospital, Boston, Massachusetts.
16
Ste Justine Research Center, University of Montreal, Montreal, Quebec, Canada.
17
Department of Kinesiology, University of Ottawa, Ottawa, Ontario, Canada.
18
Department of Psychology, Children's Hospital of Eastern Ontario, Ottawa, Canada.
19
Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.
20
Department of Psychology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.
21
Department of Neurosurgery, Children's Hospital of Eastern Ontario, Ottawa, Canada.
22
Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.
23
Department of Neurology, Stollery Children's Hospital, Edmonton, Alberta, Canada.
24
School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.

Abstract

IMPORTANCE:

Approximately one-third of children experiencing acute concussion experience ongoing somatic, cognitive, and psychological or behavioral symptoms, referred to as persistent postconcussion symptoms (PPCS). However, validated and pragmatic tools enabling clinicians to identify patients at risk for PPCS do not exist.

OBJECTIVE:

To derive and validate a clinical risk score for PPCS among children presenting to the emergency department.

DESIGN, SETTING, AND PARTICIPANTS:

Prospective, multicenter cohort study (Predicting and Preventing Postconcussive Problems in Pediatrics [5P]) enrolled young patients (aged 5-<18 years) who presented within 48 hours of an acute head injury at 1 of 9 pediatric emergency departments within the Pediatric Emergency Research Canada (PERC) network from August 2013 through September 2014 (derivation cohort) and from October 2014 through June 2015 (validation cohort). Participants completed follow-up 28 days after the injury.

EXPOSURES:

All eligible patients had concussions consistent with the Zurich consensus diagnostic criteria.

MAIN OUTCOMES AND MEASURES:

The primary outcome was PPCS risk score at 28 days, which was defined as 3 or more new or worsening symptoms using the patient-reported Postconcussion Symptom Inventory compared with recalled state of being prior to the injury.

RESULTS:

In total, 3063 patients (median age, 12.0 years [interquartile range, 9.2-14.6 years]; 1205 [39.3%] girls) were enrolled (n = 2006 in the derivation cohort; n = 1057 in the validation cohort) and 2584 of whom (n = 1701 [85%] in the derivation cohort; n = 883 [84%] in the validation cohort) completed follow-up at 28 days after the injury. Persistent postconcussion symptoms were present in 801 patients (31.0%) (n = 510 [30.0%] in the derivation cohort and n = 291 [33.0%] in the validation cohort). The 12-point PPCS risk score model for the derivation cohort included the variables of female sex, age of 13 years or older, physician-diagnosed migraine history, prior concussion with symptoms lasting longer than 1 week, headache, sensitivity to noise, fatigue, answering questions slowly, and 4 or more errors on the Balance Error Scoring System tandem stance. The area under the curve was 0.71 (95% CI, 0.69-0.74) for the derivation cohort and 0.68 (95% CI, 0.65-0.72) for the validation cohort.

CONCLUSIONS AND RELEVANCE:

A clinical risk score developed among children presenting to the emergency department with concussion and head injury within the previous 48 hours had modest discrimination to stratify PPCS risk at 28 days. Before this score is adopted in clinical practice, further research is needed for external validation, assessment of accuracy in an office setting, and determination of clinical utility.

PMID:
26954410
DOI:
10.1001/jama.2016.1203
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center