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J Pediatr. 2016 Jul;174:27-32.e1. doi: 10.1016/j.jpeds.2016.03.027. Epub 2016 Apr 11.

Psychological Factors Associated with Delayed Symptom Resolution in Children with Concussion.

Author information

1
Section of Pediatric Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO. Electronic address: Joe.grubenhoff@childrenscolorado.org.
2
Colorado School of Public Health, Aurora, CO.
3
Section of Pediatric Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Colorado School of Public Health, Aurora, CO.
4
Section of Pediatric Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO.
5
Children's Hospital Colorado, Aurora, CO; Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO.

Abstract

OBJECTIVE:

To characterize the psychological factors associated with persistent symptoms after pediatric concussion.

STUDY DESIGN:

Longitudinal cohort study of 179 children with concussion 8-18 years old evaluated in a pediatric emergency department. Participants were followed for 1 month for delayed symptom resolution, defined as ≥3 symptoms that were new/worse than preinjury symptoms measured by the use of graded symptom inventory. Preinjury psychological traits were measured by parental report on subscales of the Personality Inventory for Children-2 (maladjustment, cognitive abilities, somatization). Child report of postinjury anxiety and injury perception were measured with the State-Trait Anxiety Inventory for Children and Children's Illness Perception Questionnaire. Psychological instrument scores were compared between those with and without delayed symptom resolution via a Kruskal-Wallis test. Associations between psychological traits and delayed symptom resolution were investigated by the use of logistic regression.

RESULTS:

Delayed symptom resolution occurred in 21% of participants. Score distributions were significantly worse on the State-Trait Anxiety Inventory for Children (38 [IQR 33-40] vs 35 [IQR 31-39]; P = .04) and somatization subscale (1 [IQR 0-3] vs 1 [IQR 0-1]; P = .01) among children with delayed symptom resolution compared with children with early symptom resolution. Somatization was associated with delayed symptom resolution (aOR 1.35, 95% CI 1.08-1.69). The proportion of children with abnormal somatization scores was significantly greater in the delayed symptom resolution group (34.2%) than the early symptom resolution group (12.8%; P < .01). Other psychological measures were not different between groups.

CONCLUSION:

Somatization is associated with delayed symptom resolution in this cohort of children with concussion. Postconcussive symptoms lasting at least 1 month may warrant referral to a neuropsychologist familiar with postconcussion care.

KEYWORDS:

anxiety; children; concussion; emergency department; mild traumatic brain injury; postconcussive syndrome; somatization

PMID:
27079963
PMCID:
PMC4925252
DOI:
10.1016/j.jpeds.2016.03.027
[Indexed for MEDLINE]
Free PMC Article

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