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J Int Neuropsychol Soc. 2019 Apr;25(4):375-389. doi: 10.1017/S1355617719000286.

Predicting Wellness After Pediatric Concussion.

Author information

1
Department of Psychology,University of Montreal,Montreal, Quebec,Canada, H2V 2S9.
2
Clinical Research Unit,Children's Hospital of Eastern Ontario Research Institute,Ottawa, Ontario,Canada, K1H 5B2.
3
Departments of Psychology, Pediatrics, and Clinical Neurosciences,University of Calgary,Calgary, Alberta,Canada, T2N 1N4.
4
Children's Hospital of Eastern Ontario Research Institute,Ottawa, Ontario,Canada, K1H 8L1.
5
Bloorview Research Institute,Holland Bloorview Kids Rehabilitation Hospital,Toronto, Ontario,Canada, M4G 1R8.
6
Alberta Children's Hospital Research Institute,University of Calgary,Alberta,Canada, T3B 6A8.
7
Department of Pediatrics,Hospital for Sick Children & University of Toronto,Ontario,Canada, M5G 1X8.
8
Montreal Children's Hospital,McGill University Health Center,Montreal, Quebec,Canada, H4A 3J1.
9
Ste-Justine Hospital Research Center,Montreal, Quebec,Canada, H3T 1C5.

Abstract

OBJECTIVE:

Concussion in children and adolescents is a prevalent problem with implications for subsequent physical, cognitive, behavioral, and psychological functioning, as well as quality of life. While these consequences warrant attention, most concussed children recover well. This study aimed to determine what pre-injury, demographic, and injury-related factors are associated with optimal outcome ("wellness") after pediatric concussion.

METHOD:

A total of 311 children 6-18 years of age with concussion participated in a longitudinal, prospective cohort study. Pre-morbid conditions and acute injury variables, including post-concussive symptoms (PCS) and cognitive screening (Standardized Assessment of Concussion, SAC), were collected in the emergency department, and a neuropsychological assessment was performed at 4 and 12 weeks post-injury. Wellness, defined by the absence of PCS and cognitive inefficiency and the presence of good quality of life, was the main outcome. Stepwise logistic regression was performed using 19 predictor variables.

RESULTS:

41.5% and 52.2% of participants were classified as being well at 4 and 12 weeks post-injury, respectively. The final model indicated that children who were younger, who sustained sports/recreational injuries (vs. other types), who did not have a history of developmental problems, and who had better acute working memory (SAC concentration score) were significantly more likely to be well.

CONCLUSIONS:

Determining the variables associated with wellness after pediatric concussion has the potential to clarify which children are likely to show optimal recovery. Future work focusing on wellness and concussion should include appropriate control groups and document more extensively pre-injury and injury-related factors that could additionally contribute to wellness. (JINS, 2019, 25, 375-389).

KEYWORDS:

Traumatic brain injury; children; neuropsychology; positive outcome; post-concussive symptoms; quality of life

PMID:
31050335
DOI:
10.1017/S1355617719000286

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