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J Neurotrauma. 2020 Jan 29. doi: 10.1089/neu.2019.6683. [Epub ahead of print]

TRAJECTORIES AND PREDICTORS OF CLINICIAN-DETERMINED RECOVERY AFTER CHILD CONCUSSION.

Author information

1
Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia.
2
Royal Children's Hospital Melbourne, 6453, Parkville, Victoria, Australia.
3
The University of Melbourne Melbourne School of Psychological Sciences, 213183, Melbourne, Victoria, Australia; vicki.anderson@rch.org.au.
4
Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia; gavin.davis@me.com.
5
The University of Melbourne Melbourne School of Psychological Sciences, 213183, Melbourne, Victoria, Australia; michael.takagi@mcri.edu.au.
6
Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; kevin.dunne@rch.org.au.
7
Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia; cathriona.clarke@mcri.edu.au.
8
Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia; nicholas.anderson@mcri.edu.au.
9
Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia; vanessa.rausa@mcri.edu.au.
10
The University of Melbourne Melbourne School of Psychological Sciences, 213183, Melbourne, Victoria, Australia; melissa.doyle@mcri.edu.au.
11
Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia; georgia.parkin@mcri.edu.au.
12
Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia; katietruss@gmail.com.
13
Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia; emma.thompson@mcri.edu.au.
14
University of Padova Department of Women's and Children's Health, 165488, Padova, Veneto, Italy; silviabress@gmail.com.
15
Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia; stephen.hearps@mcri.edu.au.
16
Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; franz.babl@rch.org.au.

Abstract

OBJECTIVES:

By age 16, 20% of children will suffer a concussion. Many experience persisting post-concussive symptoms (PCS), the causes of which remain unclear. We mapped recovery trajectories to 3 months post-injury and explored predictors of outcome, including both traditional (e.g., age, sex) and novel (pre- and post-injury child mental health) factors.

METHODS:

We conducted a prospective, longitudinal study in the emergency department of a tertiary, pediatric hospital. Children were recruited within 48 hours of concussion, and assessed acutely (T0), at 2 days (T1), 2 weeks (T2), 1 month (T3), and 3 months (T4). Primary outcome was physician diagnosis at T2. Clinical history, injury mechanism, acute symptoms, and physical and cognitive function were assessed. Parents rated child behavior and fatigue and their mental health.

RESULTS:

We enrolled 256 participants; 72% males: 62 (24.3%) were symptomatic at T2. This group had a higher rate of pre-injury psychiatric diagnoses, acute (T1) parent-rated PCS and higher rate of acute CT scans. At 2 weeks, they demonstrated higher parent-rated PCS and more internalizing behaviors (ps<.01) than the recovered group. No group differences were detected for child age, sex, injury mechanism, prior concussions, pre-injury parent-rated PCS, or acute physical and cognitive status.

CONCLUSIONS:

Physician assessment identified 24.3% of children as symptomatic at 2 weeks post-concussion. Psychiatric history, parent rated PCS at T1 and internalizing behaviors at 2 weeks were major predictors of persisting symptoms, highlighting the importance of incorporating mental health considerations in managing post-concussion.

KEYWORDS:

HEAD TRAUMA; PEDIATRIC BRAIN INJURY; RECOVERY

PMID:
31996086
DOI:
10.1089/neu.2019.6683

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