Children with persistent post-concussion symptoms have a lower quality of life

1. Based on a prospective, multicenter cohort study conducted in Canada, children after a concussion who had persistent post-concussion symptoms scored lower on a health-related quality of life questionnaire.

2. Although the scores were better in children who had recovered from their concussion, there were still deficits in their quality of life questionnaire compared with previously published normal patients, indicating that additional interventional studies may need to be pursed to reduce concussions and their associated morbidity.

Evidence Rating Level: 2 (Good)

Study Rundown: Concussions remain a common consequence of traumatic injuries and are a frequent presenting condition to pediatric emergency rooms. Long-term outcomes for concussions are becoming more recognized. The current study sought to evaluate how persistent post-concussion symptoms (PPCS) affected health-related quality of life in children aged 5 to 18 years.

The study included patients from 9 pediatric emergency departments and recruited patients with concussions diagnosed by standardized questionnaire. Participants were then asked to complete health-related quality of life and post-concussion symptom inventory questionnaires at 4, 8, and 12 weeks. Participants with PPCS had lower quality of life scores at all times points compared to non-PPCS patients. The results were consistent across the physical, emotional, social, and school subdomains assessed by the questionnaire. All participants had lower quality of life scores compared to published healthy controls. While the study did include children from multiple emergency rooms, it was based in Canada and may not generalizable to the US, especially if post-concussion care is different in the two countries. Also, no control group was included for comparison (though this has been published in the past).

Click to read the study, published today in JAMA Pediatrics

Relevant Reading: Time Interval Between Concussions and Symptom Duration

In-Depth [cohort study]: This study included n=2006 children aged 5 to 18 who presented to one of 9 pediatric emergency departments with concussion as confirmed by the Acute Concussion Evaluation (ACE) questionnaire. Participants were excluded if they presented >48 hours from the time of injury, had a Glasgow Comas Scale score less than or equal to 13, had abnormal neuroimaging, required intensive care or operations, had multisystem trauma, or a history of neurodevelopmental delay. Participants or their parents (if <8 years old) completed both the Post-Concussion Symptom Inventory (PCSI) and Pediatric Quality of Life Inventory version 4.0 (PedsQL-4.0) at 4-, 8-, and 12-weeks post-concussion.

Participants with PPCS compared to without-PPCS had lower scores on the PedsQL-4.0 at 4 weeks (–10.3; 95%CI –9.4 to –11.2), 8 weeks (–8.9; 95%CI −8.2 to −9.6), and 12 weeks (–7.4; 95%CI −6.5 to −8.4). Participants with PPCS had lower scores in the physical, emotion, social, and school subdomains of the PedsQL-4.0 at all time points measured compared to those without PPCS.

Image: PD

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