Duration of post-concussive symptoms identified in pediatric patients

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1. Physical symptoms were most likely to be present immediately after a pediatric concussion, with emotional and cognitive symptoms appearing in the days to weeks following incident.

2. Thirty-two percent of pediatric patients continue to be symptomatic from concussions at 28 days after injury, with most common complaints of headache, fatigue, and taking longer to think.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Mild traumatic brain injury or concussions are common injuries in the pediatric population, and represent a main cause of childhood visits to the Emergency Department (ED). Though prior literature has examined the effects of concussions on the developing pediatric brain, little research has looked into the duration of post-concussive symptoms. This secondary analysis of a prospective cohort of pediatric patients presenting to the ED with a concussion utilized questionnaires to delineate the time course of post-concussive symptoms. Researchers found that physical symptoms were most common immediately after the concussion, with emotional and cognitive symptoms more likely to develop in the days to weeks after the initial event. Physical symptoms resolved the quickest after the concussion, with emotional and cognitive symptoms lasting longer. One month after the concussion, a small portion of patients still complained of headache, fatigue, and taking longer to think. This study is limited by its use of self-report questionnaires. Additionally, as this cohort was enrolled in a tertiary ED, these results may represent patients with more severe symptoms than those children who present to lower acuity healthcare facilities. This study provides a framework for the resolution of post-concussive patients, and may aid in determining the best time-course for full return to academics and sports in pediatric patients suffering from concussions.

Click to read the study published today in Pediatrics

Relevant Reading: Sports-Related Concussion in Children and Adolescents

Study Author, Dr. Matthew A. Eisenberg, MD, talks to 2 Minute Medicine: Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts.

“Most children will recover from a concussion within 2 weeks of the injury, but while physical symptoms such as headache and fatigue are usually present from the onset and then get better, the emotional symptoms such as irritability and frustration often come on later, even as the physical symptoms subside. Only by knowing what symptoms can be expected after a concussion can we help reassure patients and families that what they experiencing is normal, know when to refer for additional help, and make sure that children are taking appropriate precautions in regard to school and sports to achieve a full recovery.”

In-Depth [prospective cohort]: This study was a secondary analysis of a prospective cohort consisting of 190 patients aged 11 – 22 presenting to a tertiary ED with diagnosis of concussion. Patients, with the aid of their parents, filled out an initial Rivermead Post-Concussions Symptoms Questionnaire (RSPQ) questionnaire and a demographics survey at presentation and then repeated the RSPQ at 1, 2, 4, 6, 8, and 12 weeks after the first ED visit. Results suggested that physical symptoms (headache, fatigue, dizziness, nausea, etc) were most commonly present immediately after the concussion. Emotional (depression, frustration, irritability, restlessness) and cognitive (forgetfulness, inability to concentrate, taking longer to think) symptoms were less likely to present initially; these symptoms were more likely develop in the days to weeks following concussion and last longer than the majority of physical symptoms. Irritability and sleep disturbance were symptoms with the longest mean duration of 16 days.

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