Severity of post-concussive symptoms not predictive of recovery

1. In a prospective longitudinal study, severity of reported symptoms immediately following a concussion was not associated with delayed symptom resolution (DSR) in children.

2. Among children with DSR, cognitive symptoms such as difficulty remembering or difficulty concentrating were more prevalent.

Evidence Rating Level: Good (2)

Study Rundown: Concussions bring thousands of children to the Emergency Department (ED). Although the consequences of concussions have been extensively researched, there currently exists few criteria that allow the identification of children likely to suffer from persistent symptoms. This study examined whether greater symptom severity measured in the acute setting was associated with delayed symptom resolution (DSR). Results indicate that more acute symptoms were not significantly associated with DSR following a concussion. However, cognitive symptoms were found to be more characteristic of subjects with DSR. This study is limited by the fact that all symptoms were weighed equally when determining the initial severity of the concussion, not accounting for evidence from prior studies that associate particular symptoms with more significant injuries. The findings of this study underscore that while severity of symptoms following a concussion cannot be used to identify patients at risk of DSR, the prevalence of cognitive symptoms, in particular, could be used to stratify patients.

Click to read the study, published today in Pediatrics

Relevant Reading: Symptom severity predicts prolonged recovery after sport-related concussion, but age and amnesia do not.

Study Author, Dr. Joe Grubenhoff, MD, talks to 2 Minute Medicine: University of Colorado School of Medicine, Assistant Professor of Pediatrics, Section of Emergency Medicine; Children’s Hospital Colorado.

“Many people, including health care providers, assume that more severe or more numerous symptoms at the time of injury suggest a higher likelihood of long-term sequelae. Our study shows that initial symptom severity alone is a poor predictor of delayed symptom resolution, thus making follow-up an important component of management for all children first seen in an ED after a concussion.”

In-Depth [prospective longitudinal cohort study]: This study evaluated 179 children ages 8 to 18 years old presenting to the ED with a concussion. Participants completed a symptom inventory score at the initial encounter and one month later. Twenty one percent of children from the study group met criteria for DSR and had a median initial graded symptom score of 10.5 as compared to 9 for the early symptom resolution (ESR) group.  A sensitivity analysis was performed to define the point separating low from high symptoms, allowing for classification of symptom severity. This best cut point was a score of 11 and it had a sensitivity of 63% and a specificity of 50% for DSR. However, DSR was not significantly associated with a score of 11 (P = .46). Researchers also performed a hierarchical cluster analysis, which aims to identify the features most characteristic of a group. Using this method, 3 of the 6 most characteristic symptoms (phonophobia, photophobia, and blurred/double vision) were shared by both the ESR and DSR groups, suggesting that the symptoms may not be telling of patients at risk of having DSR.

Image: PD

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