Journal Article

Trajectories and Risk Factors for Pediatric Postconcussive Symptom Recovery

Anderson, Nicholas, Babl, Franz E, Takagi, Michael, Hearps, Stephen J C, Rausa, Vanessa C, Anderson, Vicki, Dunne, Kevin, Clarke, Cathriona, Truss, Katie, Bressan, Silvia, Davis, Gavin A

2021

Overview

Abstract BACKGROUND Persistent postconcussive symptoms (PCS) are poorly understood in children. Research has been limited by an assumption that children with concussion are a homogenous group. OBJECTIVE To identify (i) distinctive postconcussive recovery trajectories in children and (ii) injury-related and psychosocial factors associated with these trajectories. METHODS This study is part of a larger prospective, longitudinal study. Parents of 169 children (5-18 yr) reported their child's PCS over 3 mo following concussion. PCS above baseline levels formed the primary outcome. Injury-related, demographic, and preinjury information, and child and parent mental health were assessed for association with trajectory groups. Data were analyzed using group-based trajectory modeling, multinomial logistic regression, and chi-squared tests. RESULTS We identified 5 postconcussive recovery trajectories from acute to 3 mo postinjury. (1) Low Acute Recovered (26.6%): consistently low PCS; (2) Slow to Recover (13.6%): elevated symptoms gradually reducing; (3) High Acute Recovered (29.6%): initially elevated symptoms reducing quickly to baseline; (4) Moderate Persistent (18.3%): consistent, moderate levels of PCS; (5) Severe Persistent (11.8%): persisting high PCS. Higher levels of child internalizing behaviors and greater parental distress were associated with membership to the Severe Persistent group, relative to the Low Acute Recovered group. CONCLUSION This study indicates variability in postconcussive recovery according to 5 differential trajectories, with groups distinguished by the number of reported symptoms, levels of child internalizing behavior problems, and parental psychological distress. Identification of differential recovery trajectories may allow for targeted early intervention for children at risk of poorer outcomes. Graphical Abstract Graphical Abstract

• Publisher: Oxford University Press,Copyright by the Congress of Neurological Surgeons,Wolters Kluwer Health, Inc
• Subject: Adolescent / Behavior / Brain / Brain research / Child / Child, Preschool / Children / Children & youth / Concussion / Consciousness / Fainting / Female / Head injuries / Hospitals / Humans / Longitudinal Studies / Male / Medical imaging / Mental health / Neurosurgery / Parenting / Parents & parenting / Parents - psychology / Pediatrics / Post-Concussion Syndrome - psychology / Prospective Studies / Quality of life / Recovery (Medical) / Recovery of Function / Risk Factors / Stress (Psychology) / Traumatic brain injury