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Symptom spikes after concussion may not yield clinically significant events
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Children who had concussions showed that symptom exacerbations are common from one day to the next and are mostly temporary and overall not detrimental to recovery; thus, it is safe to return to school and sports at a gradual pace, according to findings.
“Little is currently known about the incidence, natural history and clinical significance of activity-related symptom exacerbations after pediatric concussion,” Noah D. Silverberg, PhD, clinical assistant professor, divisions of physical medicine and rehabilitation and neurology, department of medicine, University of British Columbia in Vancouver, and colleagues wrote. “The present study aims to characterize symptom exacerbations (“spikes”) as well as their antecedents and potential consequences.”
The researchers conducted a secondary analysis of a prospective, randomized clinical trial that included 63 children (41 boys, 22 girls) aged 11 to 18 years recruited from an ED with concussions that did not require hospitalization or have abnormal scans. They predicted that increases in physical and mental activity after injury would spike symptoms. In addition, the researchers hypothesized that symptom spikes would be transient and not increase risks for adverse clinical outcomes. The participants were asked to relay their symptoms after concussion and record daily activities in a diary for 10 consecutive days. The researchers examined the occurrence of symptom spikes; an increase was considered 10 or more points on the post-concussion symptom scale from day to day.
Symptoms decreased on average during the 10 days after injury (P < .001). Analysis showed that symptom spikes occurred in one-third of the participants (n = 20), but lasted briefly. Four participants experienced a second spike and no children experienced more than two spikes. A significant, sudden increase in mental or physical activity such as returning to school or activities from one day to the next increased the risk of a symptom exacerbation (RR = 0.81; 95% CI, 0.21-3.21).
“Contrary to our hypothesis, symptom spikes were not associated with physical activity or the absolute mental activity level on the day of the symptom spike or the day prior,” the researchers wrote. “However, they were associated with a sharp increase in mental activity over the preceding 24 hours. Finally, symptom spikes were associated with higher symptom reporting but not cognitive function or balance 10 days after injury.” – by Kate Sherrer
Disclosure: Silverberg reports receiving salary support from the Vancouver Coastal Health Research Institute. Please see the full study for a list of all other authors’ relevant financial disclosures.
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