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Children with persistent postconcussion symptoms reported lower quality of life
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Children with persistent symptoms for 12 weeks following a concussion demonstrated a lower health-related quality of life than children who recovered from concussion within 4 weeks, according to data published in JAMA Pediatrics.
However, deficits in overall and school-related quality of life persisted among both groups of children, even after concussion symptoms had resolved.
“Prolonged symptoms after a concussion may detrimentally affect participation in academic and recreational activities, thereby reducing social interactions,” Roger L. Zemek, MD, of the department of pediatrics at Children’s Hospital of Eastern Ontario Research Institute and the Pediatric Emergency Research Canada Predicting Persistent Postconcussive Problems in Pediatrics Concussion Team, and colleagues wrote. “Lower educational attainment and employment status have been identified in young adults who experienced concussion as children. As a result, [persistent postconcussion symptoms (PPCS)] may pose long-term challenges, thus reducing [health-related quality of life (HRQoL)], a multidimensional concept representing one’s perceived health status.”
To determine the causal link between HRQoL and PPCS in children aged 5 to 18 years following acute concussion, the researchers conducted a prospective, multicenter cohort study during a 13-month period, enrolling 2,006 children who presented with acute concussion into nine pediatric EDs within the Pediatric Emergency Research Canada Network. The children (1,241 boys; median age 11.8 years) underwent assessment with the Post-Concussion Symptom Inventory 4 weeks after injury. Symptoms were validated for independent associations of change in HRQoL with the Pediatric Quality of Life Inventory at 4, 8 and 12 week following head injury.
Some 1,667 children completed the Pediatric Quality of Life Inventory at all follow-up weeks. Among that number, children with PPCS (n = 510) had lower overall scores (average = 70) than children without PPCS (n = 1,157; average score = 80.3; OR = –10.3; 95% CI, –9.4 to –11.2). Both groups showed increased scores during the three study periods (beta = 0.56; 95% CI, 0.43-0.7); however, the PPCS group scores increased significantly faster than the scores for children without PPCS during weeks 4 through 12 postconcussion (beta = 0.36; 95% CI, 0.21-0.51). In addition, children without PPCS did not have significantly lower physical, emotional or social scores compared with healthy children at 4, 8 and 12 weeks postconcussion.
“Significant associations of poor functioning after pediatric mild [traumatic brain injury (TBI)] included lower parental education, Hispanic race/ethnicity, low household income and Medicaid insurance,” the researchers wrote. “Additional studies have found that repeated concussions may lead to greater cognitive dysfunction and neuropsychiatric conditions, which themselves can negatively affect pediatric HRQoL. Furthermore, female sex, previous TBI, and neurologic and psychological illness were associated with PPCS in both children and adults.” – by Kate Sherrer
Disclosure: The researchers reported no relevant financial disclosures.
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