Characteristics of Pediatric Mild Traumatic Brain Injury and Recovery in a Concussion Clinic Population

Philip E Rosenbaum,Gerard A Gioia,Lawrence J Cook,Christopher C Giza,Meeryo C Choe,Rachel Richards,Sara P D Chrisman,Christina Pacchia,Christopher Locandro,Frederick P Rivara

doi:10.1001/jamanetworkopen.2020.21463

Abstract

Pediatric mild traumatic brain injury (TBI) and concussion are a public health challenge with up to 30% of patients experiencing prolonged recovery. Pediatric patients presenting to concussion clinics often have ongoing impairments and may be at increased risk for persistent symptoms. Understanding this population is critical for improved prognostic estimates and optimal treatment. To describe pediatric patients presenting to concussion clinics and characterize factors associated with their recovery. This prospective cohort study included patients enrolled at multicenter concussion specialty clinics from the Four Corners Youth Consortium from December 2017 to July 2019, with up to 12-month follow-up. Patients were eligible if they were aged 5 to 18.99 years with a diagnosis of mild TBI or concussion presenting to participating clinics within 8 weeks of injury. Patients were excluded if the patient or their parents were unable to read or sign the consent document, or if the patient had a Glasgow Coma Scale score less than 13 or a penetrating injury. Data were analyzed from February 2019 to April 2020. Diagnosis of mild TBI or concussion. This study used National Institute of Neurological Disorders and Stroke common data elements, including data on demographic characteristics, injury details, history, neurological and neuropsychological assessments, and treatment. A total of 600 patients were consecutively enrolled, among whom 324 (54.0%) were female and 435 (72.5%) were adolescents (ie, aged 13-18 years). A higher proportion of girls and women (248 patients [76.5%]) were adolescents compared with boys and men (187 patients [67.8%]) (P = .02), and girls and women reported significantly more preexisting anxiety compared with boys and men (80 patients [26.7%] vs 46 patients [18.7%]; P = .03). Significantly more adolescents reported preexisting migraines compared with preadolescents (82 patients [20.9%] vs 15 patients [10.9%]; P = .01). Girls and women recovered more slowly than boys and men (persistent symptoms after injury: week 4, 217 patients [81.6%] vs 156 patients [71.2%]; week 8, 146 patients [58.9%] vs 89 patients [44.3%]; week 12, 103 patients [42.6%] vs 58 patients [30.2%]; P = .01). Patients with history of migraine or anxiety or depression recovered more slowly than those without, regardless of sex. These findings suggest that identification of subgroups of pediatric patients with mild TBI or concussion at risk for prolonged recovery could aid in better prognostic estimates and more targeted treatment interventions.

Highlights

It is estimated that more than 830 000 pediatric patients with traumatic brain injury (TBI) present to emergency departments (EDs) each year in the US.[1]
Independent of sex, patients with anxiety or depression or migraine recovered more slowly than those without these comorbidities. Meaning These findings suggest that factors, such as sex and comorbidities, in pediatric patients with mild traumatic brain injury are essential for accurate prognostic estimates and identifying targets for treatment
Pediatric Mild Traumatic Brain Injury and Recovery in a Concussion Clinic Population. These findings suggest that identification of subgroups of pediatric patients with mild TBI or concussion at risk for prolonged recovery could aid in better prognostic estimates and more targeted treatment interventions

Summary

Introduction

It is estimated that more than 830 000 pediatric patients with traumatic brain injury (TBI) present to emergency departments (EDs) each year in the US.[1] Mild TBI, including concussion, accounts for at least 75% of all TBIs reported in the US.[2] A 2015 study[3] of pediatric concussion in an ED cohort found that adolescents aged 12 to 17 years had a higher incidence of concussion compared with younger children, but relatively few studies address children in the 5 to 12 years age range. Pediatric patients with mild TBI present to a variety of medical settings, with a 2016 study[4] reporting 82% of patients first seen in primary care, 11% of patients presenting to the ED, and 5.2% of patients presenting to a specialty clinic. A more complete understanding of the full range of needs of youth with mild TBI requires the study of all mechanisms across all age ranges and clinical settings, including the outpatient clinic population

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