INITIAL CLINICAL PRESENTATION OF PEDIATRIC PATIENTS WITH PSYCHOLOGICAL DISORDERS FOLLOWING CONCUSSION

Abstract

Background:There is limited evidence regarding the impact of pre-existing psychological disorders on the initial clinical presentation in pediatric patients following concussion.Hypothesis/Purpose:To examine differences in clinical symptom measures between pediatric patients with a history of depression and/or anxiety and no history of psychological disorder (PD) following a concussion.Methods:Data were prospectively collected from participants enrolled in the North Texas Concussion Network Registry (ConTex) between August 2015 and March 2020. Participants aged 5-18 years diagnosed with a concussion were included. Demographic variables and a range of clinical measures from initial presentation were reviewed, including SCAT-5 Symptom Log, Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7) scale, and Brief Resiliency Scale (BRS). Participants were separated into four groups based on self-reported prior diagnosis: depression, anxiety, depression+anxiety, and no PD.Results:A total of 1770 participants were included: 50 with depression, 82 with anxiety, 84 with both, and 1554 with no history of PD. There was no significant difference in age, sex, prior concussion history, or time to presentation between the depression and no PD group, or between the anxiety and no PD group. A significant difference was found between the depression+anxiety group and no PD group in the following variables: age (15.11±1.8 vs 13.68±2.61 years, p<0.001), prior concussion history (40.5% vs 23.9%, p=0.001), and time to presentation (31.47±25.82 vs 19.85±26.33 days, p=0.01). Additionally, there were more females in the depression+anxiety group than the no PD group (71.4% vs 47.8%, p<0.001). The depression, anxiety, and depression+anxiety groups had significantly higher rates of learning disorders than the no PD group (40%, 47.6%, 46.4% vs 16.4%, all p<0.001).A significant difference in SCAT-5 symptom severity scores between the depression, anxiety, and depression+anxiety groups compared to the no PD group was found. The PD groups all reported higher GAD-7 and PHQ-8 scores and lower BRS scores compared to the no PD group. The depression+anxiety group had the highest symptom severity, GAD-7, and PHQ-8 scores along with the lowest BRS score. Table 1.1 summarizes these significant findings.Conclusion:Differences were seen in participants with a history of depression and/or anxiety at initial clinical presentation, including history of learning disability, SCAT-5 symptom severity scores, and common screening tests for depression, anxiety, and resiliency compared to those without a history of PD. Understanding these differences at initial presentation may urge providers to engage multidisciplinary teams early in facilitating patient recovery.Tables/Figures: