Can We Predict Which Children Are at Risk for Persistent Postconcussion Syndrome?

March 8, 2016

Can We Predict Which Children Are at Risk for Persistent Postconcussion Syndrome?

  1. Katherine Bakes, MD

A clinical risk score for use at time of emergency department presentation modestly predicted persistent postconcussion syndrome, but applying it would be impractical.

  1. Katherine Bakes, MD

Investigators developed a clinical risk score for predicting persistent postconcussion syndrome (PPCS) in a prospective cohort of 3063 children aged 5 to <18 years who were diagnosed with concussion at nine pediatric emergency departments (EDs) in Canada. Diagnostic criteria for concussion included symptoms in at least one of the following clinical domains: somatic, cognitive, emotional/behavioral, or sleep. Patients were diagnosed with PPCS if they had ≥3 new or worsening symptoms on the Postconcussion Symptom Inventory at 28 days.

Of 1701 patients in the derivation cohort and 883 in the validation cohort who completed assessments, 30% and 33%, respectively, were diagnosed with PPCS. Using a multivariable prediction model, the investigators derived a 12-point score incorporating the following variables:

  • Age 8–12 years (1 point); 13–<18 years (2 points)

  • Female sex (2 points)

  • Prior concussion with symptoms lasting ≥1 week (1 point)

  • History of physician-diagnosed migraine (1 point)

  • Answering questions slowly (1 point)

  • ≥4 errors in tandem stance testing (1 point)

  • Headache (1 point)

  • Sensitivity to noise (1 point)

  • Fatigue (2 points)

Cut-offs selected for PPCS risk stratification were: low risk, ≤3 points; medium risk, 4–8; high risk, ≥9.

The score had modest discrimination for predicting PPCS in the derivation and validation cohorts (area under the curve [AUC], 0.71 and 0.68, respectively), and outperformed emergency physicians' ability to predict PPCS (AUC, 0.55).

Comment

When resources permit, this score may help identify children who can benefit from specialized concussion clinic follow-up. However, its complexity and subjectivity make its use untenable in a busy ED. A reasonable alternative is to advise all children diagnosed with concussion to undergo physical and cognitive rest with a gradual return to activities once symptoms abate.

Editor Disclosures at Time of Publication

  • Disclosures for Katherine Bakes, MD at time of publication Grant / Research support Department of Justice Editorial boards Emergency Medicine Secrets (Elsevier)

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Reader Comments (1)

* * Physician, Pathology

Look promising

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