Editor’s Note: Dr. Julie Evans (she/her) is a resident physician in pediatrics at the University of Virginia. She is interested in general pediatrics and global health. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
Many children play sports growing up, and this is excellent for overall health. However, most sports carry some risk for concussion or mild traumatic brain injury (mTBI). Of the 44 million children and adolescents participating in sports, the estimated incidence of concussion is 1.1–1.9 million. Generally, children are expected to recover in 28 days, but symptoms can last longer, and this is known as persistent/prolonged post-concussion symptoms (PPCS).
Prognostic prediction models (PPMs) are designed to help clinicians determine the risk a patient has of developing a specific outcome. For example, can you predict how likely someone is to have strep throat based on their responses to a group of questions?
Recognizing that concussion, especially if there is delayed recovery, has effect on quality of life, Jordan Wyrwa, DO, and colleagues from Children's Hospital Colorado and the Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention completed a meta-analysis of PPMs that are intended to predict recovery from concussion. Their article, entitled “Predicting Recovery After Concussion in Pediatric Patients: A Meta-Analysis,” is being early released in Pediatrics this week (10.1542/peds.2023-065431).
After identifying 17,433 references, of which 78 full-text articles were reviewed, the authors included 6 total studies, with 13 total PPMs examined, in the meta-analysis.
The selected studies contained data from 22–510 children who were diagnosed with concussion. Patients were predominantly male, with average ages ranging from 11.4 to 14.9 years, and time since injury ranging from 2.8 hours to 5.6 days. The most common mechanism of injury was sports related.
Evidence of quality for all the PPMs studied was low (“limited confidence”) or very low (“very little confidence”).
The PPM that had the strongest quality of evidence for estimating risk for delayed recovery following mTBI in pediatric patients was the Preventing and Predicting Postconcussive Problems in Pediatrics clinical score (5P clinical score).
Two others had better-than-chance predictions:
- Buffalo concussion physical exam risk for delayed recovery (BCPE RDR)
- Grubenoff et al’s model
To learn more about how clinicians may use the 5P model to estimate risk of delayed recovery from concussion, check out this article.
