The topic of concussion gives many of us a headache, given the complexity of determining how to manage the problem acutely and and over the long term. Ewing-Cobbs et al. (10.1542/peds.2018-0939) share with us a revealing prospective, longitudinal cohort study specifically focused on what factors influence a child or teen’s vulnerability to experiencing post-concussive symptoms and the duration of those symptoms. The authors surveyed caregivers regarding a variety of demographic, cognitive, and behavioral variables present pre-concussion retrospectively and then at 3, 6, and 12 months post-concussion. They also separated children into three groups—those with mild uncomplicated traumatic brain injury (TBI) (n= 119), complicated TBI (n=110) and a control group with orthopedic injuries all recruited from emergency departments. Children were also studied for post-concussive symptoms by age group (4-8 years, 9-12 years, and 13-15 years at time of injury).
The results are largely reassuring in that post-concussive symptoms, while similar between the mild and complicated groups with TBI, persisted at one year in only 25-31% of children. The authors identify those more likely to have chronic post-concussive symptoms at one year based on predictive factors pre-injury as well as identify some factors that appear to be protective. What are those factors? There are many to be considered both favorable and unfavorable in this study such that it is easier if you link to the study and discover what they are relative to the age and gender of your patient with concussion. While this study cannot prevent a concussion from happening, it may be helpful in just how carefully and for how long you should continue to follow your patients for post-concussive symptoms. Heads up on this study if you have patients in your practice who experience a concussion—and that would include most if not all practicing pediatricians.
