Greater symptom severity at the time of injury does not predict delayed symptom resolution among children with a concussion, but severity is linked to post-concussion syndrome, according to study findings in Pediatrics.
Joseph A. Grubenhoff, MD, of the University of Colorado in Aurora, Colorado, and colleagues assessed 179 children, aged 8 to 18 years, who presented to Children’s Hospital Colorado’s trauma center ED no more than 6 hours after sustaining a concussion. Glasgow Coma Scale scores were determined by a physician and self-reported symptoms were evaluated by a graded concussion symptom inventory. The study cohort was divided into low and high acute symptom groups based on a defined cut-off score of the graded symptom inventory.
Thirty-eight children (21%) were considered to have delayed symptom resolution, defined by study researchers as, “the presence of three or more symptoms one month after injury that were absent or less severe in the week before injury.” Of the 40 children who underwent computerized tomography, five had abnormal findings and were all in the early symptom resolution group.
A symptom inventory score of 11, with a sensitivity of 63%, had a specificity of 50% for delayed symptom resolution. However, a score of 11 was not significantly associated with delayed symptom resolution.
Twenty-two children (12%) were considered to have post-concussion syndrome. The relative risk for post-concussion syndrome for children who had an initial symptom score greater than 10 was 3.1 (95% CI, 1.2-8). The odds ratio for post-concussion syndrome in the high symptom vs. low symptom group was 3.77 (95% CI, 1.3-10.6).
Three of the six most characteristic initial symptoms in the delayed symptom and early symptom resolution groups were similar, including phonophobia, photophobia, and blurred or double vision. Cognitive symptoms, such as difficulty remembering, difficulty concentrating, or “feeling foggy” were more characteristic of children in the delayed symptom resolution group.
“Greater symptom severity at the time of injury does not predict [delayed symptom resolution] among children presenting to the ED for evaluation of concussion, but it is a risk factor for meeting criteria for [post-concussion syndrome] as defined by ICD-10. These findings underscore the need to refine the definition of post-concussive syndrome to one that is truly representative of concussion sequelae and that accounts for the contribution of both physiologic and psychological processes,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.