In the Journals

Somatization linked to delayed symptom resolution in pediatric concussions

Anxiety correlated with delayed symptom resolution in children recovering from concussions and may be a priority for early intervention in future studies, according to study results published in The Journal of Pediatrics.

“Although injury factors such as the severity of injury likely contribute to the persistence of symptoms, noninjury psychological components clearly influence symptomatology after concussion,” Joseph A. Grubenhoff, MD, from the department of pediatric emergency medicine at the University of Colorado School of Medicine, and colleagues wrote. “For example, pre-existing anxiety and depression are risk factors for the development of persistent postconcussive symptoms. Even among patients who do not sustain head injuries, individuals may report symptoms consistent with postconcussive syndrome.”

To better understand the psychological factors associated with delayed symptom resolution in children after a concussion, Grubenhoff and colleagues conducted a prospective cohort study from 2010 to 2013 at a tertiary care pediatric trauma center ED. Children aged 8 to 18 years (n = 179) who had sustained concussions less than 6 hours before they arrived at the ED were enrolled in the study, and their families were contacted within 3 to 30 days for complete data collection. Participants’ responses were evaluated under the Personality Inventory for Children-2 for maladjustment, cognitive abilities and somatization and the State-Trait Anxiety Inventory for Children and Children’s Illness Perception Questionnaire. The researchers defined delayed symptom resolution by the presence of three or more symptoms 30 days after the concussion that were absent or less severe before the injury.

Twenty-one percent of patients experienced delayed symptom resolution after 1 month. Results showed somatization correlated strongly with delayed symptom resolution (adjusted OR = 1.35, 95% CI, 1.08-1.69). Scores were significantly greater for abnormal somatization in the delayed resolution symptom group than in the early symptom resolution group (34.2% vs. 12.8%; P < .01).

The investigators said their results should encourage PCPs to refer children who present with persistent symptoms, including anxiety, after a concussion to a pediatric psychologist or neuropsychologist trained in postconcussion care.

“Further study is needed to determine whether collecting information regarding a child’s pre-injury psychological tendencies soon after injury can identify children in need of earlier referral to such specialists,” Grubenhoff and colleagues wrote. — by Kate Sherrer

Disclosure: Grubenhoff reports receiving salary support from the Thrasher Research Fund Early Career Award and the NIH.

Anxiety correlated with delayed symptom resolution in children recovering from concussions and may be a priority for early intervention in future studies, according to study results published in The Journal of Pediatrics.

“Although injury factors such as the severity of injury likely contribute to the persistence of symptoms, noninjury psychological components clearly influence symptomatology after concussion,” Joseph A. Grubenhoff, MD, from the department of pediatric emergency medicine at the University of Colorado School of Medicine, and colleagues wrote. “For example, pre-existing anxiety and depression are risk factors for the development of persistent postconcussive symptoms. Even among patients who do not sustain head injuries, individuals may report symptoms consistent with postconcussive syndrome.”

To better understand the psychological factors associated with delayed symptom resolution in children after a concussion, Grubenhoff and colleagues conducted a prospective cohort study from 2010 to 2013 at a tertiary care pediatric trauma center ED. Children aged 8 to 18 years (n = 179) who had sustained concussions less than 6 hours before they arrived at the ED were enrolled in the study, and their families were contacted within 3 to 30 days for complete data collection. Participants’ responses were evaluated under the Personality Inventory for Children-2 for maladjustment, cognitive abilities and somatization and the State-Trait Anxiety Inventory for Children and Children’s Illness Perception Questionnaire. The researchers defined delayed symptom resolution by the presence of three or more symptoms 30 days after the concussion that were absent or less severe before the injury.

Twenty-one percent of patients experienced delayed symptom resolution after 1 month. Results showed somatization correlated strongly with delayed symptom resolution (adjusted OR = 1.35, 95% CI, 1.08-1.69). Scores were significantly greater for abnormal somatization in the delayed resolution symptom group than in the early symptom resolution group (34.2% vs. 12.8%; P < .01).

The investigators said their results should encourage PCPs to refer children who present with persistent symptoms, including anxiety, after a concussion to a pediatric psychologist or neuropsychologist trained in postconcussion care.

“Further study is needed to determine whether collecting information regarding a child’s pre-injury psychological tendencies soon after injury can identify children in need of earlier referral to such specialists,” Grubenhoff and colleagues wrote. — by Kate Sherrer

Disclosure: Grubenhoff reports receiving salary support from the Thrasher Research Fund Early Career Award and the NIH.