Home » Diseases » Head Trauma »

Many Kids with Concussion Have Persistent Symptoms

Jul 14, 2010 | Michael Smith | MedPage Today

Among children with mild traumatic brain injury, most will suffer no long-term ill effects, researchers here said.

But a "substantial minority" -- about one in four -- will have significant acute increases in post-concussive symptoms that in some cases persist for months, according to Keith Yeates, Ph.D., of Nationwide Children's Hospital, and colleagues.

Such symptoms -- including amnesia, vomiting, headache, and dizziness -- are markedly more common and likely to persist in children with mild concussions than in a reference group of children with orthopedic injuries, Dr. Yeates and colleagues reported in the March issue of Pediatrics. Action Points  

Explain to interested patients that post-concussive symptoms in children with mild traumatic brain injury are often regarded as having little long-term effect.

Note that this study shows that a substantial minority of victims have symptoms that can persist for months.

"This study provides reassurance for parents of kids who suffer first-time concussions because we can see that more often than not they recover fully within a short amount of time," Dr. Yeates said in a statement.

"However, the study also shows that kids who are at risk because their concussions are more severe need to be monitored for a longer period of time as their symptoms may last longer," he said.

The etiology of postconcussive symptoms after mild traumatic brain injury remains controversial and often focuses on whether the cause is physical or psychological, the researchers said.

In an attempt to shed light on that question, the researchers conducted a prospective study of consecutive patients, ages 8 to 15, treated for blunt head trauma or orthopedic injuries at the Nationwide Children's Hospital emergency department.

All told, the study enrolled 186 children with mild traumatic brain injury, defined as blunt head trauma resulting in no more than 30 minutes of unconsciousness, a Glasgow Coma Score of 13 or 14, or at least two acute symptoms of concussion, such as post-traumatic amnesia, vomiting, nausea, headache, diplopia, dizziness, and disorientation.

To form a reference group, the researchers also enrolled 99 children with upper or lower extremity factures associated with a score of no more than three on the six-point Abbreviated Injury Scale.

Recreational activities and sports caused 57% of the concussions and 62% of the orthopedic injuries; falls were the second leading cause, at 20% of concussions and 21% of orthopedic injuries.

The children were assessed by their parents within three weeks of the injury, using the Postconcussive Symptom Interview, which asks parents to report the presence or absence of 15 symptoms during the preceding week.

The process was repeated at three, six, and 12 months after the initial assessment.

The study found:

67% of the children with concussions had no postconcussive symptoms, compared with 76% of those with orthopedic injuries

12% of the children with concussion had a moderate number of postconcussive symptoms soon after the injury that persisted over the length of the study, compared with 15% of those with orthopedic injuries

15% of the children with concussion had a high number of symptoms soon after the injury, which resolved by about 100 days, compared with 5% of the reference group

9% of the children with concussion had a high number of symptoms soon after the injury that persisted throughout the year-long study, compared with 1% of those with orthopedic injuries.

The researchers divided the children with concussion according to the severity of injury, with those with no more than three clinical features classed as low severity and those with four or more classed as high severity.

Those in the high severity group were three times more likely to have a high number of persistent symptoms. (The odds ratio was 3.27, with a 95% confidence interval from 1.02 to 10.43.)

That finding suggests a clinical implication, Dr. Yeates said.

"We do know that there are kids at risk, and we can begin to identify them, monitor them over time, and provide appropriate intervention and assistance if they have these symptoms," he said.

The study was limited by a low participation rate, which may have caused some selection bias, the researchers noted. Also, the sample size was relatively small, which made it hard to determine the specific contributions of different clinical indicators to different symptoms, they said.

Another implication of the study is that long-term postconcussive symptoms are more physiological than psychological, the researchers said, since if not, they'd be seen roughly equally in both types of injuries.

On the other hand, there must be some psychological component, they said, or those suffering orthopedic injuries would have been symptom-free.