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Beauchamp MH, Dégeilh F, Rose SC. Improving outcome after paediatric concussion: challenges and possibilities. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:728-740. [PMID: 37734775 DOI: 10.1016/s2352-4642(23)00193-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 09/23/2023]
Abstract
The term concussion has permeated mainstream media and household vocabulary mainly due to awareness regarding the risks of concussion in professional contact sports, yet it occurs across a variety of settings and ages. Concussion is prevalent in infants, preschoolers, children, and adolescents, and is a common presentation or reason for referral to primary care providers, emergency departments, and specialised trauma clinics. Its broad range of symptoms and sequelae vary according to multiple individual, environmental, and clinical factors and can lead to health and economic burden. More than 20 years of research into risk factors and consequences of paediatric concussion has revealed as many questions as answers, and scientific work and clinical cases continue to expose its complexity and heterogeneity. In this Review, we present empirical evidence for improving outcome after paediatric concussion. We consider work pertaining to both sports and other injury mechanisms to provide a perspective that should be viewed as complementary to publications focused specifically on sports concussion. Contemporary challenges in prevention, diagnosis, prognosis, and intervention are discussed alongside pathways and future directions for improving outcome.
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Affiliation(s)
- Miriam H Beauchamp
- Sainte-Justine Research Center, University of Montreal, Montréal, QC, Canada; Department of Psychology, University of Montreal, Montréal, QC, Canada.
| | - Fanny Dégeilh
- Univ Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, EMPENN ERL U-1228, Rennes, France
| | - Sean C Rose
- Pediatric Neurology, Nationwide Children's Hospital, Columbus, OH, USA; Ohio State University College of Medicine, Columbus, OH, USA
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Lystad RP, McMaugh A, Herkes G, Browne G, Badgery-Parker T, Cameron CM, Mitchell RJ. Risk of impaired school performance in children hospitalized with concussion: a population-based matched cohort study. Concussion 2023; 8:CNC105. [PMID: 37691853 PMCID: PMC10488614 DOI: 10.2217/cnc-2022-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/21/2023] [Indexed: 09/12/2023] Open
Abstract
Aim To examine the impact of concussion on objective measures of school performance. Materials & methods Population-based matched cohort study using linked health and education records of young people aged ≤18 years hospitalized with concussion in New South Wales, Australia, during 2005-2018, and matched comparisons not hospitalized with any injury. Results Young people with concussion had higher risk of not achieving the national minimum standards for literacy and numeracy assessments, ranging from 30% for numeracy to 43% for spelling, and not completing high school, ranging from 29% for year 10 to 77% for year 12, compared with matched peers. Conclusion Young people hospitalized with concussion have impaired school performance compared with uninjured matched peers.
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Affiliation(s)
- Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park NSW, 2109, Australia
| | - Anne McMaugh
- The Macquarie School of Education, Macquarie University, Macquarie Park NSW, 2109, Australia
| | - Geoffrey Herkes
- Sydney Medical School, University of Sydney, Camperdown NSW, 2006, Australia
- Royal North Shore Hospital, St Leonards NSW, 2065, Australia
| | - Gary Browne
- Sydney Medical School, University of Sydney, Camperdown NSW, 2006, Australia
- The Children's Hospital at Westmead, Westmead NSW, 2145, Australia
| | - Tim Badgery-Parker
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park NSW, 2109, Australia
| | - Cate M Cameron
- Jamieson Trauma Institute, Royal Brisbane & Women's Hospital, Metro North Health, Herston QLD, 4029, Australia
- Centre for Healthcare Transformation, Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane QLD, 4000, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park NSW, 2109, Australia
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Kooper CC, van der Zee CW, Oosterlaan J, Plötz FB, Königs M. Prediction Models for Neurocognitive Outcome of Mild Traumatic Brain Injury in Children: A Systematic Review. J Neurotrauma 2023. [PMID: 36472215 DOI: 10.1089/neu.2022.0369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is highly prevalent in children. Recent literature suggests that children with mTBI are at considerable risk of persisting neurocognitive deficits, threatening post-injury child development. Nevertheless, clinical tools for early identification of children at risk are currently not available. This systematic review aims to describe the available literature on neurocognitive outcome prediction models in children with mTBI. Findings are highly relevant for early identification of children at risk of persistent neurocognitive deficits, allowing targeted treatment of these children to optimize recovery. The electronic literature search was conducted in PubMed, EMBASE, CINAHL, Cochrane, PsychINFO and Web of Science on February 9, 2022. We included all studies with multi-variate models for neurocognitive outcome based on original data from only children (age <18 years) with mTBI. Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, two authors independently performed data extraction and risk of bias analysis using the Prediction model Risk of Bias Assessment Tool (PROBAST). This systematic review identified eight original studies (nine articles) reporting prediction models for neurocognitive outcome, representing a total of 1033 children diagnosed with mTBI (mean age at injury = 10.5 years, 37.6% girls). Neurocognitive outcome assessment took place between 1 month and 7 years post-injury. Models were identified with significant predictive value for the following outcomes: memory, working memory, inhibition, processing speed, and general neurocognitive functioning. Prediction performance of these models varied greatly between weak and substantial (R2 = 10.0%-54.7%). The best performing model was based on demographic and pre-morbid risk factors in conjunction with a subacute neurocognitive screening to predict the presence of a deficit in general neurocognitive functioning at 12 months post-injury. This systematic review reflects the absence of robust prediction models for neurocognitive outcome of children with mTBI. The findings indicate that demographic factors, pre-morbid factors as well as acute and subacute clinical factors have relevance for neurocognitive outcome. Based on the available evidence, evaluation of demographic and pre-morbid risk factors in conjunction with a subacute neurocognitive screening may have the best potential to predict neurocognitive outcome in children with mTBI. The findings underline the importance of future research contributing to early identification of children at risk of persisting neurocognitive deficits.
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Affiliation(s)
- Cece C Kooper
- Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Department of Pediatrics, Amsterdam, the Netherlands.,Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Emma Neuroscience Group, Amsterdam, the Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Carlijn W van der Zee
- Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Department of Pediatrics, Amsterdam, the Netherlands
| | - Jaap Oosterlaan
- Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Department of Pediatrics, Amsterdam, the Netherlands.,Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Emma Neuroscience Group, Amsterdam, the Netherlands.,Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Follow-Me Program, Amsterdam, the Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Frans B Plötz
- Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Department of Pediatrics, Amsterdam, the Netherlands.,Tergooi Hospital, Department of Pediatrics, Blaricum, the Netherlands
| | - Marsh Königs
- Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Department of Pediatrics, Amsterdam, the Netherlands.,Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Emma Neuroscience Group, Amsterdam, the Netherlands.,Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Follow-Me Program, Amsterdam, the Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
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