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Gornall A, Takagi M, Clarke C, Babl FE, Cheng N, Davis GA, Dunne K, Anderson N, Hearps SJC, Rausa V, Anderson V. Psychological Predictors of Mental Health Difficulties After Pediatric Concussion. J Neurotrauma 2024; 41:e1639-e1648. [PMID: 38661521 DOI: 10.1089/neu.2023.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Children often experience mental health difficulties after a concussion. Yet, the extent to which a concussion precipitates or exacerbates mental health difficulties remains unclear. This study aimed to examine psychological predictors of mental health difficulties after pediatric concussion. Children (5 to <18 years of age, M = 11.7, SD = 3.3) with concussion were recruited in a single-site longitudinal prospective cohort study conducted at a tertiary children's hospital (n = 115, 73.9% male). The primary outcomes included internalizing (anxious, depressed, withdrawn behaviors), externalizing (risk-taking, aggression, attention difficulties), and total mental health problems, as measured by the Child Behavior Checklist at 2 weeks (acute) and 3 months (post-acute) after concussion. Predictors included parents' retrospective reports of premorbid concussive symptoms (Post-Concussion Symptom Inventory; PCSI), the child and their family's psychiatric history, child-rated perfectionism (Adaptive-Maladaptive Perfectionism Scale), and child-rated resilience (Youth Resilience Measure). Higher premorbid PCSI ratings consistently predicted acute and post-acute mental health difficulties. This relationship was significantly moderated by child psychiatric history. Furthermore, pre-injury learning difficulties, child psychiatric diagnoses, family psychiatric history, lower resilience, previous concussions, female sex, and older age at injury were associated with greater mental health difficulties after concussion. Pre-injury factors accounted for 23.4-39.9% of acute mental health outcomes, and 32.3-37.8% of post-acute mental health outcomes. When acute mental health was factored into the model, a total of 47.0-68.8% of variance was explained by the model. Overall, in this sample of children, several pre-injury demographic and psychological factors were observed to predict mental health difficulties after a concussion. These findings need to be validated in future research involving larger, multi-site studies that include a broader cohort of children after concussion.
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Affiliation(s)
- Alice Gornall
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, School of Psychological Sciences, Melbourne, Victoria, Australia
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, School of Psychological Sciences, Melbourne, Victoria, Australia
- School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cathriona Clarke
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Nicholas Cheng
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, School of Psychological Sciences, Melbourne, Victoria, Australia
| | - Gavin A Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kevin Dunne
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Department of Rehabilitation Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Vanessa Rausa
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, School of Psychological Sciences, Melbourne, Victoria, Australia
- School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
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2
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Swaney EEK, Babl FE, Rausa VC, Anderson N, Hearps SJC, Parkin G, Hart-Smith G, Zaw T, Carroll L, Takagi M, Seal ML, Davis GA, Anderson V, Ignjatovic V. Discovery of Alpha-1-Antichymotrypsin as a Marker of Delayed Recovery from Concussion in Children. J Neurotrauma 2024. [PMID: 38597719 DOI: 10.1089/neu.2023.0503] [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: 04/11/2024] Open
Abstract
Of the four million children who experience a concussion each year, 30-50% of children will experience delayed recovery, where they will continue to experience symptoms more than two weeks after their injury. Delayed recovery from concussion encompasses emotional, behavioral, physical, and cognitive symptoms, and as such, there is an increased focus on developing an objective tool to determine risk of delayed recovery. This study aimed to identify a blood protein signature predictive of delayed recovery from concussion in children. Plasma samples were collected from children who presented to the Emergency Department at the Royal Children's Hospital, Melbourne, within 48h post-concussion. This study involved a discovery and validation phase. For the discovery phase, untargeted proteomics analysis was performed using single window acquisition of all theoretical mass spectra to identify blood proteins differentially abundant in samples from children with and without delayed recovery from concussion. A subset of these proteins was then validated in a separate participant cohort using multiple reaction monitoring and enzyme linked immunosorbent assay. A blood protein signature predictive of delayed recovery from concussion was modeled using a Support Vector Machine, a machine learning approach. In the discovery phase, 22 blood proteins were differentially abundant in age- and sex-matched samples from children with (n = 9) and without (n = 9) delayed recovery from concussion, six of whom were chosen for validation. In the validation phase, alpha-1-ACT was shown to be significantly lower in children with delayed recovery (n = 12) compared with those without delayed recovery (n = 28), those with orthopedic injuries (n = 7) and healthy controls (n = 33). A model consisting of alpha-1-ACT concentration stratified children based on recovery from concussion with an 0.88 area under the curve. We have identified that alpha-1-ACT differentiates between children at risk of delayed recovery from those without delayed recovery from concussion. To our knowledge, this is the first study to identify alpha-1-ACT as a potential marker of delayed recovery from concussion in children. Multi-site studies are required to further validate this finding before use in a clinical setting.
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Affiliation(s)
- Ella E K Swaney
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Vanessa C Rausa
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Georgia Parkin
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Gene Hart-Smith
- Australian Proteomics Analysis Facility, Macquarie University, Sydney, New South Wales, Australia
| | - Thiri Zaw
- Australian Proteomics Analysis Facility, Macquarie University, Sydney, New South Wales, Australia
| | - Luke Carroll
- Australian Proteomics Analysis Facility, Macquarie University, Sydney, New South Wales, Australia
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Marc L Seal
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Gavin A Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Neurosurgery, Austin and Cabrini Hospitals, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Psychology Service, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Vera Ignjatovic
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Australia
- Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, FL, USA
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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3
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Fabiano F, Takagi M, Anderson N, Babl FE, Bressan S, Clarke C, Davies K, Davis GA, Dunne K, Hearps S, Ignjatovic V, Rausa VC, Seal M, Anderson V. Fatigue recovery and connected factors following paediatric concussion. Br J Sports Med 2024; 58:59-65. [PMID: 37699656 DOI: 10.1136/bjsports-2023-106894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE Using a biopsychosocial framework and the three-factor fatigue model, we aimed to (1) plot recovery of fatigue over the 3 months following paediatric concussion and (2) explore factors associated with persisting fatigue during the first 3 months postconcussion. METHODS 240 children and adolescents aged 5-18 years (M=11.64, SD=3.16) completed assessments from time of injury to 3 months postinjury. Separate linear mixed effects models were conducted for child and parent ratings on the PedsQL-Multidimensional Fatigue Scale to plot recovery across domains (General, Cognitive, Sleep/Rest) and Total fatigue, from 1 week to 3 months postinjury. Two-block hierarchical regression analyses were then conducted for parent and child ratings of fatigue at each time point, with age, sex and acute symptoms in block 1 and child and parent mental health variables added to block 2. RESULTS There was a significant reduction in both child and parent ratings across the 3 months postinjury for all fatigue domains (all p<0.001). For both child and parent fatigue ratings, child mental health was the most significant factor associated with fatigue at all time points. Adding child and parent mental health variables in the second block of the regression substantially increased the variance explained for both child and parent ratings of fatigue. CONCLUSION Our findings confirm that fatigue improves during the first 3 months postconcussion and highlights the importance of considering child and parent mental health screening when assessing patients with persisting postconcussive symptoms.
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Affiliation(s)
- Fabian Fabiano
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Michael Takagi
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E Babl
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Silvia Bressan
- Department of Women's and Children's Health, Università degli Studi di Padova, Padova, Italy
| | - Cathriona Clarke
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Katie Davies
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Gavin A Davis
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Cabrini Health, Melbourne, Victoria, Australia
| | - Kevin Dunne
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Rehabilitation, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Stephen Hearps
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vera Ignjatovic
- Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
- Departments of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vanessa C Rausa
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Marc Seal
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
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Mayer AR, McQuaid JR, Wick TV, Dodd AB, Robertson-Benta CR, Stephenson DD, van der Horn HJ, Quinn DK, Davis WA, Hittson AK, Sapien RE, Phillips JP, Campbell RA. Sex- and Age-Related Differences in Post-Concussive Symptom Reporting Among Children and Their Parents. J Neurotrauma 2024; 41:209-221. [PMID: 37725586 PMCID: PMC11071089 DOI: 10.1089/neu.2023.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
Pediatric mild traumatic brain injury (pmTBI) has received increased public attention over the past decade, especially for children who experience persistent post-concussive symptoms (PCS). Common methods for obtaining pediatric PCS rely on both self- and parental report, exhibit moderate test-retest reliability, and variable child-parent agreement, and may yield high false positives. The current study investigated the impact of age and biological sex on PCS reporting (Post-Concussion Symptom Inventory) in patients with pmTBI (n = 286) at retrospective, 1 week, 4 months, and 1 year post-injury time points, as well as reported symptoms in healthy controls (HC; n = 218) at equivalent assessment times. HC and their parents reported higher PCS for their retrospective rating relative to the other three other study visits. Child-parent agreement was highest for female adolescents, but only approached acceptable ranges (≥ 0.75) immediately post-injury. Poor-to-fair child/parental agreement was observed for most other study visits for pmTBI and at all visits for HC. Parents rated female adolescents as being more symptomatic than their male counterparts in spite of small (pmTBI) or no (HC) sex-related differences in self-reported ratings, suggestive of a potential cultural bias in parental ratings. Test-retest reliability for self-report was typically below acceptable ranges for both pmTBI and HC groups, with reliability decreasing for HC and increasing for pmTBI as a function of time between visits. Parental test-retest reliability was higher for females. Although continued research is needed, current results support the use of child self-report over parental ratings for estimating PCS burden. Results also highlight the perils of relying on symptom self-report for diagnostic and prognostic purposes.
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Affiliation(s)
- Andrew R. Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jessica R. McQuaid
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Tracey V. Wick
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Andrew B. Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Cidney R. Robertson-Benta
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - David D. Stephenson
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Harm J. van der Horn
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Davin K. Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, New Mexico, USA
| | - William A. Davis
- Department of Orthopedics and Rehabilitation, University of New Mexico, Albuquerque, New Mexico, USA
| | - Anne K. Hittson
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Robert E. Sapien
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - John P. Phillips
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Richard A. Campbell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, New Mexico, USA
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Davis GA, Schneider KJ, Anderson V, Babl FE, Barlow KM, Blauwet CA, Bressan S, Broglio SP, Emery CA, Echemendia RJ, Gagnon I, Gioia GA, Giza CC, Leddy JJ, Master CL, McCrea M, McNamee MJ, Meehan WP, Purcell L, Putukian M, Moser RS, Takagi M, Yeates KO, Zemek R, Patricios JS. Pediatric Sport-Related Concussion: Recommendations From the Amsterdam Consensus Statement 2023. Pediatrics 2024; 153:e2023063489. [PMID: 38044802 DOI: 10.1542/peds.2023-063489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 12/05/2023] Open
Abstract
The 6th International Consensus Conference on Concussion in Sport, Amsterdam 2022, addressed sport-related concussion (SRC) in adults, adolescents, and children. We highlight the updated evidence-base and recommendations regarding SRC in children (5-12 years) and adolescents (13-18 years). Prevention strategies demonstrate lower SRC rates with mouthguard use, policy disallowing bodychecking in ice hockey, and neuromuscular training in adolescent rugby. The Sport Concussion Assessment Tools (SCAT) demonstrate robustness with the parent and child symptom scales, with the best diagnostic discrimination within the first 72 hours postinjury. Subacute evaluation (>72 hours) requires a multimodal tool incorporating symptom scales, balance measures, cognitive, oculomotor and vestibular, mental health, and sleep assessment, to which end the Sport Concussion Office Assessment Tools (SCOAT6 [13+] and Child SCOAT6 [8-12]) were developed. Rather than strict rest, early return to light physical activity and reduced screen time facilitate recovery. Cervicovestibular rehabilitation is recommended for adolescents with dizziness, neck pain, and/or headaches for greater than 10 days. Active rehabilitation and collaborative care for adolescents with persisting symptoms for more than 30 days may decrease symptoms. No tests and measures other than standardized and validated symptom rating scales are valid for diagnosing persisting symptoms after concussion. Fluid and imaging biomarkers currently have limited clinical utility in diagnosing or assessing recovery from SRC. Improved paradigms for return to school were developed. The variable nature of disability and differences in evaluating para athletes and those of diverse ethnicity, sex, and gender are discussed, as are ethical considerations and future directions in pediatric SRC research.
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Affiliation(s)
- Gavin A Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Neurosurgery, Austin Health, Melbourne, Victoria, Australia
- Neurosurgery, Cabrini Health, Melbourne, Victoria, Australia
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology
- Hotchkiss Brain Institute
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Royal Children's Hospital, Melbourne, Victoria, Australia
- Departments of Paediatrics and Critical Care, University of Melbourne, Victoria, Australia
| | - Karen M Barlow
- University of Queensland, Children's Hospital and Health Services,Brisbane, Queensland, Australia
| | - Cheri A Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, Massachusetts
| | | | | | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology
- Hotchkiss Brain Institute
| | - Ruben J Echemendia
- University Orthopedics Concussion Care Clinic, State College, Pennsylvania
- University of Missouri - Kansas City, Kansas City, Missouri
| | - Isabelle Gagnon
- McGill University, Montreal, Quebec, Canada
- Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | | | | | - John J Leddy
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Christina L Master
- University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | | | - Laura Purcell
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia
| | - Keith Owen Yeates
- Hotchkiss Brain Institute
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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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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7
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Yumul JN, Catroppa C, McKinlay A, Anderson V. Post-Concussive Symptoms in Preschool Children up to Three Months Post-Injury. Dev Neurorehabil 2023; 26:338-347. [PMID: 37548355 DOI: 10.1080/17518423.2023.2242945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 06/20/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND AND AIMS Post-concussive symptoms (PCS) are central to the assessment and management of mild traumatic brain injury (mTBI); however, this remains poorly understood in children aged ≤5 years. The study aimed to explore individual PCS, pattern of parents' PCS report over time, proportion of symptomatic children, and variables associated with parents' report of PCS in their preschool child after a mTBI. METHODS Children aged 2-5 years with either a mTBI (n=13) or limb injury (n=6) were recruited from the emergency department (ED). Parent ratings of child PCS were assessed at ED presentation, at one month, and at three months post-injury. Injury (e.g. injury group, pain), child (e.g. pre-existing behavior, symptoms), and parent (e.g. parental stress, education) characteristics were considered when investigating variables that may be relevant to parent report of PCS. RESULTS The number of total, physical, and sleep PCS were significantly higher after mTBI, with a significant decrease in physical and sleep PCS over time. The proportion of symptomatic children was comparable between injury groups at each time point. Acute pain and pre-injury symptoms were significantly associated with parents' acute PCS report in the mTBI group. Further research is needed on variables that may be relevant to parents' PCS report at follow-up. CONCLUSION Preliminary findings suggest a general trauma response after a mTBI or limb injury, but acute physical and sleep PCS may help differentiate the injury groups. Injury and premorbid child variables may be relevant to parents' report of acute PCS in their child. Additional research is needed to investigate PCS in preschoolers and variables that may predict parents' PCS report.
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Affiliation(s)
- Joy Noelle Yumul
- Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Cathy Catroppa
- Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
| | - Audrey McKinlay
- Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- University of Canterbury, Christchurch, New Zealand
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
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8
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Davis GA, Rausa VC, Babl FE, Davies K, Takagi M, Crichton A, McKinlay A, Anderson N, Hearps SJ, Clarke C, Pugh R, Dunne K, Barnett P, Anderson V. Improving subacute management of post concussion symptoms: a pilot study of the Melbourne Paediatric Concussion Scale parent report. Concussion 2022; 7:CNC97. [PMID: 35733949 PMCID: PMC9199568 DOI: 10.2217/cnc-2021-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/07/2022] [Indexed: 11/21/2022] Open
Abstract
Aim: To pilot a modification of the Post Concussion Symptom Inventory, the Melbourne Paediatric Concussion Scale (MPCS) and examine its clinical utility. Materials & methods: A total of 40 families of concussed children, aged 8–18 years, were recruited from the emergency department. Parent responses to the MPCS in the emergency department and 2-weeks post injury determined child symptomatic status. Association between MPCS symptom endorsement and symptomatic group status was examined. Results: All additional MPCS items were endorsed by at least 25% of the parents of symptomatic children at 2 weeks. MPCS items were classified into nine symptom domains, with most falling in mood, neurological, autonomic and vestibular domains. Conclusion: The additional items and domain classifications in the MPCS have the potential to improve subacute diagnostic precision, monitoring of clinical recovery and identification of appropriate interventions post pediatric concussion.
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Affiliation(s)
- Gavin A Davis
- Murdoch Children's Research Institute, Melbourne, 3052, Australia.,Department of Neurosurgery, Austin Hospital, 3084, and Cabrini Hospital, 3144, Melbourne, Australia
| | - Vanessa C Rausa
- Murdoch Children's Research Institute, Melbourne, 3052, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, 3052, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, 3052, Australia
| | - Katie Davies
- Murdoch Children's Research Institute, Melbourne, 3052, Australia
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, 3052, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, 3052, and Turner Institute for Brain and Mental Health, Monash University, 3800, Melbourne, Australia
| | - Alison Crichton
- Murdoch Children's Research Institute, Melbourne, 3052, Australia
| | - Audrey McKinlay
- Murdoch Children's Research Institute, Melbourne, 3052, Australia.,Department of Psychology, University of Canterbury, Ilam, 8041, New Zealand
| | | | | | - Cathriona Clarke
- Murdoch Children's Research Institute, Melbourne, 3052, Australia
| | - Remy Pugh
- Murdoch Children's Research Institute, Melbourne, 3052, Australia
| | - Kevin Dunne
- Murdoch Children's Research Institute, Melbourne, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, 3052, Australia.,Department of Rehabilitation Medicine, Royal Children's Hospital, Melbourne, 3052, Australia
| | - Peter Barnett
- Murdoch Children's Research Institute, Melbourne, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, 3052, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, 3052, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, 3052, Australia.,Psychology Service, Royal Children's Hospital, Melbourne, 3052, Australia
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9
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Shapiro JS, Takagi M, Silk T, Anderson N, Clarke C, Davis GA, Hearps SJ, Ignjatovic V, Rausa V, Seal ML, Babl FE, Anderson V. No Evidence of a Difference in Susceptibility-Weighted Imaging Lesion Burden or Functional Network Connectivity between Children with Typical and Delayed Recovery Two Weeks Post-Concussion. J Neurotrauma 2021; 38:2384-2390. [PMID: 33823646 PMCID: PMC8881952 DOI: 10.1089/neu.2021.0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Susceptibility weighted imaging (SWI) and resting state functional magnetic resonance imaging have been highlighted as two novel neuroimaging modalities that have been underutilized when attempting to predict whether a child with concussion will recover normally or have a delayed recovery course. This study aimed to investigate whether there was a difference between children who recover normally from a concussion and children with delayed recovery in terms of SWI lesion burden and resting state network makeup. Forty-one children who presented to the emergency department of a tertiary level pediatric hospital with concussion participated in this study as a part of a larger prospective, longitudinal observational cohort study into concussion assessment and recovery. Children underwent neuroimaging 2 weeks post-injury and were classified as either normally recovering (n = 27), or delayed recovering (n = 14) based on their post-concussion symptoms at 2 weeks post-injury. No participants showed lesions detected using SWI; therefore, no group differences could be assessed. No between-group resting state network differences were uncovered using dual regression analysis. These findings, alongside previously published work, suggest that potential causes of delayed recovery from concussion may not be found using current neuroimaging paradigms.
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Affiliation(s)
- Jesse S. Shapiro
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Monash School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Monash School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Tim Silk
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Cathriona Clarke
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Gavin A. Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Vera Ignjatovic
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Vanessa Rausa
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Marc L. Seal
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Franz E. Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
- Psychology Service, Royal Children's Hospital, Melbourne, Victoria, Australia
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10
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Truss K, Hearps SJC, Babl FE, Takagi M, Davis GA, Clarke C, Anderson N, Rausa VC, Bressan S, Dunne K, Anderson V. Trajectories and Risk Factors for Pediatric Postconcussive Symptom Recovery. Neurosurgery 2021; 88:36-45. [PMID: 32717073 DOI: 10.1093/neuros/nyaa310] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/02/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Persistent postconcussive symptoms (PCS) are poorly understood in children. Research has been limited by an assumption that children with concussion are a homogenous group. OBJECTIVE To identify (i) distinctive postconcussive recovery trajectories in children and (ii) injury-related and psychosocial factors associated with these trajectories. METHODS This study is part of a larger prospective, longitudinal study. Parents of 169 children (5-18 yr) reported their child's PCS over 3 mo following concussion. PCS above baseline levels formed the primary outcome. Injury-related, demographic, and preinjury information, and child and parent mental health were assessed for association with trajectory groups. Data were analyzed using group-based trajectory modeling, multinomial logistic regression, and chi-squared tests. RESULTS We identified 5 postconcussive recovery trajectories from acute to 3 mo postinjury. (1) Low Acute Recovered (26.6%): consistently low PCS; (2) Slow to Recover (13.6%): elevated symptoms gradually reducing; (3) High Acute Recovered (29.6%): initially elevated symptoms reducing quickly to baseline; (4) Moderate Persistent (18.3%): consistent, moderate levels of PCS; (5) Severe Persistent (11.8%): persisting high PCS. Higher levels of child internalizing behaviors and greater parental distress were associated with membership to the Severe Persistent group, relative to the Low Acute Recovered group. CONCLUSION This study indicates variability in postconcussive recovery according to 5 differential trajectories, with groups distinguished by the number of reported symptoms, levels of child internalizing behavior problems, and parental psychological distress. Identification of differential recovery trajectories may allow for targeted early intervention for children at risk of poorer outcomes.
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Affiliation(s)
- Katie Truss
- Murdoch Children's Research Institute, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | | | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Gavin A Davis
- Murdoch Children's Research Institute, Melbourne, Australia
| | | | | | | | - Silvia Bressan
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Kevin Dunne
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Australia.,Department of Rehabilitation Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Psychology Service, Royal Children's Hospital, Melbourne, Australia
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11
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Anderson V, Rausa VC, Anderson N, Parkin G, Clarke C, Davies K, McKinlay A, Crichton A, Davis GA, Dalziel K, Dunne K, Barnett P, Hearps SJ, Takagi M, Babl FE. Protocol for a randomised clinical trial of multimodal postconcussion symptom treatment and recovery: the Concussion Essentials study. BMJ Open 2021; 11:e041458. [PMID: 33574145 PMCID: PMC7880104 DOI: 10.1136/bmjopen-2020-041458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION While most children recover from a concussion shortly after injury, approximately 30% experience persistent postconcussive symptoms (pPCS) beyond 1-month postinjury. Existing research into the treatment of pPCS have evaluated unimodal approaches, despite evidence suggesting that pPCS likely represent an interaction across various symptom clusters. The primary aim of this study is to evaluate the effectiveness of a multimodal, symptom-tailored intervention to accelerate symptom recovery and increase the proportion of children with resolved symptoms at 3 months postconcussion. METHODS AND ANALYSIS In this open-label, assessor-blinded, randomised clinical trial, children with concussion aged 8-18 years will be recruited from The Royal Children's Hospital (The RCH) emergency department, or referred by a clinician, within 17 days of initial injury. Based on parent ratings of their child's PCS at ~10 days postinjury, symptomatic children (≥2 symptoms at least 1-point above those endorsed preinjury) will undergo a baseline assessment at 3 weeks postinjury and randomised into either Concussion Essentials (CE, n=108), a multimodal, interdisciplinary delivered, symptom-tailored treatment involving physiotherapy, psychology and education, or usual care (UC, n=108) study arms. CE participants will receive 1 hour of intervention each week, for up to 8 weeks or until pPCS resolve. A postprogramme assessment will be conducted at 3 months postinjury for all participants. Effectiveness of the CE intervention will be determined by the proportion of participants for whom pPCS have resolved at the postprogramme assessment (primary outcome) relative to the UC group. Secondary outcome analyses will examine whether children receiving CE are more likely to demonstrate resolution of pPCS, earlier return to normal activity, higher quality of life and a lower rate of utilisation of health services, compared with the UC group. ETHICS AND DISSEMINATION Ethics were approved by The RCH Human Research Ethics Committee (HREC: 37100). Parent, and for mature minors, participant consent, will be obtained prior to commencement of the trial. Study results will be disseminated at international conferences and international peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12617000418370; pre-results.
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Affiliation(s)
- Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
- Psychology Service, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Vanessa C Rausa
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Nicholas Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Georgia Parkin
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Cathriona Clarke
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Katie Davies
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Audrey McKinlay
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Psychology, University of Canterbury, Ilam, Christchurch, New Zealand
| | - Ali Crichton
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Gavin A Davis
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Neurosurgery, Austin and Cabrini Hospitals, Melbourne, Victoria, Australia
| | - Kim Dalziel
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Kevin Dunne
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Rehabilitation Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Peter Barnett
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Stephen Jc Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Michael Takagi
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Franz E Babl
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia
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12
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Bressan S, Clarke CJ, Anderson V, Takagi M, Hearps SJC, Rausa V, Anderson N, Doyle M, Dunne K, Oakley E, Davis GA, Babl FE. Use of the sport concussion assessment tools in the emergency department to predict persistent post-concussive symptoms in children. J Paediatr Child Health 2020; 56:1249-1256. [PMID: 32436608 DOI: 10.1111/jpc.14910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/13/2020] [Accepted: 03/15/2020] [Indexed: 11/28/2022]
Abstract
AIM The Sport Concussion Assessment Tool v3 (SCAT3) and its child version (ChildSCAT3) are composite tools including a symptom scale, a rapid cognitive assessment (standardised assessment of concussion (SAC)) and the modified Balance Error Scoring System (mBESS). It is unclear whether their use for the acute assessment of paediatric concussion in the emergency department (ED) may help predict persistent post-concussive symptoms (PPCS). We aim to assess the predictive value of the main SCAT3/ChildSCAT3 components for PPCS when applied in the ED. METHODS A single-site, prospective longitudinal cohort study of children aged 5-18 years assessed within 48 h of their concussion at the ED of a state-wide tertiary paediatric hospital and followed up at the affiliated concussion clinic, between November 2013 and August 2017. PPCS was defined as ≥2 new or worsening symptoms at 1 month post-injury using the Post-Concussive Symptom Inventory. RESULTS Of the 370 children enrolled, 213 (57.7% <13 years old) provided complete data. Of these, 34.7% had PPCS at 1 month post-injury (38.2% of children <13 years and 30.0% ≥13 years of age, P = 0.272). The adjusted ORs from multiple logistic regression models, for number and severity of symptoms, and for the SAC and mBESS performance in both the ChildSCAT3/SCAT3, were all not significant. The area under the curve of receiver operator characteristic curves for all analysed ChildSCAT3/SCAT3 components was below 0.6. CONCLUSIONS Although SCAT3 and ChildSCAT3 are recommended tools to assist with concussion diagnosis and monitoring of patient recovery, their use in the ED does not seem to help predict PPCS.
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Affiliation(s)
- Silvia Bressan
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Cathriona J Clarke
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Psychology Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Takagi
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen J C Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vanessa Rausa
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Melissa Doyle
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kevin Dunne
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Rehabilitation Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ed Oakley
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Gavin A Davis
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurosurgery, Austin Health & Cabrini Hospital, Melbourne, Victoria, Australia
| | - Franz E Babl
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
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13
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Mayer AR, Stephenson DD, Dodd AB, Robertson-Benta CR, Pabbathi Reddy S, Shaff NA, Yeates KO, van der Horn HJ, Wertz CJ, Park G, Oglesbee SJ, Bedrick EJ, Campbell RA, Phillips JP, Quinn DK. Comparison of Methods for Classifying Persistent Post-Concussive Symptoms in Children. J Neurotrauma 2020; 37:1504-1511. [PMID: 31964232 PMCID: PMC7307699 DOI: 10.1089/neu.2019.6805] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Pediatric mild traumatic brain injury (pmTBI) has received increased public scrutiny over the past decade, especially regarding children who experience persistent post-concussive symptoms (PPCS). However, several methods for defining PPCS exist in clinical and scientific literature, and even healthy children frequently exhibit non-specific, concussive-like symptoms. Inter-method agreement (six PPCS methods), observed misclassification rates, and other psychometric properties were examined in large cohorts of consecutively recruited adolescent patients with pmTBI (n = 162) 1 week and 4 months post-injury and in age/sex-matched healthy controls (HC; n = 117) at equivalent time intervals. Six published PPCS methods were stratified into Simple Change (e.g., International Statistical Classification of Diseases and Related Health Problems, 10th revision [ICD-10]) and Standardized Change (e.g., reliable change indices) algorithms. Among HC, test-retest reliability was fair to good across the 4-month assessment window, with evidence of bias (i.e., higher symptom ratings) during retrospective relative to other assessments. Misclassification rates among HC were higher (>30%) for Simple Change algorithms, with poor inter-rater reliability of symptom burden across HC and their parents. A 49% spread existed in terms of the proportion of pmTBI patients "diagnosed" with PPCS at 4 months, with superior inter-method agreement among standardized change algorithms. In conclusion, the self-reporting of symptom burden is only modestly reliable in typically developing adolescents over a 4-month period, with additional evidence for systematic bias in both adolescent and parental ratings. Significant variation existed for identifying pmTBI patients who had "recovered" (i.e., those who did not meet individual criteria for PPCS) from concussion across the six definitions, representing a considerable challenge for estimating the true incidence rate of PPCS in published literature. Although relatively straightforward to obtain, current findings question the utility of the most commonly used Simple Change scores for diagnosis of PPCS in clinical settings.
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Affiliation(s)
- Andrew R. Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | - David D. Stephenson
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Andrew B. Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Cidney R. Robertson-Benta
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Sharvani Pabbathi Reddy
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Nicholas A. Shaff
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Harm J. van der Horn
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Christopher J. Wertz
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Grace Park
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Scott J. Oglesbee
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Edward J. Bedrick
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Richard A. Campbell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, New Mexico, USA
| | - John P. Phillips
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Davin K. Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, New Mexico, USA
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14
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Shapiro JS, Silk T, Takagi M, Anderson N, Clarke C, Davis GA, Dunne K, Hearps SJ, Ignjatovic V, Rausa V, Seal M, Babl FE, Anderson V. Examining Microstructural White Matter Differences between Children with Typical and Those with Delayed Recovery Two Weeks Post-Concussion. J Neurotrauma 2020; 37:1300-1305. [DOI: 10.1089/neu.2019.6768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jesse S. Shapiro
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Tim Silk
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Cathriona Clarke
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Gavin A. Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kevin Dunne
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Australia
- Department of Rehabilitation Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - Vera Ignjatovic
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Vanessa Rausa
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Marc Seal
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Franz E. Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Australia
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Australia
- Psychology Service, Royal Children's Hospital, Melbourne, Victoria, Australia
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15
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Anderson V, Davis GA, Takagi M, Dunne K, Clarke C, Anderson N, Rausa VC, Doyle M, Parkin G, Truss K, Thompson E, Bressan S, Hearps S, Babl FE. Trajectories and Predictors of Clinician-Determined Recovery after Child Concussion. J Neurotrauma 2020; 37:1392-1400. [PMID: 31996086 DOI: 10.1089/neu.2019.6683] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
By age 16, 20% of children will suffer a concussion. Many experience persisting post-concussive symptoms (PCS), the cause(s) of which remain unclear. We mapped concussion recovery to 3 months post-injury and explored non-modifiable (e.g., age, sex, pre-injury factors, injury mechanism, acute PCS) and modifiable (post-acute child symptoms) predictors of persisting symptoms in order to identify opportunities for early intervention. We conducted a prospective, longitudinal study in the emergency department of a tertiary, pediatric hospital recruiting children within 48 h of concussion (T0), with follow-up at 2 days (T1), 2 weeks (T2), 1 month (T3), and 3 months (T4). Primary outcome was T2 clinician diagnosis. Clinical history, injury mechanism, acute symptoms, and physical and cognitive function were assessed. Parents rated child behavior and fatigue, and their mental health. We enrolled 256 participants, 72% males: 62 (24.3%) were symptomatic at T2. Recovered and symptomatic groups endorsed similar pre-injury PCS, but group differences were found at T1 across all PCS subscales, except Emotional, where symptoms were not evident until T2. By T2, there was significant PCS reduction, steepest in the "Recovered" group, which also had a lower rate of pre-injury psychiatric diagnoses, acute CT scans and less severe parent-rated PCS at T1 than the symptomatic group. They all demonstrated lower parent-rated PCS and less internalizing behaviors (all, p < 0.01). No differences were detected for child age, sex, injury factors, pre-injury parent-rated PCS, or acute physical and cognitive status. Our findings also highlight the importance of considering both pre- and post-injury mental health status in managing post-concussion.
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Affiliation(s)
- Vicki Anderson
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Royal Children's Hospital, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Gavin A Davis
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Michael Takagi
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Kevin Dunne
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Cathriona Clarke
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vanessa C Rausa
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Melissa Doyle
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Georgia Parkin
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Katie Truss
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Emma Thompson
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Silvia Bressan
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Stephen Hearps
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E Babl
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
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16
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Teh Z, Takagi M, Hearps SJC, Babl FE, Anderson N, Clarke C, Davis GA, Dunne K, Rausa VC, Anderson V. Acute cognitive postconcussive symptoms follow longer recovery trajectories than somatic postconcussive symptoms in young children. Brain Inj 2020; 34:350-356. [PMID: 32013575 DOI: 10.1080/02699052.2020.1716996] [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: 10/25/2022]
Abstract
Objective: To investigate somatic and cognitive postconcussive symptoms (PCS) using the symptom evaluation subtest (cSCAT3-SE) of the Child Sports Concussion Assessment Tool 3 (Child SCAT) in tracking PCS up to 2 weeks postinjury.Methods: A total of 96 participants aged 5 to 12 years (Mage = 9.55, SD = 2.20) completed three assessment time points: 48 h postinjury (T0), 2 to 4 days postinjury (T1), and 2 weeks postinjury (T2). The Wilcoxon signed-rank test was used to analyze differences between cognitive and somatic symptoms over time, while the Friedman test was used to analyze differences within symptom type over time.Results: Cognitive PCS were found to be significantly higher than somatic PCS at all assessment time points and were also found to significantly decline from 4 days onwards postinjury; in contrast, somatic PCS significantly declined as early as 48 hpostinjury.Discussion: Differences between cognitive and somatic PCS emerge as early as a few days postinjury, with cognitive PCS being more persistent than somatic PCS across 2 weeks. Research in symptom-specific interventions may be of benefit in helping young children manage severe PCS as early as 2 weeks postinjury.
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Affiliation(s)
- Zoe Teh
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Michael Takagi
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Stephen J C Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Franz E Babl
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Emergency Department, The Royal Children's Hospital, Melbourne, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Nicholas Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Cathriona Clarke
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Gavin A Davis
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Kevin Dunne
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Australia.,Department of Rehabilitation Medicine, The Royal Children's Hospital, Melbourne, Australia
| | - Vanessa C Rausa
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Australia.,Psychological Service, The Royal Children's Hospital, Melbourne, Australia
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Gornall A, Takagi M, Clarke C, Babl FE, Davis GA, Dunne K, Anderson N, Hearps SJ, Demaneuf T, Rausa V, Anderson V. Behavioral and Emotional Difficulties after Pediatric Concussion. J Neurotrauma 2020; 37:163-169. [DOI: 10.1089/neu.2018.6235] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alice Gornall
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Cathriona Clarke
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E. Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Gavin A. Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kevin Dunne
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
- Department of Rehabilitation Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Thibaut Demaneuf
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vanessa Rausa
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
- Psychology Service, Royal Children's Hospital, Melbourne, Victoria, Australia
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18
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Takagi M, Hearps SJC, Babl FE, Anderson N, Bressan S, Clarke C, Davis GA, Doyle M, Dunne K, Lanyon C, Rausa V, Thompson E, Anderson V. Does a computerized neuropsychological test predict prolonged recovery in concussed children presenting to the ED? Child Neuropsychol 2019; 26:54-68. [PMID: 31364925 DOI: 10.1080/09297049.2019.1639653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Computerized neuropsychological tests (CNTs) are widely used internationally in concussion management. Their prognostic value for predicting recovery post-concussion is poorly understood, particularly in pediatric populations. The aim of the present study was to examine whether cognitive functioning (measured by CogSport) has prognostic value for predicting rapid versus slow recovery. This is a prospective longitudinal observational cohort study conducted at a state-wide tertiary pediatric hospital. Data were collected at 1-4, 14, and 90 days post-injury. Eligible children were aged ≥5 and <18 years presenting to the Emergency Department having sustained a concussion within 48 h. Concussion was defined according to the Zurich/Berlin Consensus Statement on Concussion in Sport. Dependent variables were reaction times and error rates on the CogSport Brief Battery. In total, 220 cases were analyzed; 98 in a rapid recovery group (asymptomatic at 14 days post-injury, mean age 11.5 [3.2], 73.5% male) and 122 in a slow recovery group (symptomatic at 14 days post-injury, mean age 12.0 [3.1], 69.7% male). Longitudinal GEE analyses modeled the trajectories of both mean log10-transformed reaction time and error rates between groups over time (1-4, 14 and 90 days). Both group main and interaction (time by group) terms for all models were non-significant (p > .05). Cognitive functioning, measured by CogSport and assessed within 1-4 days of concussion, does not predict prolonged recovery in a pediatric sample. Further, there were no significant group differences at any time point. Considering the widespread use and promotion of CNTs, it is important that clinicians understand the significant limitations of the CogSport battery.
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Affiliation(s)
- Michael Takagi
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen J C Hearps
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Franz E Babl
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Silvia Bressan
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Cathriona Clarke
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Gavin A Davis
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Melissa Doyle
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Kevin Dunne
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Department of Rehabilitation Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Chloe Lanyon
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Vanessa Rausa
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Emma Thompson
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Vicki Anderson
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Psychology Service, The Royal Children's Hospital, Melbourne, Australia
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19
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Takagi M, Babl FE, Anderson N, Bressan S, Clarke CJ, Crichton A, Dalziel K, Davis GA, Doyle M, Dunne K, Godfrey C, Hearps SJC, Ignjatovic V, Parkin G, Rausa V, Seal M, Thompson EJ, Truss K, Anderson V. Protocol for a prospective, longitudinal, cohort study of recovery pathways, acute biomarkers and cost for children with persistent postconcussion symptoms: the Take CARe Biomarkers study. BMJ Open 2019; 9:e022098. [PMID: 30804026 PMCID: PMC6443052 DOI: 10.1136/bmjopen-2018-022098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 09/20/2018] [Accepted: 11/20/2018] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION The majority of children who sustain a concussion will recover quickly, but a significant minority will experience ongoing postconcussive symptoms, known as postconcussion syndrome (PCS). These symptoms include emotional, behavioural, cognitive and physical symptoms and can lead to considerable disability. The neurobiological underpinnings of PCS are poorly understood, limiting potential clinical interventions. As such, patients and families frequently re-present to clinical services, who are often ill equipped to address the multifactorial nature of PCS. This contributes to the high cost of concussion management and the disability of children experiencing PCS. The aims of the present study are: (1) to plot and contrast recovery pathways for children with concussion from time of injury to 3 months postinjury, (ii) evaluate the contribution of acute biomarkers (ie, blood, MRI) to delayed recovery postconcussion and (3) estimate financial costs of child concussion to patients attending the emergency department (ED) of a tertiary children's hospital and factors predicting high cost. METHODS AND ANALYSIS Take C.A.Re is a prospective, longitudinal study at a tertiary children's hospital, recruiting and assessing 525 patients aged 5-<18 years (400 concussion, 125 orthopaedic injury) who present to the ED with a concussion and following them at 1-4 days, 2 weeks, 1 month and 3 months postinjury. Multiple domains are assessed: preinjury and postinjury, clinical, MRI, blood samples, neuropsychological, psychological and economic. PCS is defined as the presence of ≥2 symptoms on the Post Concussive Symptoms Inventory rated as worse compared with baseline 1 month postinjury. Main analyses comprise longitudinal Generalised Estimating Equation models and regression analyses of predictors of recovery and factors predicting high economic costs. ETHICS AND DISSEMINATION Ethical approval has been obtained through the Royal Children's Hospital Melbourne Human Research Ethics Committee (33122). We aim to disseminate the findings through international conferences, international peer-reviewed journals and social media. TRIAL REGISTRATION NUMBER ACTRN12615000316505; Results.
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Affiliation(s)
- Michael Takagi
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Franz E Babl
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Carlton, Victoria, Australia
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Silvia Bressan
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Cathriona J Clarke
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Ali Crichton
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kim Dalziel
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Gavin A Davis
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Neurosurgery, Austin and Cabrini Hospitals, Parkville, Victoria, Australia
| | - Melissa Doyle
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Kevin Dunne
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Carlton, Victoria, Australia
- Department of Rehabilitation Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Celia Godfrey
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Carlton, Victoria, Australia
| | - Stephen J C Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vera Ignjatovic
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Carlton, Victoria, Australia
| | - Georgia Parkin
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vanessa Rausa
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Marc Seal
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Emma Jane Thompson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Katie Truss
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Carlton, Victoria, Australia
- Psychology Service, Royal Childrens Hospital, Melbourne, Victoria, Australia
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20
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Minney MJ, Roberts RM, Mathias JL, Raftos J, Kochar A. Service and support needs following pediatric brain injury: perspectives of children with mild traumatic brain injury and their parents. Brain Inj 2018; 33:168-182. [PMID: 30396278 DOI: 10.1080/02699052.2018.1540794] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To provide a qualitative examination of the service and support needs of children who have had a mild traumatic brain injury (mTBI), and their parents, in order to improve clinical services. METHODS Semi-structured interviews were conducted with 9 children (8-12 years; M = 10.6 years, SD = 0.8) and their parents (n = 9) 29-55 days (M = 34 days; SD = 9.3) after presenting to an Australian Paediatric Emergency Department (PED) for mTBI. Children's post-concussive symptoms (PCS) were additionally measured using the Post-Concussive Symptom Inventory (PCSI). Audio recordings were transcribed, and a thematic analysis was conducted. RESULTS Post-injury needs were reflected in four main themes: Communication; Family Burden; Continuity of Care; and Social and Community Support. These themes reflected children's and parents' needs for information, emotional/social/community support, and follow-up care. Both the children's and parents' needs, and the extent to which they were met, appeared to be related to the severity and duration of the child's PCS. CONCLUSIONS Dedicated pediatric mTBI follow-up services that build on family's resources and meet their individual needs for information, emotional support, and referral may assist in optimizing post-injury outcomes.
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Affiliation(s)
- M J Minney
- a School of Psychology , University of Adelaide , Adelaide , Australia
| | - R M Roberts
- a School of Psychology , University of Adelaide , Adelaide , Australia
| | - J L Mathias
- a School of Psychology , University of Adelaide , Adelaide , Australia
| | - J Raftos
- b Pediatric Emergency Department , Women's & Children's Hospital , North Adelaide , Australia
| | - A Kochar
- b Pediatric Emergency Department , Women's & Children's Hospital , North Adelaide , Australia
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21
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Babl FE, Dionisio D, Davenport L, Baylis A, Hearps SJC, Bressan S, Thompson EJ, Anderson V, Oakley E, Davis GA. Accuracy of Components of SCAT to Identify Children With Concussion. Pediatrics 2017; 140:peds.2016-3258. [PMID: 28771406 DOI: 10.1542/peds.2016-3258] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Sport Concussion Assessment Tool version 3 (SCAT3) and its child version (ChildSCAT3) are composite physical and neuropsychological scoring systems used to assess athletes after sport-related concussion. Based on limited validation data, we aimed to evaluate the ability of SCAT3 and ChildSCAT3 to differentiate children aged 5 to 16 years with concussion from controls. METHODS Prospective observational study of children in the emergency department with concussion (CONC group) and 2 control groups ([1] upper-limb injury [ULI] and [2] Well children) with equal-sized subgroups in 3 age bands of 5 to 8, 9 to 12, and 13 to 16 years. ChildSCAT3 was used for participants aged 5 to 12 years, and SCAT3 was used for participants aged 13 to 16 years. Differences between study groups were analyzed by using analysis of variance models, adjusting for age and sex. RESULTS We enrolled 264 children (90 CONC, 90 ULI, and 84 Well) in equal-sized age bands. The number and severity of child- and parent-reported symptom scores were significantly higher in the CONC group than either control group (P < .001). Mean double (ChildSCAT3 P < .001) and tandem stance errors (both P ≤ .01) were also significantly higher, and immediate memory was significantly lower for the CONC group (P < .01). No statistically significant group differences were found for orientation and digit backward tasks. There were no significant differences between ULI and Well control groups. CONCLUSIONS Overall, SCAT3 and ChildSCAT3 can differentiate concussed from nonconcussed patients, particularly in symptom number and severity.
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Affiliation(s)
- Franz E Babl
- Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; .,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; and
| | - Diana Dionisio
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Lucy Davenport
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Amy Baylis
- Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Silvia Bressan
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Emma J Thompson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; and
| | - Ed Oakley
- Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; and
| | - Gavin A Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurosurgery, Austin Health and Cabrini Hospital, Malvern, Victoria, Australia
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Truss K, Godfrey C, Takagi M, Babl FE, Bressan S, Hearps S, Clarke C, Dunne K, Anderson V. Trajectories and Risk Factors for Post-Traumatic Stress Symptoms following Pediatric Concussion. J Neurotrauma 2017; 34:2272-2279. [PMID: 28293983 DOI: 10.1089/neu.2016.4842] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A substantial minority of children experience post-traumatic stress symptoms (PTSS) following injury. Research indicates variation in the trajectory of PTSS following pediatric injury, but investigation of PTSS following concussion has assumed homogeneity. This study aimed to identify differential trajectories of PTSS following pediatric concussion and to investigate risk factors, including acute post-concussive symptoms (PCS), associated with these trajectories. A total of 120 children ages 8-18 years reported PTSS for 3 months following concussion diagnosis using the Child PTSD Symptom Scale, with a score of 16 or above indicating probable post-traumatic stress disorder diagnosis. Age, gender, injury mechanism, loss of consciousness, previous concussions, prior hospitalization, prior diagnosis of depression or anxiety, and acute PCS were assessed as risk factors. Data were analyzed using group-based trajectory modeling. Results revealed 16% of children had clinically significant PTSS 2 weeks post-concussion, declining to 10% at 1 month and 6% at 3 months post-injury. Group-based trajectory modeling identified three trajectories of PTSS post-concussion: "resilient" (70%); "recovering" (25%), in which children experienced elevated acute symptoms that declined over time; and "chronic symptomatology" (5%). Due to small size, the chronic group should be interpreted with caution. Higher acute PCS and prior diagnosis of depression or anxiety both significantly increased predicted probability of recovering trajectory group membership. These findings establish that most children are resilient to PTSS following concussion, but that PTSS do occur acutely in a substantial minority of children. The study indicates mental health factors, particularly PTSS, depression, and anxiety, should be considered integral to models of concussion management and treatment.
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Affiliation(s)
- Katherine Truss
- 1 Murdoch Childrens Research Institute , Melbourne, Australia .,2 School of Psychological Sciences, University of Melbourne , Melbourne, Australia
| | - Celia Godfrey
- 1 Murdoch Childrens Research Institute , Melbourne, Australia .,3 Department of Pediatrics, University of Melbourne , Melbourne, Australia
| | - Michael Takagi
- 1 Murdoch Childrens Research Institute , Melbourne, Australia
| | - Franz E Babl
- 1 Murdoch Childrens Research Institute , Melbourne, Australia .,3 Department of Pediatrics, University of Melbourne , Melbourne, Australia .,4 Emergency Department, Royal Children's Hospital , Melbourne, Australia
| | - Silvia Bressan
- 1 Murdoch Childrens Research Institute , Melbourne, Australia .,5 Department of Women's and Children's Health, University of Padova , Padova, Italy
| | - Stephen Hearps
- 1 Murdoch Childrens Research Institute , Melbourne, Australia
| | | | - Kevin Dunne
- 1 Murdoch Childrens Research Institute , Melbourne, Australia .,3 Department of Pediatrics, University of Melbourne , Melbourne, Australia .,6 Department of Rehabilitation Medicine, Royal Children's Hospital , Melbourne, Australia
| | - Vicki Anderson
- 1 Murdoch Childrens Research Institute , Melbourne, Australia .,2 School of Psychological Sciences, University of Melbourne , Melbourne, Australia .,7 Psychology Service, Royal Children's Hospital , Melbourne, Australia
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23
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Hearps SJC, Takagi M, Babl FE, Bressan S, Truss K, Davis GA, Godfrey C, Clarke C, Doyle M, Rausa V, Dunne K, Anderson V. Validation of a Score to Determine Time to Postconcussive Recovery. Pediatrics 2017; 139:peds.2016-2003. [PMID: 28138006 DOI: 10.1542/peds.2016-2003] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A reliable, developmentally appropriate and standardized method for assessing postconcussive symptoms (PCS) is essential to accurately determine recovery postconcussion and to effectively manage return to normal activities. The aim of this study was to develop an evidence-based, psychometrically validated approach to determining clinically useful cutoff scores by using a commonly administered PCS measure. METHODS The current study was a prospective, longitudinal observational study conducted between July 2013 and November of 2015 at a statewide tertiary pediatric hospital. Participants were 120 children (5-18 years of age) presenting to the emergency department with a concussion within 48 hours of injury. PCS were assessed by using the Postconcussion Symptom Inventory (PCSI), acutely, 1 to 4 days postinjury and 2 weeks postinjury. Using comprehensive clinical assessment as gold standard, we assessed the clinical cutoff discrimination ability of PCSI at 2 weeks postinjury by using published approaches, and then varying each approach to optimize their discrimination ability. RESULTS Existing and potential clinical cutoff scores were explored in predicting delayed recovery. Receiver operating characteristic curve results returned acceptable discrimination and sensitivity when PCSI items increased in severity from preinjury by 1 or more. Compared with a published cutoff score being 3+ items with increased severity, the current study suggests a more stringent cutoff requirement of 2+ is better able to accurately classify symptomatic children. CONCLUSIONS This study provides the first validated index (2+ items, 1+ severity) of concussion recovery for children and youth. Further studies in more varied samples are needed to establish the effectiveness of this method.
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Affiliation(s)
| | - Michael Takagi
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences and
| | - Franz E Babl
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; .,Department of Paediatrics, University of Melbourne, Victoria, Australia.,Emergency Department
| | - Silvia Bressan
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Katherine Truss
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences and
| | - Gavin A Davis
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Celia Godfrey
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Cathriona Clarke
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Melissa Doyle
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences and
| | - Vanessa Rausa
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences and
| | - Kevin Dunne
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Victoria, Australia.,Department of Rehabilitation Medicine, and
| | - Vicki Anderson
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences and.,Department of Paediatrics, University of Melbourne, Victoria, Australia.,Psychology Service, Royal Children's Hospital, Melbourne, Victoria, Australia; and
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