Postconcussive symptoms in hospitalized pediatric patients after mild traumatic brain injury.
BACKGROUND
Mild traumatic brain injury (MTBI) is common in the pediatric population. The symptom complex that might be expected in children after MTBI is not well documented. We sought to clarify the frequency and severity of concussive symptoms reported by children who required hospitalization for MTBI.


METHODS
Pediatric blunt trauma patients (age, 11-17 years) admitted for treatment of MTBI (GCS 14-15) were prospectively enrolled over a 2-year period. Consented patients were administered a 22-question Likert-based concussion symptom scale (normal, total score 0-8). The symptom scale was repeated at the time of routine follow-up trauma clinic visit. The frequency and severity of concussive symptoms were analyzed at both time-points.


RESULTS
For the 2-year period, 116 children participated in the study including 63 who returned for clinic follow-up. The overall population had mean age of 14.1 years (median 14) and was 69.8% male. The mean symptom score (sum of Likert scores [scale 0-6] for 22 questions) was 27.9 (median, 23.5) at hospitalization and 9.2 (median, 4.0) at follow-up. An abnormal symptom score (>8) was reported in 83.6% of hospitalized patients and 38.1% at follow-up. Girls had a significantly higher mean symptom score at initial testing than boys (33.9 vs 25.3, respectively; P < .05). This difference disappeared by the time of follow-up (girls 9.2 vs boys 9.1, P = .98) The most common initial symptom was headache (71.5% of patients) and most severe (highest mean score) was fatigue (mean, 2.0; median, 2.0). At follow-up, the most common symptom was excess sleep (38.1%) and most severe symptom falling asleep (mean, 1.0; median, 0). There were no significant differences in initial scores based on reported loss of consciousness, prior concussion history, or GCS 14 vs 15.


CONCLUSIONS
Symptoms after MTBI are quite common at the time of hospitalization. Symptom scores improve to near normal for most by outpatient follow-up. The most common symptom was headache, but the most severe was fatigue, in this hospitalized pediatric population. Thoughtful assessment and follow-up of this patient population are warranted.
Blinman
Thane A
TA
Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. blinman@email.chop.edu
Houseknecht
Eileen
E
Snyder
Caitlin
C
Wiebe
Douglas J
DJ
Nance
Michael L
ML
D000293:Adolescent; D001924:Brain Concussion; D001930:Brain Injuries / Q000150:complications*; D002648:Child; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006261:Headache / Q000209:etiology*; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D011446:Prospective Studies; D014505:Urban Population; D014949:Wounds, Nonpenetrating / Q000150:complications