Epidemiology of postconcussion syndrome in pediatric mild traumatic brain injury.
BACKGROUND
Much disagreement exists as to whether postconcussion syndrome (PCS) is attributable to brain injury or to other factors such as trauma alone, preexisting psychosocial problems, or medicolegal issues. We investigated the epidemiology and natural history of PCS symptoms in a large cohort of children with a mild traumatic brain injury (mTBI) and compared them with children with an extracranial injury (ECI).


METHODS
This investigation was a prospective, consecutive controlled-cohort study of 670 children who presented to a tertiary referral emergency department with mTBI and 197 children who presented with ECI. For all participants, data were collected by use of a telephone interview of a parent 7 to 10 days after injury. If a change from preinjury symptoms was reported by a parent, follow-up continued monthly until symptom resolution. Outcomes were measured by using the Post Concussion Symptom Inventory, Rivermead Postconcussion Symptom Questionnaire, Brief Symptom Inventory, and Family Assessment Device.


RESULTS
There was a significant difference between the mTBI and ECI groups in their survival curves for time to symptom resolution (log rank [Mantel-Cox] 11.15, P < .001). Three months after injury, 11% of the children in the mTBI group were symptomatic (13.7% of children older than 6 years) compared with 0.5% of the children in the ECI group. The prevalence of persistent symptoms at 1 year was 2.3% in the mTBI group and 0.01% in the ECI group. Family functioning and maternal adjustment did not differ between groups.


CONCLUSIONS
Among school-aged children with mTBI, 13.7% were symptomatic 3 months after injury. This finding could not be explained by trauma, family dysfunction, or maternal psychological adjustment. The results of this study provide clear support for the validity of the diagnosis of PCS in children.
Barlow
Karen Maria
KM
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada. karen.barlow@albertahealthservices.ca
Crawford
Susan
S
Stevenson
Andrea
A
Sandhu
Sandeep Sona
SS
Belanger
François
F
Dewey
Deborah
D
D000293:Adolescent; D001924:Brain Concussion / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D001930:Brain Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016021:Epidemiologic Studies; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D011584:Psychology; D011795:Surveys and Questionnaires; D013997:Time Factors