title: Parental anxiety at initial acute presentation is not associated with prolonged symptoms following pediatric concussion.
abstract: OBJECTIVE
  Anxiety modulates symptom perception in adults following concussion, prolonging the time to full recovery. The authors sought to determine whether parental anxiety was associated with persistent postconcussive symptoms (PCS) in their children following concussion.
  
  
  METHODS
  A prospective observational cohort with 98 children aged 5 to 17 years following concussion participated from a tertiary pediatric emergency department (ED). The main exposure was parental anxiety at the time of acute presentation following pediatric concussion, measured using the self-administered, validated Spielberger State-Trait Anxiety Inventory-State Anxiety Scale (STAI-S). The primary outcome measured was presence of PCS in the child at 1 month, per the validated Post-Concussive Symptom Inventory (PCSI). Secondary outcome measures included parental anxiety score over time, school absenteeism, and return to sports. Data were collected during the initial ED visit and at 3-day, 7-day, 2-week, 1-month, and 3-month follow-ups.
  
  
  RESULTS
  Of 98 children enrolled, 27% (95% confidence interval [CI] = 19% to 36%) developed PCS at 1 month. No significant associations were detected between parental anxiety at the index visits and the number of previous pediatric concussions (p = 0.73), sex (p = 0.61), loss of consciousness (p = 0.43), history of migraines (p = 0.31), or history of anxiety diagnosed in the patients (p = 0.09). A significant association was noted between patient diagnosis of attention deficit hyperactivity disorder (ADHD) and parental anxiety at the index visits (p = 0.001). Parental anxiety at acute presentation was not associated with children's prolonged symptoms at 1 month (p = 0.63). Parental anxiety remained elevated in parents whose children had prolonged symptoms compared to those parents whose children's symptoms resolved (median = 30, interquartile range [IQR] = 22 to 44; and median = 21, IQR = 20 to 25, respectively; p < 0.001). Initial parental anxiety presentation was not associated with school absenteeism (p = 0.23) or not returning to sport or gym class (p = 0.89). There were no significant effects involving ADHD alone (p = 0.44) or together with baseline parental anxiety (p = 0.36 for ADHD and p = 0.55 for anxiety) using logistic regression analysis to examine potential predictive effects of child's ADHD combined with parental anxiety at the index visit on persistent symptoms at 1 month.
  
  
  CONCLUSIONS
  Parental anxiety at time of acute presentation does not appear to be associated with prolongation of postconcussive symptoms in their children. However, parents of persistently symptomatic children remain significantly more anxious than those whose children's symptoms have resolved. Future research should attempt to reduce the familial burden of concussion through expectation management strategies.
authors.affiliation: Division of Pediatric Emergency Medicine, Children's Hospital of Eastern Ontario, Ontario; Department of Pediatrics, University of Ottawa, Ontario; Children's Hospital of Eastern Ontario Research Institute, Ontario.
authors.forename: Roger
authors.initials: R
authors.lastname: Zemek
authors.forename: Chantalle
authors.initials: C
authors.lastname: Clarkin
authors.forename: Ken J
authors.initials: KJ
authors.lastname: Farion
authors.forename: Michael
authors.initials: M
authors.lastname: Vassilyadi
authors.forename: Peter
authors.initials: P
authors.lastname: Anderson
authors.forename: Brendan
authors.initials: B
authors.lastname: Irish
authors.forename: Kristian
authors.initials: K
authors.lastname: Goulet
authors.forename: Nick
authors.initials: N
authors.lastname: Barrowman
authors.forename: Martin H
authors.initials: MH
authors.lastname: Osmond
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000523:psychology*; D001924:Brain Concussion / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology*; D038223:Post-Concussion Syndrome / Q000175:diagnosis; D011446:Prospective Studies