title: Association of Persistent Postconcussion Symptoms With Pediatric Quality of Life.
abstract: OBJECTIVE
  Persistent postconcussion symptoms (PPCS) pose long-term challenges and can negatively affect patients' health-related quality of life (HRQoL). To date, no large comprehensive study has addressed the association between PPCS and HRQoL.
  
  
  OBJECTIVE
  To determine the association between HRQoL and PPCS at 4 weeks after concussion and assess the degree of impairment of HRQoL in the subsequent 12 weeks.
  
  
  METHODS
  In a prospective, multicenter cohort study (Predicting Persistent Postconcussive Problems in Pediatrics [5P]) from August 14, 2013, to September 30, 2014, children aged 5 to 18 years who presented to the emergency department within 48 hours after head injury and were considered to have an acute concussion were enrolled across 9 pediatric emergency departments within the Pediatric Emergency Research Canada Network. Persistent postconcussion symptoms were defined as 3 or more persistent symptoms on the validated Post-Concussion Symptom Inventory at 4 weeks. Linear mixed effects random coefficients models evaluated the association between PPCS and HRQoL, adjusting for potential confounders including age, sex, prior concussions, migraine, anxiety, learning disability, depression, and sleep disorder.
  
  
  METHODS
  The primary outcome was HRQoL assessed with the validated Pediatric Quality of Life Inventory version 4.0 (PedsQL-4.0) at 4, 8, and 12 weeks after head injury.
  
  
  RESULTS
  Of 2006 children enrolled (median age, 11.8 years [interquartile range, 8.9-14.6 years]; 1241 boys and 765 girls), 1667 (83.1%) completed the PedsQL-4.0 at all 3 time points. Of these 1667 children, the 510 with PPCS (30.6%) had lower total PedsQL-4.0 scores (mean, 70.0) than did those without PPCS (mean, 80.3; mean difference, -10.3; 95% CI, -9.4 to -11.2). Patients with PPCS also had significantly lower physical, emotional, social, and school PedsQL-4.0 subscores at 4, 8, and 12 weeks. Patients with PPCS had lower HRQoL than published healthy norms at 4 weeks (mean difference, 13.89; 95% CI, 11.55-16.23), 8 weeks (mean difference, 11.63; 95% CI, 9.34-13.93), and 12 weeks (mean difference, 9.38; 95% CI, 7.01-11.75; P < .001). Patients who recovered from concussion also had lower HRQoL than norms at 4 weeks (mean difference, 3.56; 95% CI, 1.28-5.85) and 8 weeks (mean difference, 2.75; 95% CI, 0.48-5.02; P < .05). School functioning PedsQL-4.0 subscores were significantly lower for all children regardless of PPCS status at all time points.
  
  
  CONCLUSIONS
  Children with PPCS have lower HRQoL compared with those who have recovered from concussion, yet deficits in HRQoL are pervasive across all domains and may persist for months even in children whose symptoms have resolved. Future interventional research should target the effect of concussion on HRQoL.
authors: Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors: Zuzana
authors: Z
authors: Novak
authors: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
authors: Mary
authors: M
authors: Aglipay
authors: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
authors: Nick
authors: N
authors: Barrowman
authors: Department of Psychology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada4Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
authors: Keith O
authors: KO
authors: Yeates
authors: Ste.-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada6Department of Psychology, University of Montreal, Montreal, Quebec, Canada.
authors: Miriam H
authors: MH
authors: Beauchamp
authors: Ste.-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada7Department of Pediatrics, Hospital Ste.-Justine, Montreal, Quebec, Canada.
authors: Jocelyn
authors: J
authors: Gravel
authors: Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada.
authors: Stephen B
authors: SB
authors: Freedman
authors: Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada10School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.
authors: Isabelle
authors: I
authors: Gagnon
authors: Department of Neuropsychology, Children's National Health System, George Washington University School of Medicine, Rockville, Maryland.
authors: Gerard
authors: G
authors: Gioia
authors: Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Kathy
authors: K
authors: Boutis
authors: Department of Pediatrics, Izaak Walton Killam Health Centre, Halifax, Nova Scotia, Canada.
authors: Emma
authors: E
authors: Burns
authors: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
authors: Andrée-Anne
authors: AA
authors: Ledoux
authors: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada14Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
authors: Martin H
authors: MH
authors: Osmond
authors: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada14Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
authors: Roger L
authors: RL
authors: Zemek
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001924:Brain Concussion / Q000150:complications; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D038223:Post-Concussion Syndrome / Q000175:diagnosis* / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D018570:Risk Assessment