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- Title
Postconcussive Symptoms After Early Childhood Concussion.
- Authors
Dupont, Dominique; Tang, Ken; Beaudoin, Cindy; Dégeilh, Fanny; Gagnon, Isabelle; Yeates, Keith Owen; Rose, Sean C.; Gravel, Jocelyn; Burstein, Brett; Stang, Antonia S.; Stanley, Rachel M.; Zemek, Roger L.; Beauchamp, Miriam H.
- Abstract
Key Points: Question: What amount and type of postconcussive symptoms occur after early childhood concussion and how do they evolve? Findings: In this cohort study of 303 children aged 6 to 72 months recruited from urban pediatric emergency departments and daycares, those with concussion exhibited more postconcussive symptoms than uninjured children and children with orthopedic injury acutely and at 10 days, 1 month, and 3 months after injury. Symptoms, documented using a developmentally-appropriate measure, were most common in the physical and behavioral domains. Meaning: These findings suggest that early childhood concussion can result in significantly elevated postconcussive symptoms, which may remain present 3 months after injury and are not solely attributable to general injury effects or typical development. This cohort study examines postconcussive symptoms in the first 3 months after concussion among children aged 6 to 72 months using a developmentally appropriate measure. Importance: Research on postconcussive symptoms (PCS) following early childhood concussion has been hindered by a lack of measures suitable for this age group, resulting in a limited understanding of their evolution in young children. Objective: To document PCS in the first 3 months after early childhood concussion using a developmentally appropriate measure. Design, Setting, and Participants: This cohort study used data collected at 3 Canadian and 1 US urban pediatric emergency departments (EDs) and 8 Canadian daycares from December 2018 to December 2022 as part of the Kids' Outcomes and Long-Term Abilities (KOALA) project, a prospective, multicenter, longitudinal cohort study. Participants included children aged 6 to 72 months with early childhood concussion or orthopedic injury (OI) or uninjured children from the community to serve as controls. Data were analyzed from March 2023 to January 2024. Exposure: Concussion sustained between ages 6 and 72 months. Main Outcomes and Measures: Primary outcomes were cognitive, physical, behavioral and total PCS assessed prior to injury (retrospectively), acutely (within 48 hours), and at 10 days, 1 month, and 3 months after injury or recruitment through caregiver observations using the Report of Early Childhood Traumatic Injury Observations & Symptoms inventory. Group comparisons were analyzed using ordinal regression models. Results: The study included 303 children (mean [SD] age, 35.8 [20.2] months; 152 [50.2%] male). Of these, 174 children had a concussion (mean [SD] age, 33.3 [19.9] months), 60 children had an OI (mean [SD] age, 38.4 [19.8] months) and 69 children were uninjured controls (mean [SD] age, 39.7 [20.8] months). No meaningful differences were found between the concussion and comparison groups in retrospective preinjury PCS. Significant group differences were found for total PCS at the initial ED visit (concussion vs OI: odds ratio [OR], 4.33 [95% CI, 2.44-7.69]; concussion vs control: OR, 7.28 [95% CI, 3.80-13.93]), 10 days (concussion vs OI: OR, 4.44 [95% CI, 2.17-9.06]; concussion vs control: OR, 5.94 [95% CI, 3.22-10.94]), 1 month (concussion vs OI: OR, 2.70 [95% CI, 1.56-4.68]; concussion vs control: OR, 4.32 [95% CI, 2.36-7.92]), and 3 months (concussion vs OI: OR, 2.61 [95% CI, 1.30-5.25]; concussion vs control: OR, 2.40 [95% CI, 1.36-4.24]). Significant group differences were also found for domain-level scores (cognitive, physical, behavioral) at various time points. Conclusions and Relevance: In this early childhood cohort study, concussion was associated with more PCS than OIs or typical development up to 3 months after injury. Given the limited verbal and cognitive abilities typical of early childhood, using developmentally appropriate manifestations and behaviors is a valuable way of tracking PCS and could aid in concussion diagnosis in young children.
- Subjects
ALBERTA; OHIO; QUEBEC (Province); UNITED States; WOUNDS &; injuries; RESEARCH funding; KRUSKAL-Wallis Test; LOGISTIC regression analysis; CHILDREN'S hospitals; HOSPITAL emergency services; DESCRIPTIVE statistics; CHI-squared test; LONGITUDINAL method; ODDS ratio; POSTCONCUSSION syndrome; URBAN hospitals; ONE-way analysis of variance; CHILD development; EPIDEMIOLOGY; CHILD care; DATA analysis software; CONFIDENCE intervals; SYMPTOMS; CHILDREN
- Publication
JAMA Network Open, 2024, Vol 7, Issue 3, pe243182
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.3182