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Predicting Persistent Post-concussive Problems in Pediatrics

young boy holding his head
Concussion is a silent epidemic and serious public health problem with children and adolescents enduring the greatest incidence. Persistent postconcussive symptoms (PCS) is defined as the persistence of somatic (e.g., headache, dizziness, fatigue), cognitive (e.g., memory, confusion) and other physical, psychological, and behavioural changes lasting more than one month following injury. PCS can sometimes impacts children and family quality of life through impaired memory and attention resulting in difficulties with school work, changes in moods and loss of activities. It is believed that PCS is quite common (6-59% of children with concussion), but no large studies have determined the true prevalence.

Results from a recent study by our ED Research team revealed that validated, easy-to-use prognosticators do not exist for clinicians to identify children at highest risk for PCS. As a result, physicians cannot accurately inform children and families about symptom duration, nor initiate pharmacotherapy or other management to reduce the occurrence or severity of PCS.

The CHEO ED Research team is leading a national study to help answer some of these important questions. More than 800 children from Emergency departments across Canada have participated in this study.

RESULTS: Enrollment in this study is now complete and the results are in. Experts from across Canada and the United States developed a PPCS risk score that when applied to a child within 48-hours of their head injury, was proven to be significantly better than the child’s physician was at predicting future PPCS. The score incorporates nine clinical variables containing information from demographics, history, initial symptoms, cognitive complaints, and a physical examination.

The 5P study unveiled a number of findings. For instance, while boys sustained more concussions, girls had twice the odds of boys for having symptoms last at least one month. In addition, older children and teens have a higher risk of PPCS than children under 8 years old do. Click here to read more.
Advancing Concussion Assessment in Pediatrics (A-CAP) Study

Clinicians urgently need evidence-based guidance to manage concussions in children.
The diagnosis and prognosis of concussion lacks a gold standard, An approach that incorporates both neurobiological and psychosocial markers is needed for effective diagnosis and prognosis. Innovative research is needed to improve assessment of concussion.

The research will enhance our understanding of pediatric mild traumatic brain injury.

The research also will improve the clinical care and outcomes of children with concussion.

UPDATE: This study is up and running and has recruited 129 young people and their families so far.



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