Predicting Persistent Post-concussive Problems in Pediatrics
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.
Biphasic AnaphylaxisWe are also conducting a study on children presenting to the emergency department with anaphylaxis or allergic reaction to investigate why some children are at risk of biphasic (also called delayed) anaphylaxis. Biphasic anaphylaxis occurs when the initial symptoms of an allergic reaction go away but then return few hours or days later without exposure to the initial substance that caused the reaction. UPDATE: 50 patients were enrolled in this study. 24% developed a biphasic reaction.FINDINGS: More research is needed to investigate the epidemiology of biphasic allergic reactions in children. A large study would help us to better understand which children are at risk of these reactions which would improve the care of allergic reactions in our Emergency Departments.
In this CHEO Discovery Minute, Dr. Amy Plint shares the results from the OUCH Trial, a randomized control trial. Dr. Plint and her research team wanted to improve pain control in kids who come to the emergency department with musculoskeletal injuries.
Approximately one out of every 100 children who visits an emergency department for care receives sedation for common procedures, such as setting fractures or treatment of complex cuts. Dr. Maala Bhatt, together with researchers from across Canada, wanted to know if there was an increased risk of adverse events if a child hadn’t fasted before sedation. In this CHEO Discovery Minute, Dr. Bhatt shares that there was no difference in the rate of adverse events in young patients when researchers compared those who hadn’t fasted before being sedated for a procedure and those who had met fasting guidelines.
Thousands of children arrive each day to Emergency Departments across Canada with head injuries. Most are mild but a few may be life-threatening. Dr. Martin Osmond and colleagues across Canada developed the CATCH 2 rule. With this rule physicians are better informed of those at high risk for bleeding inside the head and this can assist them in determining who requires a prompt CT scan or close observation. It can also lessen anxiety for families of children whose injuries are determined to be less severe.