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Progress Made in Developing Pediatric Post-Concussion Symptoms Risk Score

OTTAWA, CANADA – Even though about a third of children suffering an acute concussion go on to experience somatic, cognitive, and psychological or behavioral symptoms, emergency physicians have had little way to predict who would develop persistent post-concussion symptoms (PPCS).

A study published recently in JAMA, however, describes the results of the effort to create and validate a clinical risk score for PPCS among children presenting to the emergency department.

For the prospective, multicenter cohort study, Predicting and Preventing Postconcussive Problems in Pediatrics (5P), Children’s Hospital of Eastern Ontario-led researchers enrolled 1,205 patients aged 5 to younger than 18 who presented within 48 hours of an acute head injury at one of nine pediatric EDs within the Pediatric Emergency Research Canada (PERC) network. The derivation cohort study was conducted from August 2013 through September 2014, followed by the validation cohort from October 2014 through June 2015.

The primary outcome was defined as PPCS risk score at 28 days, which was defined as three or more new or worsening symptoms using the patient-reported Post-concussion Symptom Inventory compared with recalled state of being prior to the injury.

Results indicate that persistent post-concussion symptoms were present in 31% of patients. The 12-point PPCS risk score model for the derivation cohort included the following variables:

  • female sex,
  • age 13 or older,
  • physician-diagnosed migraine history,
  • prior concussion with symptoms lasting longer than one week,
  • headache,
  • sensitivity to noise,
  • fatigue,
  • answering questions slowly, and
  • four or more errors on the Balance Error Scoring System tandem stance.

“The area under the curve was 0.71 (95% CI, 0.69-0.74) for the derivation cohort and 0.68 (95% CI, 0.65-0.72) for the validation cohort,” study authors report.

“A clinical risk score developed among children presenting to the emergency department with concussion and head injury within the previous 48 hours had modest discrimination to stratify PPCS risk at 28 days,” the researchers conclude. “Before this score is adopted in clinical practice, further research is needed for external validation, assessment of accuracy in an office setting, and determination of clinical utility."

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