Abstract
Objective
Research in pediatric concussion has investigated mechanism of injury and symptom reporting separately, but there is no study that examines differences in symptom reporting across multiple mechanisms of injury in elementary school–aged children. The purpose of the study was to examine symptom presentation and determine if symptoms of concussed children in middle childhood differ based upon mechanism of injury.
Methods
Participants included 104 children between the ages of 6 and 10 years enrolled from area concussion clinics within 30 days of injury. All participants completed an initial clinic visit that collected demographic and injury characteristics as well as measures of post-concussion symptoms, anxiety, and depression based on parent report. We grouped the participants based on mechanism of injury (sports related, fall, hit by object, and motor vehicle accident).
Results
There was a significant group difference for age (p = 0.02) and history of previous concussion. Headache, fatigue, and trouble concentrating were the most commonly reported symptoms (> 50% of sample). We found no significant group differences in reported symptoms, although sleep disturbance approached significance. We also found no significant differences for total post-concussion symptom counts or total scores on a screener for anxiety or depression.
Conclusions
Overall, there were no symptom differences by mechanism of injury in this young age group; however, research with larger samples is needed to enhance knowledge of the physical and emotional sequelae of concussion in younger children and inform best practices for timely interventions.
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Data Availability
The data that support the findings of this study are available from the corresponding author, Nyaz Didehbani, Ph.D., upon reasonable request.
References
Arbogast, K. B., Curry, A. E., Pfeiffer, M. R., Zonfrillo, M. R., Haarbauer-Krupa, J., Breiding, M. J., Coronado, V. G., & Master, C. L. (2016). Point of health care entry for youth with concussion within a large pediatric care network. JAMA Pediatrics, 170(7), e160294. https://doi.org/10.1001/jamapediatrics.2016.0294.
Bahkos, L. L., Lockhart, G. R., Myers, R., & Linakis, J. G. (2010). Emergency department visits for concussion in young child athletes. Pediatrics, 126(3), e550–e556. https://doi.org/10.1542/peds.2009-3101.
Barlow, K. M., Crawford, S., Stevenson, A., Sandhu, S. S., Belanger, F., & Dewey, D. (2010). Epidemiology of postconcussion syndrome in pediatric mild traumatic brain injury. Pediatrics, 126(2), e374–e381. https://doi.org/10.1542/peds.2009-0925.
Bunt, S. C., Didehbani, N., Tarkenton, T., Rossetti, H., Hicks, C., Vargas, B., Silver, C., Nakonezny, P., Bell, K., Batjer, H., & Cullum, C. M. (2020). Sex differences and reporting of SCAT-5 concussion symptoms in adolescent athletes. Clinical Journal of Sports Medicine Advance online publication. https://doi.org/10.1097/JSM.0000000000000788.
Chrisman, S. P. D., Lowry, S., Herring, S. A., Kroshus, E., Hoopes, T. R., Higgins, S. K., & Rivara, F. P. (2019). Concussion incidence, duration, and return to school and sport in 5- to 14-year-old American football athletes. Journal of Pediatrics, 207, 176–184.e1. https://doi.org/10.1016/j.jpeds.2018.11.003.
Cullum, C. M., Bunt, S., Hicks, C., Didehbani, N., Miller, S., Vargas, B., Sabo, T., Bell, K., & Batjer, H. H. (2020). The North Texas Concussion Registry (ConTex). BMJ Open, 10, e0322345. https://doi.org/10.1136/bmjopen-2019-032345.
Echemendia, R. J., Meeuwisse, W., & McCory, P. (2017). Sport Concussion Assessment Tool- 5th edition. BJ Sports Med, 51, 851–858. https://doi.org/10.1136/bjsports-2017-097506SCAT5.
Eisenberg, M. A., Meehan III, W. P., & Mannix, R. (2014). Duration and course of post-concussive symptoms. Pediatrics, 133(6), 999–1006. https://doi.org/10.1542/peds.2014-0158.
Gilchrist, J., Thomas, K. E., Xu, L., McGuire, L. C., & Coronado, V. G. (2011). Nonfatal sports and recreation related traumatic brain injuries among children and adolescents treated in emergency departments in the United States, 2001–2009. Morbidity and Mortality Weekly Report (MMWR), 60(39), 1337–1342 https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6039a1.htm.
Guerriero, R. M., Kuemmerle, K., Pepin, M. J., Taylor, A. M., Wolff, R., & Meehan, W. P. (2018). The association between premorbid conditions in school-aged children with prolonged concussion recovery. Journal of Child Neurology, 33(2), 168–173. https://doi.org/10.1177/0883073817749655.
Haider, M. N., Leddy, J. J., Pavlesen, S., Kluczynski, M., Baker, J. G., Meicznikowski, J. C., & Willer, B. S. (2018). A systematic review of criteria used to define recovery from sport-related concussion in youth athletes. British Journal of Sports Medicine, 52(18), 1179–1190. https://doi.org/10.1136/bjsports-2016-096551.
Howell, D., Kriz, P., Mannix, R. C., Kirchberg, T., Master, C. L., & Meehan III, W. P. (2019). Concussion symptom profiles among child, adolescent, and young adult athletes. Clinical Journal of Sport Medicine, 29(5), 391–397. https://doi.org/10.1097/JSM.0000000000000629.
Iverson, G. L., Gardner, A. J., Terry, D. P., Ponsford, J. L., Sills, A. K., Broshek, D. K., & Solomon, G. S. (2017). Predictors of clinical recovery from concussion: a systematic review. British Journal of Sports Medicine, 51(12), 941–948. https://doi.org/10.1136/bjsports-2017-097729.
Kroenke, K., & Spitzer, R. (2002). The PHQ-9: a new depression diagnostic and severity measure. Psychiatric Annals, 32(9), 509–521. https://doi.org/10.3928/0048-5713-20020901-06.
Kroenke, K., Strine, T. W., Spitzer, R. L., Williams, J. B., Berry, J. T., & Mokdad, A. H. (2009). The PHQ-8 as a measure of current depression in the general population. Journal of Affective Disorders, 114(1–3), 163–173. https://doi.org/10.1016/j.jad.2008.06.026
McCrory, P., Feddermann-Demont, N., Dvořák, J., Cassidy, J. D., McIntosh, A., Vos, P. E., Echemendia, R. J., Meeuwisse, W., & Tarnutzer, A. A. (2017). What is the definition of sports-related concussion: a systematic review. British Journal of Sports Medicine, 51(11), 877–887. https://doi.org/10.1136/bjsports-2016-097393.
Plourde, V., Daya, H., Low, T. A., Barlow, K. M., & Brooks, B. L. (2019). Evaluating anxiety and depression symptoms in children and adolescents with prior mild traumatic brain injury: agreement between methods and respondents. Child Neuropsychology, 25(1), 44–59. https://doi.org/10.1080/09297049.2018.1432585.
Smith, S. R. (2007). Making sense of multiple informants in child and adolescent psychopathology: a guide for clinicians. Journal of Psychoeducational Assessment, 25(2), 139–149. https://doi.org/10.1177/0734282906296233.
Spitzer, R. L., Kroenke, K., & Williams, J. B. (2006). A brief measure for assessing generalized anxiety: the GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092.
Starkey, N. J., Jones, K., Case, R., Theadom, A., Barker-Collo, S., & Feigin, V. (2018). Post-concussive symptoms after a mild traumatic brain injury during childhood and adolescence. Brain Injury, 32(5), 617–626. https://doi.org/10.1080/02699052.2018.1439533.
Taylor, C. A., Bell, J. M., Breiding, M. J., & Xu, L. (2017). Traumatic brain injury–related emergency department visits, hospitalizations, and deaths—United States, 2007 and 2013. Morbidity and Mortality Weekly Report (MMWR) Surveillance Summaries, 66(SS-9), 1–16. https://doi.org/10.15585/mmwr.ss6609a1.
Varriano, B., Tomlinson, G., Tarazi, A., Wennberg, R., Tator, C., & Tartaglia, M. C. (2018). Age, gender and mechanism of injury interactions in post-concussion syndrome. Canadian Journal of Neurological Sciences, 45(6), 636–642. https://doi.org/10.1017/cjn.2018.322.
Zemek, R., Barrowman, N., Freedman, S. B., Gravel, J., Gagnon, I., McGahern, C., Aglipay, M., Sangha, G., Boutis, K., Beer, D., Craig, W., Burns, E., Farion, K. J., Mikrogianakis, A., Barlow, K., Dubrovsky, A. S., Meeuwisse, W., Gioia, G., Meehan, W. P., III, … Osmond, M. H., for the Pediatric Emergency Research Canada (PERC) Concussion Team (2016). Clinical risk score for persistent postconcussion symptoms among children with acute concussion in the ED. Journal of the American Medical Association, 315(10), 1014–1025. https://doi.org/10.1001/jama.2016.1203
Funding
This study was funded by a grant from the Texas Institute for Brain Injury and Repair (TIBIR), a state-funded initiative as part of the Peter J. O’Donnell Jr. Brain Institute at the University of Texas Southwestern Medical Center.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the University of Texas Southwestern Medical Center Institutional Review Board (No. STU012015-032).
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Written assent was obtained from all individual participants under the age of 18 included in the study as well as written consent for participation from the parent/legal guardian. Written informed consent was obtained from all individual participants aged 18 or older.
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Didehbani, N., Silver, C.H., Hicks, C. et al. Concussion Symptoms by Mechanism of Injury in Elementary School–Aged Children. J Pediatr Neuropsychol 6, 170–175 (2020). https://doi.org/10.1007/s40817-020-00087-2
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DOI: https://doi.org/10.1007/s40817-020-00087-2