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Post-concussive Signs and Symptoms in Preschool Children: A Systematic Review

Abstract

Mild traumatic brain injury (mTBI) is common in children aged < 5 years, however, less is known about their experience of post-concussive signs and symptoms. This systematic review aims to identify post-concussive signs and symptoms experienced by preschool children up to 12 months post-injury, and to review the methods used to report this data. Relevant findings, including rates, progression, and possible predictors of post-concussive signs and symptoms were also identified. Databases (Ovid MEDLINE, EMBASE, PsycInfo, PubMed, Scopus) and reference lists were searched for relevant articles, which were screened based on specified criteria. Eleven articles met the inclusion criteria, being original studies published in English and presenting data on post-concussive signs and symptoms specific to preschool children with mTBI. Most reviewed studies investigated acute presentations of mTBI, and identified that preschool children demonstrate post-concussive symptoms (PCS) similar to other age groups. Post-traumatic amnesia duration of approximately one day was reported in preschool children following mTBI, as were changes in mood and behavior during the recovery period. Parents were the main informants, with data obtained through either interview or questionnaire. Review findings highlight the lack of empirical data regarding the presentation and progression of PCS in preschoolers following mTBI and evidence on how to best manage this group during recovery.

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Acknowledgements

We would like to acknowledge Poh Chua, Librarian at The Royal Children’s Hospital, Melbourne, for her assistance with the search strategy.

Funding

No funding was secured for this study. Joy Noelle Yumul was supported by the Melbourne Research Scholarship from the University of Melbourne. Vicki Anderson was supported by an Australian National Health and Medical Research Council (NHMRC) Senior Research Practitioner Fellowship. Louise Crowe was supported by a NHMRC Early Career Fellowship and the Myer Foundation. The work is also supported by the Victorian Government Operational Infrastructure Fund.

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Joy Noelle Yumul contributed to the conceptualization of the manuscript, performed the literature search, article screening, data extraction, risk of bias assessment, and drafted and revised the manuscript. Louise Crowe screened the articles for inclusion in the review and reviewed first through final drafts. Cathy Catroppa contributed to the article selection, assessed the risk of bias of the included articles, and reviewed first through final drafts. Vicki Anderson and Audrey McKinlay contributed to the conceptualization, critical review, and revision of the manuscript for important intellectual content. All authors read and approved the final manuscript.

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Correspondence to Joy Noelle Yumul.

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LC and AM are co-senior authors.

Appendix 1 Examples of the strategy used for literature search in electronic databases

Appendix 1 Examples of the strategy used for literature search in electronic databases

Database Search strategy
Scopus ( TITLE-ABS-KEY ( brain-injur* OR head-injur* OR craniocerebral-trauma OR cranio-cerebral-trauma OR concussion OR tbi OR mtbi OR cmtbi OR moderate-tbi OR severe-tbi)) AND ( TITLE-ABS-KEY ( postconcussion OR post-concussion OR postconcussive OR post-concussive OR pcs OR ppcs OR pta OR amnesia OR disorientation OR memory-loss OR loss-of-memory OR confusion OR fogginess OR foggy OR dazed OR altered-mental-state)) AND ( ( TITLE-ABS-KEY ( toddler* OR pre-schooler* OR preschooler* OR kinder OR kinders OR kindergarten* OR kinder-aged OR two-year-old* OR two-years-old* OR three-year-old* OR three-years-old* OR four-year-old* OR four-years-old* OR five-year-old* OR five-years-old*) OR TITLE-ABS-KEY ( 2-year-old* OR 2-years-old* OR 3-year-old* OR 3-years-old* OR 4-year-old* OR 4-years-old* OR 5-year-old* OR 5-years-old* OR aged-two OR aged-2 OR aged-three OR aged-3 OR aged-four OR aged-4 OR aged-five OR aged-5 OR child and/or children))) AND ( LIMIT-TO ( LANGUAGE, "English"))
MEDLINE (Ovid) 1. Brain injuries/ or brain injuries, traumatic/
2. Craniocerebral trauma/ or head injuries, closed/
3. Brain Concussion/
4. (traumatic-brain-injur* or head-injur* or concussion or tbi or mtbi or moderate-TBI or cmTBI or severe-TBI).tw,kf.
5. Post-Concussion Syndrome/
6. Amnesia/
7. (postconcussion or post-concussion or postconcussive or post-concussive or pcs or ppcs or pta or amnesia or disorientation or memory-loss or (loss adj2 memory) or confusion or fogginess or foggy or dazed or altered-mental-state).tw,kf.
8. (toddler* or pre-schooler* or preschooler* or kinder or kinders or kindergarten* or kinder-aged or two-year-old* or two-years-old* or three-year-old* or three-years-old* or four-year-old* or four-years-old* or five-year-old* or five-years-old* or 2-year-old* or 2-years-old* or 3-year-old* or 3-years-old* or 4-year-old* or 4-years-old* or 5-year-old* or 5-years-old* or aged-two or aged-2 or aged-three or aged-3 or aged-four or aged-4 or aged-five or aged-5 or child and/or children).af.
9. (1 or 2 or 3 or 4) and (5 or 6 or 7) and 8
10. limit 9 to english language

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Yumul, J.N., Crowe, L., Catroppa, C. et al. Post-concussive Signs and Symptoms in Preschool Children: A Systematic Review. Neuropsychol Rev (2021). https://doi.org/10.1007/s11065-021-09518-z

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Keywords

  • Preschool children
  • mTBI
  • Concussion
  • Post-concussive symptoms