1 Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
2 Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
J Neurotrauma. 2019 Jun;36(11):1758-1767. doi: 10.1089/neu.2018.6009. Epub 2019 Mar 6.
The identification of clinical phenotypes may help parse the substantial heterogeneity that characterizes children with concussion. This study used latent class analysis (LCA) to identify discernible phenotypes among children with acute concussion and examine the association between phenotypes and persistent post-concussive symptoms (PPCS) at 4 and 12 weeks post-injury. We conducted LCA of variables representing pre-injury history, clinical presentation, and parent symptom ratings, derived from a prospective cohort, observational study that recruited participants from August 2013 until June 2015 at nine pediatric emergency departments within the Pediatric Emergency Research Canada network. This substudy included 2323 children from the original cohort ages 8.00-17.99 years who had data for at least 80% of all variables included in each LCA. Concussion was defined according to Zurich consensus statement diagnostic criteria. The primary outcome was PPCS at 4 and 12 weeks after enrollment. Participants were 39.5% female and had a mean age of 12.8 years (standard deviation = 2.6). Follow-up was completed by 1980 (85%) at 4 weeks and 1744 (75%) at 12 weeks. LCA identified four groups with discrete pre-injury histories, four groups with discrete clinical presentations, and seven groups with discrete profiles of acute symptoms. Clinical phenotypes based on the profile of group membership across the three LCAs varied significantly in their predicted probability of PPCS at 4 and 12 weeks. The results indicate that children with concussion can be grouped into distinct clinical phenotypes, based on pre-injury history, clinical presentation, and acute symptoms, with markedly different risks of PPCS. With further validation, clinical phenotypes may provide a useful heuristic for clinical assessment and management.
临床表型的识别有助于解析儿童脑震荡的显著异质性。本研究采用潜在类别分析（LCA）来识别急性脑震荡儿童的可识别表型，并检查表型与损伤后 4 周和 12 周持续性脑震荡后症状（PPCS）之间的关系。我们对来自前瞻性队列观察研究的变量进行了 LCA，这些变量代表了损伤前的病史、临床表现和父母的症状评分，该研究于 2013 年 8 月至 2015 年 6 月期间在加拿大儿科急诊研究网络的 9 个儿科急诊部门招募参与者。该子研究包括来自原始队列的 2323 名年龄在 8.00-17.99 岁的儿童，他们至少有 80%的所有变量的数据都包含在每个 LCA 中。脑震荡根据苏黎世共识声明的诊断标准定义。主要结局是在登记后 4 周和 12 周时的 PPCS。参与者中女性占 39.5%，平均年龄为 12.8 岁（标准差=2.6）。在 4 周时有 1980 名（85%）参与者完成了随访，在 12 周时有 1744 名（75%）参与者完成了随访。LCA 确定了四个具有离散损伤前病史的组、四个具有离散临床表现的组和七个具有离散急性症状特征的组。基于三个 LCA 中组内成员的特征的临床表型在 4 周和 12 周时 PPCS 的预测概率上差异显著。结果表明，基于损伤前的病史、临床表现和急性症状，脑震荡患儿可以分为不同的临床表型，而 PPCS 的风险明显不同。随着进一步验证，临床表型可能为临床评估和管理提供有用的启发。
