Murdoch Children's Research Institute, Melbourne, Australia.
School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
Neurosurgery. 2020 Dec 15;88(1):36-45. doi: 10.1093/neuros/nyaa310.
Persistent postconcussive symptoms (PCS) are poorly understood in children. Research has been limited by an assumption that children with concussion are a homogenous group.
To identify (i) distinctive postconcussive recovery trajectories in children and (ii) injury-related and psychosocial factors associated with these trajectories.
This study is part of a larger prospective, longitudinal study. Parents of 169 children (5-18 yr) reported their child's PCS over 3 mo following concussion. PCS above baseline levels formed the primary outcome. Injury-related, demographic, and preinjury information, and child and parent mental health were assessed for association with trajectory groups. Data were analyzed using group-based trajectory modeling, multinomial logistic regression, and chi-squared tests.
We identified 5 postconcussive recovery trajectories from acute to 3 mo postinjury. (1) Low Acute Recovered (26.6%): consistently low PCS; (2) Slow to Recover (13.6%): elevated symptoms gradually reducing; (3) High Acute Recovered (29.6%): initially elevated symptoms reducing quickly to baseline; (4) Moderate Persistent (18.3%): consistent, moderate levels of PCS; (5) Severe Persistent (11.8%): persisting high PCS. Higher levels of child internalizing behaviors and greater parental distress were associated with membership to the Severe Persistent group, relative to the Low Acute Recovered group.
This study indicates variability in postconcussive recovery according to 5 differential trajectories, with groups distinguished by the number of reported symptoms, levels of child internalizing behavior problems, and parental psychological distress. Identification of differential recovery trajectories may allow for targeted early intervention for children at risk of poorer outcomes.
儿童持续性脑震荡后症状（PCS）的认识不足。研究受到一种假设的限制，即患有脑震荡的儿童是一个同质群体。
确定（i）儿童脑震荡后具有独特的恢复轨迹，以及（ii）与这些轨迹相关的损伤相关和心理社会因素。
本研究是一项更大的前瞻性、纵向研究的一部分。169 名儿童（5-18 岁）的父母在脑震荡后 3 个月内报告了他们孩子的 PCS。高于基线水平的 PCS 是主要结果。评估了与轨迹组相关的损伤相关、人口统计学和受伤前信息，以及儿童和家长的心理健康。使用基于群组的轨迹建模、多项逻辑回归和卡方检验进行数据分析。
我们从急性到受伤后 3 个月确定了 5 种脑震荡后恢复轨迹。（1）低急性恢复（26.6%）：PCS 始终较低；（2）恢复缓慢（13.6%）：症状逐渐升高；（3）高急性恢复（29.6%）：最初升高的症状迅速恢复到基线；（4）中度持续（18.3%）：持续中度 PCS；（5）严重持续（11.8%）：持续高 PCS。儿童内化行为水平较高和父母压力较大与严重持续组有关，而与低急性恢复组相比。
本研究表明，根据 5 种不同的轨迹，脑震荡后恢复存在变异性，这些轨迹的区别在于报告的症状数量、儿童内化行为问题的水平以及父母的心理困扰。确定不同的恢复轨迹可能允许对有较差结局风险的儿童进行有针对性的早期干预。
