Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada.
J Pediatr. 2021 Jan;228:190-198.e3. doi: 10.1016/j.jpeds.2020.08.061. Epub 2020 Aug 25.
To characterize symptom burden, school function, and physical activity in youth 1 year following acute concussion and those with subsequent repeat concussion.
Secondary analysis of Predicting Persistent Postconcussive Problems in Pediatrics prospective, multicenter cohort study conducted in 9 Canadian emergency departments. Participants were children between ages 5 and 18 years who presented consecutively ≤48 hours of concussion and agreed to participate in a post hoc electronic survey 1 year after injury. Outcomes were assessed using a standardized 25-question symptom scale derived from the Post-Concussion Symptom Inventory-Parent; school function and physical activity outcomes were queried. The primary outcome was total symptom score 1 year following concussion, defined as the number of symptoms experienced more than before injury.
Of 3052 youth enrolled in the Predicting Persistent Postconcussive Problems in Pediatrics study, 432 (median [IQR] age, 11.5 [9,14] years; 266 [62%] male) completed the 1-year survey; 34 respondents reported a repeat concussion. Following acute concussion, youth were more likely to be symptom-free than following repeat concussion (75% vs 50%; difference = 25% [95% CI 8-41]; P = .002) and to have recovered fully (90% vs 74%; difference = 17% [95% CI 5-34]; P = .002) after 1 year. Although physical symptoms were less 1 year after initial emergency department presentation for both groups (P < .001), youth with a repeat concussion reported greater headache persistence (26% vs 13%; difference = 13% [95% CI 1,31]; P = .024). Both groups returned to their normal school routine (100% vs 95%; difference = 5% [95% CI -5 to 8; P = .618). Youth without repeat concussion more frequently returned to normal physical activities (98% vs 85%; difference = 13% [95% CI 4-28]; P < .0001) and sport (95% vs 82%; difference = 13% [95% CI 3-29]; P = .009).
Most youth are symptom-free and fully recovered 1 year following concussion. Some children with repeat concussion have worse outcomes and have delays in returning to normal school routines and sport.
描述青少年急性脑震荡后 1 年的症状负担、学校功能和身体活动情况，以及随后发生重复脑震荡的情况。
对Predicting Persistent Postconcussive Problems in Pediatrics前瞻性、多中心队列研究进行二次分析，该研究在加拿大 9 个急诊部门进行。参与者为年龄在 5 至 18 岁之间的连续≤48 小时出现脑震荡且同意在损伤后 1 年进行后续电子调查的儿童。使用从 Post-Concussion Symptom Inventory-Parent 衍生的标准化 25 项症状量表评估结果；询问了学校功能和身体活动结果。主要结局是脑震荡后 1 年的总症状评分，定义为经历的症状数多于受伤前。
在 Predicting Persistent Postconcussive Problems in Pediatrics 研究中，共有 3052 名青少年入组，其中 432 名（中位数[IQR]年龄，11.5[9，14]岁；266[62%]为男性）完成了 1 年的调查；34 名受访者报告了重复脑震荡。与重复脑震荡相比，青少年在急性脑震荡后更有可能无症状（75%比 50%；差异=25%[95%CI 8-41]；P=0.002），且在 1 年后完全康复（90%比 74%；差异=17%[95%CI 5-34]；P=0.002）。尽管两组在初次急诊就诊后 1 年的身体症状都有所减轻（P<0.001），但有重复脑震荡的青少年报告头痛持续存在的情况更严重（26%比 13%；差异=13%[95%CI 1，31]；P=0.024）。两组均恢复正常的学校常规（100%比 95%；差异=5%[95%CI -5 至 8；P=0.618）。无重复脑震荡的青少年更频繁地恢复正常的身体活动（98%比 85%；差异=13%[95%CI 4-28]；P<0.0001）和运动（95%比 82%；差异=13%[95%CI 3-29]；P=0.009）。
大多数青少年在脑震荡后 1 年无症状且完全康复。一些有重复脑震荡的儿童预后更差，且在恢复正常学校常规和运动方面存在延迟。
