Wilson Rebecca, Jackson Joni, Birnie Kate, Ijaz Sharea, Booker Matthew, Burrell Alex, Haythornthwaite Giles, Hong Jialan, Lyttle Mark D, Pocock Lucy, Scott Lauren J, Williams Cathy, Wright Ingram, Savovic Jelena, Mytton Julie, Redaniel Maria Theresa
NIHR ARC West, Bristol, UK
Population Health Sciences, University of Bristol, Bristol, UK.
BMJ Paediatr Open. 2025 Apr 5;9(1):e003036. doi: 10.1136/bmjpo-2024-003036.
To identify predictors of persisting symptoms after concussion (PSaC) in children, following any medically attended traumatic brain injury (TBI).
Retrospective cohort study.
Linked primary and secondary care data from UK Clinical Practice Research Datalink and Hospital Episode Statistics.
Children aged 1-17 years with a medically attended TBI between 2013 and 2017.
A binary indicator of PSaC or suspected PSaC, measured using either a clinical code for PSaC or medical attendances for one or more PSaC symptoms 3-12 months after TBI.
We identified 137 873 children with a TBI; 4620 (3.4%) had PSaC or suspected PSaC. More females (3.8%) had PSaC than males (3.1%). Those with PSaC were older at the time of TBI compared with those without PSaC (8 vs 5.5 years). In a multivariable logistic regression model, older age (OR =1.02 per year increase in age, 95% CI 1.01 to 1.03), female sex (OR=1.20, 95% CI 1.13 to 1.28), being Asian (OR=1.37, 95% CI 1.22 to 1.54) or mixed ethnicity (OR=1.18, 95% CI 1.01 to 1.37) (compared with white ethnicity), having a history of headaches (OR=3.52, 95% CI 3.13 to 3.95), learning disabilities (OR=2.06, 95% CI 1.69 to 2.52), ADHD (OR=2.41, 95% CI 1.91 to 3.04), anxiety (OR=2.58, 95% CI 2.18 to 3.05), depression (OR=4.00, 95% CI 3.28 to 4.89) or sleep disorders (OR=2.35, 95% CI 1.99 to 2.78) were associated with increased odds of PSaC.
These results may be used to identify children more likely to develop PSaC following a TBI and those who may benefit from targeted healthcare for PSaC symptoms. Identifying cases of PSaC in primary care data was challenging as perhaps many children do not attend services for suspected PSaC or, if they did, are not diagnosed with PSaC. Furthermore, the clinical predictors are a measure of healthcare access for these symptoms; thus, results could be influenced by patient or carer's health-seeking behaviour.
确定在任何接受过医疗救治的创伤性脑损伤（TBI）后，儿童脑震荡后持续症状（PSaC）的预测因素。
回顾性队列研究。
来自英国临床实践研究数据链和医院事件统计的初级和二级医疗保健数据相链接。
2013年至2017年间因TBI接受过医疗救治的1至17岁儿童。
PSaC或疑似PSaC的二元指标，通过PSaC的临床编码或TBI后3至12个月出现一种或多种PSaC症状的就医情况来衡量。
我们确定了137873名患有TBI的儿童；4620名（3.4%）有PSaC或疑似PSaC。患有PSaC的女性（3.8%）比男性（3.1%）多。与没有PSaC的儿童相比，患有PSaC的儿童在发生TBI时年龄更大（8岁对5.5岁）。在多变量逻辑回归模型中，年龄较大（年龄每增加一岁，OR = 1.02，95%CI 1.01至1.03）、女性（OR = 1.20，95%CI 1.13至1.28）、亚裔（OR = 1.37，95%CI 1.22至1.54）或混合种族（OR = 1.18，95%CI 1.01至1.37）（与白人种族相比）、有头痛病史（OR = 3.52，95%CI 3.13至3.95）、学习障碍（OR = 2.06，95%CI 1.69至2.52）、注意力缺陷多动障碍（ADHD）（OR = 2.41，95%CI 1.91至3.04）、焦虑（OR = 2.58，95%CI 2.18至3.05）、抑郁（OR = 4.00，95%CI 3.28至4.89）或睡眠障碍（OR = 2.35，95%CI 1.99至2.78）与PSaC的几率增加相关。
这些结果可用于识别TBI后更有可能出现PSaC的儿童以及那些可能从针对PSaC症状的针对性医疗保健中受益的儿童。在初级保健数据中识别PSaC病例具有挑战性，因为可能许多儿童未因疑似PSaC就诊，或者即使就诊也未被诊断为PSaC。此外，临床预测因素是这些症状的医疗保健可及性的一种衡量；因此，结果可能会受到患者或护理人员的就医行为的影响。
