Association of Persistent Postconcussion Symptoms With Pediatric Quality of Life

Abstract

Persistent postconcussion symptoms (PPCS) pose long-term challenges and can negatively affect patients' health-related quality of life (HRQoL). To date, no large comprehensive study has addressed the association between PPCS and HRQoL. OBJECTIVES To determine the association between HRQoL and PPCS at 4 weeks after concussion and assess the degree of impairment of HRQoL in the subsequent 12 weeks. DESIGN, SETTING, AND PARTICIPANTS In a prospective, multicenter cohort study (Predicting Persistent Postconcussive Problems in Pediatrics [5P]) from August 14, 2013, to September 30, 2014, children aged 5 to 18 years who presented to the emergency department within 48 hours after head injury and were considered to have an acute concussion were enrolled across 9 pediatric emergency departments within the Pediatric Emergency Research Canada Network. Persistent postconcussion symptoms were defined as 3 or more persistent symptoms on the validated Post-Concussion Symptom Inventory at 4 weeks. Linear mixed effects random coefficients models evaluated the association between PPCS and HRQoL, adjusting for potential confounders including age, sex, prior concussions, migraine, anxiety, learning disability, depression, and sleep disorder. MAIN OUTCOMES AND MEASURES The primary outcome was HRQoL assessed with the validated Pediatric Quality of Life Inventory version 4.0 (PedsQL-4.0) at 4, 8, and 12 weeks after head injury. RESULTS Of 2006 children enrolled (median age, 11.8 years [interquartile range, 8.9-14.6 years]; 1241 boys and 765 girls), 1667 (83.1%) completed the PedsQL-4.0 at all 3 time points. Of these 1667 children, the 510 with PPCS (30.6%) had lower total PedsQL-4.0 scores (mean, 70.0) than did those without PPCS (mean, 80.3; mean difference,-10.3; 95% CI, −9.4 to −11.2). Patients with PPCS also had significantly lower physical, emotional, social, and school PedsQL-4.0 subscores at 4, 8, and 12 weeks. Patients with PPCS had lower HRQoL than published healthy norms at 4 weeks (mean difference, 13.89; 95% CI, 11.55-16.23), 8 weeks (mean difference, 11.63; 95% CI, 9.34-13.93), and 12 weeks (mean difference, 9.38; 95% CI, 7.01-11.75; P < .001). Patients who recovered from concussion also had lower HRQoL than norms at 4 weeks (mean difference, 3.56; 95% CI, 1.28-5.85) and 8 weeks (mean difference, 2.75; 95% CI, 0.48-5.02; P < .05). School functioning PedsQL-4.0 subscores were significantly lower for all children regardless of PPCS status at all time points. CONCLUSIONS AND RELEVANCE Children with PPCS have lower HRQoL compared with those who have recovered from concussion, yet deficits in HRQoL are pervasive across all domains and may persist for months even in children whose symptoms have resolved. Future interventional research should target the effect of concussion on HRQoL.

Social support during youth concussion recovery

“…Several significant sex and gender differences exist in recovery. Females experience more cognitive and emotional symptoms than males (34,35), and are more likely to experience prolonged recovery, and identifying as a girl is associated with reduced health-related quality of life after a pediatric concussion (36). Adolescent girls have also been found to report more social support than boys, perceive higher levels of social support from classmates and close friends, and place higher importance on this support (37).…”

“…Adolescent girls have also been found to report more social support than boys, perceive higher levels of social support from classmates and close friends, and place higher importance on this support (37). Additionally, boys are more likely to seek out informational and tangible rather than emotional support (36). Differences in the recovery and social support experiences highlight the need to explore the perspectives of high-school aged boys on what constitutes meaningful support and the influence of gender on youth's lived experiences with social support during recovery.…”

Evaluation of a pilot paediatric concussion telemedicine programme for northern communities in Manitoba

“…With proper medical assessment and follow-up, the majority of paediatric patients will experience complete recovery within 1 month post-injury [3]. However, patients without timely access to post-injury medical care remain at risk of additional injury associated with premature return to sports and other high-risk activities, as well as the development of persistent symptoms that can have a negative impact on mental health, school functioning and quality of life [4][5][6][7].…”

Health-related quality of life following adolescent sports-related concussion or fracture: a prospective cohort study

“…10,23 Preliminary studies suggest that children and adolescents with mild, moderate, and severe TBI can experience acute and persistent impairments in HRQOL. 5,6,[12][13][14]21,22,[26][27][28][29][30]34,41 However, it remains unclear what clinical variables are associated with worse initial HRQOL following adolescent acute SRC and how these outcomes compare to those experienced by adolescents with injuries that are unrelated to the brain.…”