Characteristics of Diagnosed Concussions in Children Aged 0 to 4 Years Presenting to a Large Pediatric Healthcare Network

Abstract

The aim of the study was to comprehensively describe the natural history of concussion in early childhood between 0 and 4 years.Methods: Retrospective cohort study of 329 patients aged 0 to 4 years, with an International Classification of Diseases, Ninth Revision, concussion diagnosis in the Children's Hospital of Philadelphia healthcare network from October 1, 2013, to September 30, 2015. Clinical data were abstracted from the Children's Hospital of Philadelphia electronic health record, which captured all clinical care visits and injury characteristics.Results: Nearly 9 (86.6%) of 10 patients sought care in the emergency department or urgent care setting, most commonly on the day of injury (56.2%) and as a result of a fall (64.4%). More than two-thirds (64.4%) of patients or their parent/caregiver reported somatic symptoms (ie, vomiting or headache), whereas close to half (49.2%) reported sleep issues. One of 5 patients identified emotional symptoms (21.9%) or visiovestibular dysfunction (20.4%). Many patients also experienced symptoms not included in standard assessment tools including personality changes (34.0%) and change in appetite (12.8%). Conclusions:These results provide insight into the clinical characteristics of concussion in early childhood up to 4 years of age. Because assessment in this group relies heavily on parent/caregiver symptom reporting, rather than patient self-report, these results will aid clinicians with the challenge of diagnosing concussions in this population. These findings highlight the need to develop additional tools to adequately and systematically assess common signs and symptoms of concussion in early childhood that may not be included in standard assessment scales routinely used in older adolescents and adults.

Report of Early Childhood Traumatic Injury Observations & Symptoms: Preliminary Validation of an Observational Measure of Postconcussive Symptoms

“…These results differ somewhat from previous work documenting greater sleep and irritability symptoms in children 2 years of age and older than in those younger than 2 years. 14,19 The current results do align with these previous studies highlighting the need to include behavioral manifestations when documenting early childhood PCS.…”

“…Similarly, another study 19 found that although conventional PCS such as headache, irritability, and drowsiness were frequently endorsed by parents of young children, they also reported additional observations such as decreased engagement, behavioral dysregulation, and increased dependence (eg, wanting to be cuddled more). Finally, behavioral changes (eg, increased crying and meltdowns) 14 have been observed in children 2 years of age and younger, reinforcing the idea that existing PCS measures do not adequately capture these unique manifestations.…”

“…Other recent work also found that sensitivity to light is rarely reported after early childhood mTBI. 14,19 In the Behavioral domain, the infrequently endorsed items represented manifestations that might not be applicable to the younger age range (eg, "Says he/she is feeling sad or depressed" or "Is afraid of hurting themselves, is too cautious or doesn't take risks"). In addition, none of the regression symptoms were endorsed by more than 15% of the sample.…”

Longitudinal trends in incidence and health care use for pediatric concussion in Alberta, Canada

“…20,21 In addition, as most concussion symptom scales have only been validated in children aged five and older, young children may be misdiagnosed with other non-concussion diagnostic codes. 22 Furthermore, previous studies often fail to group visits to distinguish a new injury from a follow-up visit and thereby define EOC. [12][13][14][15] This precludes accurate incidence estimates, which may hamper the efficient allocation of resources.…”

“… 20 , 21 In addition, as most concussion symptom scales have only been validated in children aged five and older, young children may be misdiagnosed with other non-concussion diagnostic codes. 22 …”