Specialty-Specific Diagnoses in Pediatric Patients With Postconcussion Syndrome: Experience From a Multidisciplinary Concussion Clinic

Shah, Ankoor S.; Raghuram, Aparna; Kaur, Karampreet; Lipson, Sophie; Shoshany, Talia N.; Stevens, Rebecca; O’Brien, Michael J.; Howell, David R.; Fleischman, Katie M.; Barnack, Danielle; Molind, Heather; Kuemmerle, Karameh Hawash; Brodsky, Jacob R.

doi:10.1097/jsm.0000000000000891

Cited by 9 publications

(11 citation statements)

References 50 publications

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“…Post-injury nervousness, reported at the time of their first clinic visit, was strongly associated with experiencing greater post-injury physical (e.g., headaches, nausea, vomiting, dizziness, vision problems, fatigue, sensitivity to light, sleep disturbance), cognitive (feeling mentally foggy, concentration difficulty, and memory difficulty) and emotional (e.g., irritability, sadness, and feeling more emotional) symptoms. These results are consistent with prior studies suggesting that post-injury anxiety is common (16), associated with greater overall symptom reporting (27,28), and is a risk for slower recovery (14).…”

Section: Model 1 Modelsupporting

confidence: 92%

“…A total of 158 participants were included in this study. The mean age of participants was 17.3 years (SD = 2.9; range [13][14][15][16][17][18][19][20][21][22][23][24]. The sample included modestly more girls/young women (54.4%) than Pre-injury health variables and prior concussion history had missing data for 1-5 subjects per variable.…”

Section: Resultsmentioning

confidence: 99%

“…Post-injury anxiety is associated with a slower recovery and slower return to sports participation among adolescents (14), and anxious symptom profiles are common among youth presenting to specialty concussion clinics (15). Preliminary evidence indicates that in such specialty clinics, anxiety rates are particularly high, with anxiety diagnoses evident in almost 60% of youth experiencing persistent symptoms and prolonged recovery in one study (16).…”

Section: Introductionmentioning

confidence: 92%

“…Concussion outcome research with youth generally follows two methodologies, one recruiting subjects who are acutely injured from schools, and usually medically monitored by athletic trainers, and the other recruiting subjects from specialty clinics. Research in specialty clinics is important because youth presenting for specialty care are at increased risk for slow recovery and persistent symptoms (11,(16)(17)(18). More research is needed from specialty clinics to better understand factors relating to persistent symptoms and, in particular, ways to advance and improve concussion treatment and rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

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Anxiety Is Associated With Diverse Physical and Cognitive Symptoms in Youth Presenting to a Multidisciplinary Concussion Clinic

2022

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IntroductionPre-injury and post-injury anxiety are prevalent and important to consider in the medical management of concussions in youth. We examined the association between anxiety and other physical, cognitive, and emotional symptoms in injured adolescents and young adults undergoing an initial evaluation in a specialty concussion clinic.MethodsParticipants were 158 adolescents and young adults presenting to a multidisciplinary concussion clinic for evaluation and treatment (54.4% girls and women; mean age = 17.3 years; SD = 2.9). Their median days post injury was 29 (interquartile range = 14–49; range = 7–349). They were divided into binary groups based on whether they had a pre-injury history of anxiety diagnosis or treatment and whether they were experiencing current anxiety in the week prior to the evaluation, and then compared on the Post-Concussion Symptom Scale.ResultsYouth with a pre-injury history of anxiety reported greater post-concussion symptoms (Md total score = 36.0, IQR = 21.5–53.0) compared to youth with no pre-injury history of anxiety (Md total score = 20.5, IQR = 6.0–36.0; MW U = 1,520.00 p = 0.001, r = 0.26, small-medium effect size). They reported significantly worse headaches, nausea, balance difficulty, dizziness, vision problems, fatigue, concentration difficulty, irritability, nervousness, sadness, feeling more emotional, trouble falling asleep, and sleeping more than usual. Youth with high post-injury anxiety reported greater post-concussion symptoms (Md total score = 55.0, IQR = 33.0–62.5) compared to youth with low post-injury anxiety (Md total score = 19.0, IQR = 6.0–35.0; MW U = 681.00, p < 0.001, r = 0.49, large effect size). They reported significantly worse headaches, nausea, vomiting, dizziness, vision problems, fatigue, sensitivity to light, feeling mentally foggy, feeling slowed down, concentration difficulty, memory difficulty, irritability, sadness, feeling more emotional, drowsiness, trouble falling asleep, sleeping less than usual, and sleeping more than usual. Logistic regressions revealed that both pre-injury and post-injury anxiety were strong predictors of persistent post-concussion symptoms, with high post-injury anxiety presenting the strongest independent predictor, while attention-deficit hyperactivity disorder and pre-injury migraines were not significant predictors. Essentially all adolescents with high post-injury anxiety (97.1%) and nearly 9 of 10 adolescents with pre-injury treatment for anxiety (87.8%) met criteria for persistent post-concussion symptoms.DiscussionPre-injury and post-injury anxiety are important risk factors for greater post-concussion symptoms among adolescents and young adults. Elevated post-injury anxiety was the strongest predictor of persistent post-concussion symptoms. Assessment of anxiety is important among adolescents presenting for concussion care and delivery of evidence-supported treatments for anxiety are important considerations for treatment planning for these youth.

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Section: Model 1 Modelsupporting

confidence: 92%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Anxiety Is Associated With Diverse Physical and Cognitive Symptoms in Youth Presenting to a Multidisciplinary Concussion Clinic

2022

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“…At our institution, an optometrist specializing in visual function and binocular vision disorders (co-senior author, AR) and a pediatric otologist specializing in pediatric vestibular disorders (co–senior author, JRB) routinely work in tandem to evaluate many patients complaining of dizziness, imbalance, and vision issues. They also evaluate concussed patients who may or may not complain of these symptoms through our multidisciplinary concussion clinic 7 . As a result, we have observed many pediatric patients with vestibular disorders such as vestibular migraine, persistent postural perceptual dizziness, and benign paroxysmal positional vertigo to have coexisting deficits in vergence and accommodation.…”

mentioning

confidence: 99%

Vergence and Accommodation Deficits in Children and Adolescents with Vestibular Disorders

et al. 2022

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SIGNIFICANCEThe high frequency of vergence and accommodation deficits coexisting in patients with a vestibular diagnosis merits a detailed visual function examination.PURPOSEDeficits in vergence and saccades have been reported in patients with vestibular symptomatology. We retrospectively evaluated visual function deficits in adolescents with vestibular diagnoses and concussion.METHODSThe following inclusion criteria were used: vestibular and optometric evaluations between 2014 and 2020, 6 to 22 years old, and 20/25 best-corrected vision or better. Clinical criteria assigned vestibular diagnoses and concussion diagnoses. Vestibular diagnoses included vestibular migraine, benign paroxysmal positional vertigo, and persistent postural perceptual dizziness. Visual function deficits were compared with a pediatric control group (30). Nonparametric statistics assessed differences in group distribution.RESULTSA total of 153 patients were included: 18 had vestibular diagnoses only, 62 had vestibular diagnoses related to concussion, and 73 had concussion only. Vergence deficits were more frequent in patients with vestibular diagnoses and concussion (42%) and concussion only (34%) compared with controls (3%; all P = .02). Accommodation deficits were more frequent in patients with vestibular diagnoses only (67%), vestibular diagnoses and concussion (71%), and concussion (58%) compared with controls (13%; all P = .002). Patients with vestibular migraine and concussion (21) had more vergence deficits (62%) and accommodation insufficiency (52%) than concussion-only patients (47%, P = .02; 29%, P = .04). Patients with benign paroxysmal positional vertigo and concussion (20) had lower positive fusional vergence and failed near vergence facility (35%) more than concussion-only patients (16%; P = .03).CONCLUSIONSVisual function deficits were observed at a high frequency in patients with a vestibular diagnosis with or without a concussion and particularly in vestibular migraine or benign paroxysmal positional vertigo. Visual function assessments may be important for patients with vestibular diagnoses.

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Characteristics of Benign Paroxysmal Positional Vertigo in Young Children

2022

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Objectives This study aimed to determine the clinical characteristics of benign paroxysmal positional vertigo (BPPV) in young children. Study Design Retrospective case review. Methods All children <10 years old that have been diagnosed with BPPV at our pediatric vestibular program between December 2012–July 2021 were selected. Clinical features were identified by medical record review, including demographics, comorbidities, canal involvement, response to treatment, and incidence of recurrence. Results A total of 34 children were diagnosed with BPPV with a mean age of 7.9 years old (SD ± 1/7; range 5–9) at the time of diagnosis and a male:female ratio of 1:1. Involved semicircular canals included posterior in 82% (n = 28), horizontal in 41% (n = 14), and superior in 24% (n = 8) of patients, respectively. Comorbid diagnoses included migraine (n = 14), concussion (n = 10), acute vestibular syndrome (n = 4), and persistent postural perceptual dizziness (n = 6). Recurrence with initially confirmed resolution occurred in 10 patients (29%) with a mean of 2.5 recurrences per patient (SD: 2.2; range 1–8). A family history of vertigo or migraine was identified in 11 and 17 patients, respectively. Conclusions BPPV is a cause of vertigo in children that may be overlooked. A relatively high proportion of patients demonstrated horizontal or superior canal involvement, recurrence, and additional comorbid causes of dizziness. Thus, providers evaluating young children with dizziness should perform diagnostic maneuvers to evaluate BPPV of all semicircular canals and continue to monitor children after successful treatment for recurrence. Level of Evidence 4, Case Series Laryngoscope, 133:694–699, 2023

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Specialty-Specific Diagnoses in Pediatric Patients With Postconcussion Syndrome: Experience From a Multidisciplinary Concussion Clinic

Cited by 9 publications

References 50 publications

Anxiety Is Associated With Diverse Physical and Cognitive Symptoms in Youth Presenting to a Multidisciplinary Concussion Clinic

Anxiety Is Associated With Diverse Physical and Cognitive Symptoms in Youth Presenting to a Multidisciplinary Concussion Clinic

Vergence and Accommodation Deficits in Children and Adolescents with Vestibular Disorders

Characteristics of Benign Paroxysmal Positional Vertigo in Young Children

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