Symptom Experience and Quality of Life in Children after Sport-Related Head Injuries: A Cross-Sectional Study

Abstract

Background: Sports are a major cause of concussions, and little is known about the symptom experience and health-related quality of life (HRQL) in children who remain symptomatic for over 3 months following such head injuries. Methods: A cross-sectional study of children aged 10-18 years was performed who were referred to the Neurosurgery Clinic at our centre following a head injury. Symptom experience was measured using the modified Concussion Symptom Scale, and HRQL was measured using the Pediatric Quality of Life Inventory (PedsQL). The Immediate Postconcussion Assessment and Cognitive Test (ImPACT) was administered to assess neurocognitive and neurobehavioural sequelae. Results: Symptoms with the highest mean symptom scores on a Likert scale of 0-6 in 35 children at the time of assessment included headaches (3.1), poor concentration (2.7), memory problems (2.1), fatigue (2.1) and sensitivity to noise (2.0). Compared with normative data, children in this study had ImPACT summary scores between the 28th and 38th percentiles and a comparably low Cognitive Efficiency Index score. Mean scores for females were consistently statistically significantly lower (p < 0.05) than for males across all of the HRQL domains. Trouble falling asleep and memory problems explained 62% of the variance in the PedsQL total scores. Conclusions: Children continue to experience many symptoms at least 3 months following sport-related head injuries that significantly impact their HRQL and neurocognitive abilities.

Lived Experiences of Adolescent Athletes Following Sport-Related Concussion

“…Our findings are supported by other studies that identified a negative impact on aspects of HRQOL following sport-related concussion 19 , 22 , 47 , 51 , 52 or mild traumatic brain injury 9 , 32 , 35 among children and adolescents. All but 1 of these investigations used patient-reported outcomes in evaluating HRQOL, which allows for standardization administration and measurement but does not necessarily take into account the relevance of the questions or additional meaning behind the lived experiences of the adolescents.…”

“…Health-related quality of life (HRQOL) is a concept that considers the physical, psychological, and social aspects of one’s health and is defined by the individual’s experiences, beliefs, expectations, and perceptions of his or her ability to function in numerous domains of health and well-being. 45 Sport-related concussion symptoms and impairments can negatively influence aspects of HRQOL 19 , 22 , 32 , 35 , 47 , 52 , 60 and should be an important component of concussion assessment. As there is currently no patient-reported outcome measure for sport-related concussion, 49 researchers have used a combination of outcomes to assess aspects of HRQOL: generic (eg, Pediatric Quality of Life Inventory), 19 , 35 , 52 specific (eg, Beck Depression Inventory, Profile of Mood States), 20 , 23 , 27 and single item (eg, Global Rating of Change).…”

“…45 Sport-related concussion symptoms and impairments can negatively influence aspects of HRQOL 19,22,32,35,47,52,60 and should be an important component of concussion assessment. As there is currently no patient-reported outcome measure for sport-related concussion, 49 researchers have used a combination of outcomes to assess aspects of HRQOL: generic (eg, Pediatric Quality of Life Inventory), 19,35,52 specific (eg, Beck Depression Inventory, Profile of Mood States), 20,23,27 and single item (eg, Global Rating of Change). 47 While these measures provide a basic understanding of the effect of a concussion on domains of HRQOL, they fail to provide deeper insight into the specific reasons for and meanings behind perceived perceptions of injury.…”

Quality of Life and Symptom Burden 1 Month After Concussion in Children and Adolescents

“…In addition, we observed a moderately strong correlation between symptoms and QOL ratings, extending work done among individuals of similar age to our sample (10-18 years) who presented to a specialty clinic for evaluation of persistent (>3 months) concussion symptoms and demonstrated reduced QOL in both psychosocial and physical health. 33 Collectively, prior work and the data from our investigation suggest that impairments in QOL following a concussion may serve as a marker to identify children and adolescents who should be further evaluated in a specialty concussion program. 13 Our study had some limitations and our findings should be interpreted in light of them.…”

Evaluation and management of sport-related concussions in adolescent athletes

“…For adolescent athletes, same day return to sports is not recommended regardless of full clinical recovery (4). It is important to recognize that some emotional or behavioral symptoms may persist for weeks to months even after full physical and cognitive recovery from concussion (32)(33)(34)(35).…”