Research Reports - Psychological factors associated with delayed symptom resolution in children with concussion

J Pediatr. 2016 Apr 11. pii: S0022-3476(16)00342-5. doi:
10.1016/j.jpeds.2016.03.027. [Epub ahead of print]

Grubenhoff JA(1), Currie D(2), Comstock RD(3), Juarez-Colunga E(2), Bajaj L(4),
Kirkwood MW(5).

OBJECTIVE: To characterize the psychological factors associated with persistent
symptoms after pediatric concussion.
STUDY DESIGN: Longitudinal cohort study of 179 children with concussion
8-18 years old evaluated in a pediatric emergency department. Participants were
followed for 1 month for delayed symptom resolution, defined as ≥3 symptoms that
were new/worse than preinjury symptoms measured by the use of graded symptom
inventory. Preinjury psychological traits were measured by parental report on
subscales of the Personality Inventory for Children-2 (maladjustment, cognitive
abilities, somatization). Child report of postinjury anxiety and injury
perception were measured with the State-Trait Anxiety Inventory for Children and
Children's Illness Perception Questionnaire. Psychological instrument scores were
compared between those with and without delayed symptom resolution via a
Kruskal-Wallis test. Associations between psychological traits and delayed
symptom resolution were investigated by the use of logistic regression.
RESULTS: Delayed symptom resolution occurred in 21% of participants. Score
distributions were significantly worse on the State-Trait Anxiety Inventory for
Children (38 [IQR 33-40] vs 35 [IQR 31-39]; P = .04) and somatization subscale (1
[IQR 0-3] vs 1 [IQR 0-1]; P = .01) among children with delayed symptom resolution
compared with children with early symptom resolution. Somatization was associated
with delayed symptom resolution (aOR 1.35, 95% CI 1.08-1.69). The proportion of
children with abnormal somatization scores was significantly greater in the
delayed symptom resolution group (34.2%) than the early symptom resolution group
(12.8%; P < .01). Other psychological measures were not different between groups.
CONCLUSION: Somatization is associated with delayed symptom resolution in this
cohort of children with concussion. Postconcussive symptoms lasting at least
1 month may warrant referral to a neuropsychologist familiar with postconcussion
care. 

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