Research Reports - Trajectories and risk-factors for posttraumatic stress symptoms following pediatric concussion

J Neurotrauma. 2017 Mar 15. doi: 10.1089/neu.2016.4842. [Epub ahead of print]

Truss K(1,)(2), Godfrey C(3,)(4), Takagi M(5), Babl F(6,)(1,)(7), Bressan
S(8,)(9), Hearps SJC(10), Clarke C(11), Dunne K(12,)(1,)(13), Anderson
V(1,)(14,)(15).

A substantial minority of children experience posttraumatic stress symptoms
(PTSS) following injury. Research indicates variation in the trajectory of PTSS
following pediatric injury, but investigation of PTSS following concussion has
assumed homogeneity. This study aimed to identify differential trajectories of
PTSS following pediatric concussion and to investigate risk-factors, including
acute post-concussive symptoms (PCS), associated with these trajectories. 120
children aged 8-18 years reported PTSS for 3 months following concussion
diagnosis using the Child PTSD Symptom Scale, with a score of 16 or above
indicating probable PTSD diagnosis. Age, gender, injury mechanism, loss of
consciousness, previous concussions, prior hospitalisation, prior diagnosis of
depression or anxiety, and acute PCS were assessed as risk-factors. Data were
analysed using group-based trajectory modelling. Results revealed 16% of children
had clinically significant PTSS 2 weeks post-concussion, declining to 10% at 1
month and 6% at 3 months post-injury. Group-based trajectory modelling identified
three trajectories of PTSS post-concussion: 'resilient' (70%); 'recovering'
(25%), in which children experienced elevated acute symptoms that declined over
time; and 'chronic symptomatology' (5%). Due to small size, the chronic group
should be interpreted with caution. Higher acute PCS and prior diagnosis of
depression or anxiety both significantly increased predicted probability of
recovering trajectory group membership. These findings establish that most
children are resilient to PTSS following concussion, but that PTSS do occur
acutely in a substantial minority of children. The study indicates mental health
factors, particularly PTSS, depression, and anxiety, should be considered
integral to models of concussion management and treatment. 

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