Research Reports - Predictors of post-concussive symptoms in young children

J Int Neuropsychol Soc. 2016 Sep;22(8):793-803. doi: 10.1017/S1355617716000709.

Bernard CO(1), Ponsford JA(1), McKinlay A(2), McKenzie D(3), Krieser D(4).

OBJECTIVES: A notable minority of children will experience persistent
post-concussive symptoms (PCS) following mild traumatic brain injury (mTBI),
likely maintained by a combination of injury and non-injury related factors.
Adopting a prospective longitudinal design, this study aimed to investigate the
relative influence of child, family, and injury factors on both acute and
persistent PCS in young children.
METHODS: Participants were 101 children aged 2-12 who presented to an Emergency
Department, with either mTBI or minor bodily trauma (control). PCS were assessed
at time of injury, 1 week, and 1, 2, and 3 months post-injury. Predictors
included injury and demographic variables, premorbid child behavior, sleep
hygiene, and parental stress. Random effects ordinal logistic regression models
were used to analyze the relative influence of these predictors on PCS at early
(acute - 1 week) and late (1-3 month) post-injury phases.
RESULTS: Presence of mTBI was a stronger predictor of PCS in the early [odds
ratio (OR)=18.2] compared with late (OR=7.3) post-injury phase. Older age at
injury and pre-existing learning difficulties were significant predictors of PCS
beyond 1 month post-injury. Family factors, including higher levels of parental
stress, higher socio-economic status, and being of Anglo-Saxon descent,
consistently predicted greater PCS.
CONCLUSIONS: Injury characteristics were significantly associated with PCS for 3
months following mTBI but the association weakened over time. On the other hand,
pre-existing child and family factors displayed an increasingly strong
association with PCS over time. Follow-up for these "at-risk" children which also
addresses family stress may minimize longer-term complications.  

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