Research Reports - Duration and course of post-concussive symptoms

Pediatrics. 2014 Jun;133(6):999-1006

Eisenberg MA(1), Meehan WP 3rd(2), Mannix R(2)

OBJECTIVES: To examine the incidence, duration, and clinical course of individual
post-concussive symptoms in patients presenting to a pediatric emergency
department (ED) with a concussion.
METHODS: We conducted secondary analysis of a prospective cohort study of
patients 11 to 22 years old presenting to the ED of a children's hospital with an
acute concussion. The main outcome measure was duration of symptoms, assessed by
the Rivermead Post-Concussion Symptoms Questionnaire (RPSQ). Patients initially
completed a questionnaire describing mechanism of injury, associated symptoms,
past medical history, and the RPSQ, then were serially administered the RPSQ for
3 months after the concussion or until all symptoms resolved.
RESULTS: Headache, fatigue, dizziness, and taking longer to think were the most
common symptoms encountered at presentation, whereas sleep disturbance,
frustration, forgetfulness, and fatigue were the symptoms most likely to develop
during the follow-up period that had not initially been present. Median duration
of symptoms was the longest for irritability (16 days), sleep disturbance (16
days), frustration (14 days), and poor concentration (14 days), whereas nausea,
depression, dizziness, and double-vision abated most quickly. One month after
injury, nearly a quarter of children still complained of headache, >20% suffered
from fatigue, and nearly 20% reported taking longer to think.
CONCLUSIONS: Among patients presenting to a pediatric ED after a concussion,
physical symptoms such as headache predominate immediately after the injury,
emotional symptoms tend to develop later in the recovery period, and cognitive
symptoms may be present throughout.

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