How to Predict Pediatric Post-Concussion Symptoms: Published in JAMA


Ottawa, Ontario — Tuesday March 1, 2016

A new study based on the largest prospective cohort of children with concussion in the world published today in the Journal of the American Medical Association (JAMA). The study introduces a validated clinical prediction score that will help health providers and researchers to predict the duration of pediatric concussion symptoms.

“For the first time, clinicians and researchers alike can determine a child’s level of risk for persistent post-concussion symptoms,” said Dr. Roger Zemek, lead author, scientist at the Children’s Hospital of Eastern Ontario (CHEO) and associate professor at the University of Ottawa. “Every concussion is unique; much like every child. It is important to set realistic expectations for recovery.”

A concussion is a serious public health problem with children and adolescents enduring the greatest incidence. One-third of them experience ongoing physical symptoms (e.g., headache or dizziness), cognitive symptoms (e.g., difficulty concentrating or feeling in a fog), emotional symptoms or behavioral symptoms beyond one month, known as persistent post-concussion symptoms (PPCS). Consequences may include missed school, depressed mood, loss of social and physical activities, and lower quality of life.

The 5P study: Predicting and Preventing Post-concussive Problems in Pediatrics, led at CHEO and including nine pediatric emergency departments across Canada, enrolled over 3,000 children. All participants were aged 5-18 years old and evaluated within the first 48-hours after head injury (with most patients presenting within 3 hours of their injury).

Experts from across Canada and the United States developed a PPCS risk score that when applied to a child within 48-hours of their head injury, was proven to be significantly better than the child’s physician was at predicting future PPCS. The score incorporates nine clinical variables containing information from demographics, history, initial symptoms, cognitive complaints, and a physical examination.

The 5P study unveiled a number of findings. For instance, while boys sustained more concussions, girls had twice the odds of boys for having symptoms last at least one month. In addition, older children and teens have a higher risk of PPCS than children under 8 years old do.

“By predicting high or low risk of post-concussion symptoms, we can be more efficient in arranging follow-up. Those at low risk may not need specialty referral, whereas those at high risk could be prioritized for early follow-up with concussion specialists,” said Dr. Zemek. “This study will be a cornerstone for future concussion treatment; researchers now have the ability to target high risk children for novel interventions with the goal of preventing PPCS.”

5P sites include the Children’s Hospital of Eastern Ontario, Stollery Children’s Hospital, Alberta Children’s Hospital Research Institute, Children’s Hospital of Winnipeg, Hospital for Sick Children, Children’s Hospital of Western Ontario, CHU Sainte-Justine, Montreal Children’s Hospital, and IWK Health Sciences Centre.

The Canadian Institutes of Health Research (CIHR) and the Ontario Neurotrauma Foundation (ONF) funded this study.

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