Frequency and Predictors of Persisting Symptoms 1 Year After Early Childhood Concussion.

OBJECTIVES

Concussion is common in early childhood, yet the rate of persisting symptoms after concussion (PSaC) is unknown. We sought to determine the frequency of PSaC after early childhood concussion and identify potential predictors of PSaC.

METHODS

We conducted a cohort study enrolling children aged 6 months to younger than 6 years presenting to Canadian and US emergency departments (EDs) with concussion or orthopedic injury (OI) and uninjured children from the community (community controls [CCs]). The primary outcome was PSaC at 1 month after injury determined by reliable change analysis. PSaC were also tracked through 12 months after injury. Potential predictors of PSaC were analyzed using multivariable logistic regression.

RESULTS

We enrolled 418 children: 235 with concussion, 108 with OI, and 75 CCs. Median age was 2.8 years, and 50.7% were male. At 1 month, PSaC were documented in 28% of children with concussion, higher than in the OI group (10%, P = .006) and the CC group (2%, P < .001). After concussion, PSaC were documented in 24% of children at 3 months and 16% at 12 months. Total symptom burden in the ED predicted PSaC at 1 month (odds ratio, 1.108; 95% CI, 1.004-1.223; P = .04). Age, loss of consciousness, receiving brain imaging in the ED, attending daycare or school, and parent education did not predict PSaC.

CONCLUSIONS

PSaC are common after early childhood concussion. Acute symptom burden in the ED predicts PSaC at 1 month. Greater focus on research in this age group and the development of clinical infrastructure is necessary to address these ongoing symptoms.