Risk model helps doctors predict post-concussive symptoms in pediatric patients

A new concussion assessment tool could improve doctors’ ability to determine whether pediatric patients will experience persistent post-concussive symptoms (PPCS), according to results of a new study published online March 8 in JAMA.

Each year, 750,000 children present with concussion symptoms in EDs around the United States, with pediatric concussion rates doubling nationwide over the past 10 years. While most of these patients see symptoms fade within two weeks, some continue to experience debilitating symptoms long after the initial incident, according to lead author Roger Zemek, MD, of Children’s Hospital of Eastern Ontario in Ottawa, and colleagues. 

“Approximately one-third of children experiencing acute concussion experience ongoing somatic, cognitive, and psychological or behavioral symptoms, referred to as persistent post-concussion symptoms,” they wrote. “However, validated and pragmatic tools enabling clinicians to identify patients at risk for PPCS do not exist.”

Zemek and his team set out to create and validate a risk score model aimed at predicting the likelihood of PPCS in pediatric concussion patients. They designed a 12-point risk assessment using variables including sex, age, migraine history, prior concussion with persistent symptoms, headache, sensitivity to noise, fatigue, answering speed and balance errors, which they used to score a total of 3,063 pediatric patients in two separate cohorts. Patients were then reassessed for PPCS at 28-day follow-up.

Their results showed that of the 2,584 participants that completed follow-up at 28 days following the incident, PPCS were present in 801 cases (31 percent). They also showed their PPCS risk model was significantly better than physician judgment at predicting future post-concussive symptoms.

“The risk stratification score has the potential to individualize concussion care through optimal symptom management and appropriate follow-up,” the authors concluded. “Future clinical benefits might include identifying high-risk individuals for further screening, prioritization for specialized concussion evaluations, and initiation of emerging treatments to prevent PPCS.”