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. 2016 Jul:174:39-44.e1.
doi: 10.1016/j.jpeds.2016.03.020. Epub 2016 Apr 5.

History of Somatization Is Associated with Prolonged Recovery from Concussion

Jeremy M Root  1 , Noel S Zuckerbraun  2 , Li Wang  3 , Daniel G Winger  3 , David Brent  4 , Anthony Kontos  5 , Robert W Hickey  2
Affiliations

History of Somatization Is Associated with Prolonged Recovery from Concussion

Jeremy M Root et al. J Pediatr. 2016 Jul.

Abstract

Objective: To determine the association between a history of somatization and prolonged concussion symptoms, including sex differences in recovery.

Study design: A prospective cohort study of 10- to 18-year-olds with an acute concussion was conducted from July 2014 to April 2015 at a tertiary care pediatric emergency department. One hundred twenty subjects completed the validated Children's Somatization Inventory (CSI) for pre-injury somatization assessment and Postconcussion Symptoms Scale (PCSS) at diagnosis. PCSS was re-assessed by phone at 2 and 4 weeks. CSI was assessed in quartiles with a generalized estimating equation model to determine relationship of CSI to PCSS over time.

Results: The median age of our study participants was 13.8 years (IQR 11.5, 15.8), 60% male, with separate analyses for each sex. Our model showed a positive interaction between total CSI score, PCSS and time from concussion for females P < .01, and a statistical trend for males, P = .058. Females in the highest quartile of somatization had higher PCSS than the other 3 CSI quartiles at each time point (B -26.7 to -41.1, P values <.015).

Conclusions: Patients with higher pre-injury somatization had higher concussion symptom scores over time. Females in the highest somatization quartile had prolonged concussion recovery with persistently high symptom scores at 4 weeks. Somatization may contribute to sex differences in recovery, and assessment at the time of concussion may help guide management and target therapy.

Keywords: gender differences; prolonged concussion syndrome; somatization.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1. Female PCSS Scores Over 4 Weeks by CSI Quartiles
Females with CSI scores at 13 and above started with high PCSS scores and remained with persistently high scores – consistent with a prolonged concussion—at both 2 and 4 week follow up. (Abnormal PCSS: > 8 for females)
Figure 2
Figure 2. Male PCSS Scores Over 4 Weeks by CSI Quartiles
At four week follow up, most of the males from all four CSI quartiles had PCSS scores within the normal range. (Abnormal PCSS: > 6 for males)
See this image and copyright information in PMC

Comment in

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