History of Somatization Is Associated with Prolonged Recovery from Concussion

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.

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. 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)