Post-concussion symptom burden in children following motor vehicle collisions

Abstract

Objective: Motor vehicle collisions generate considerable transmitted forces resulting in traumatic brain injury in children presenting to emergency departments (EDs). To date, no large study has examined post-concussive symptoms in children sustaining concussions in motor vehicle collisions. This study aimed to compare trends in acute post-concussive symptom burden in children with concussion following motor vehicle collisions as compared to other injury mechanisms.

Methods: The study is a secondary analysis of the Predicting Persistent Post-concussive Problems in Pediatrics study, which prospectively recruited a multicenter cohort of 3029 children 5-17 years of age presenting to the ED with concussion from 2013-2015. Post-concussive symptom ratings were obtained at pre-specified time points for 12 weeks post-injury, using the validated Post-Concussion Symptom Inventory (PCSI). Symptom severity and recovery trajectories were measured using delta scores on the PCSI (mean post-injury symptom score minus perceived pre-injury score). A multivariable, longitudinal model evaluated the adjusted effect of mechanism of injury (motor vehicle collisions vs other mechanisms) on mean symptom scores, compared to perceived pre-injury reports, and the temporal change in mean scores over during recovery.

Results: Of 3029 study participants, 56 (1.8%) sustained concussion from motor vehicle collisions. Children sustaining concussion in a motor vehicle collision had lower post-concussive symptom scores upon ED presentation, measured as differences from their perceived pre-injury reports, as compared to other injury mechanisms (-0.36 [95% confidence interval (CI) = -0.58, -0.15]). However, the motor vehicle collisions group showed the smallest decline in symptom burden over 1 month following injury (-0.54 [95% CI = -0.81, -0.27]).

Conclusions: Children sustaining concussions in motor vehicle collisions may have lower initial symptom burdens but slower symptom recovery at 1 month compared to other mechanisms of injury and may represent a distinct population for prognostic counseling in the ED requiring further research.

Keywords: concussion; motor vehicle collision; post‐concussive symptoms; traumatic brain injury.

FIGURE 1

Symptom recovery trajectories stratified by injury mechanism. The individual trajectories of PCSI over the study period are presented for each of the 4 mechanisms of injury groups. In all 4 groups, clear decreases in the group‐level PCSI mean and median PCSI over time were evident, with the most dramatic changes occurring during the initial weeks after injury. In addition, all 4 groups were characterized by some heterogeneity in recovery trajectory

FIGURE 2

Predicted PCSI by injury mechanism. Summarized non‐linear plots of the predicted values (ie, estimated PCSI) over time based on the fitted model demonstrate a steep initial recovery followed by a plateauing of PCSI for each of the 4 mechanisms of injury groups, characterized by some heterogeneity in recovery trajectory