Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2024 Mar 4;7(3):e243182.
doi: 10.1001/jamanetworkopen.2024.3182.

Postconcussive Symptoms After Early Childhood Concussion

Dominique Dupont  1   2 , Ken Tang  3 , Cindy Beaudoin  1   2 , Fanny Dégeilh  4 , Isabelle Gagnon  5   6 , Keith Owen Yeates  7   8 , Sean C Rose  9   10 , Jocelyn Gravel  2 , Brett Burstein  11   12 , Antonia S Stang  13 , Rachel M Stanley  10   14 , Roger L Zemek  15 , Miriam H Beauchamp  1   2 ; PERC KOALA Study
Collaborators, Affiliations
Multicenter Study

Postconcussive Symptoms After Early Childhood Concussion

Dominique Dupont et al. JAMA Netw Open. .

Abstract

Importance: Research on postconcussive symptoms (PCS) following early childhood concussion has been hindered by a lack of measures suitable for this age group, resulting in a limited understanding of their evolution in young children.

Objective: To document PCS in the first 3 months after early childhood concussion using a developmentally appropriate measure.

Design, setting, and participants: This cohort study used data collected at 3 Canadian and 1 US urban pediatric emergency departments (EDs) and 8 Canadian daycares from December 2018 to December 2022 as part of the Kids' Outcomes and Long-Term Abilities (KOALA) project, a prospective, multicenter, longitudinal cohort study. Participants included children aged 6 to 72 months with early childhood concussion or orthopedic injury (OI) or uninjured children from the community to serve as controls. Data were analyzed from March 2023 to January 2024.

Exposure: Concussion sustained between ages 6 and 72 months.

Main outcomes and measures: Primary outcomes were cognitive, physical, behavioral and total PCS assessed prior to injury (retrospectively), acutely (within 48 hours), and at 10 days, 1 month, and 3 months after injury or recruitment through caregiver observations using the Report of Early Childhood Traumatic Injury Observations & Symptoms inventory. Group comparisons were analyzed using ordinal regression models.

Results: The study included 303 children (mean [SD] age, 35.8 [20.2] months; 152 [50.2%] male). Of these, 174 children had a concussion (mean [SD] age, 33.3 [19.9] months), 60 children had an OI (mean [SD] age, 38.4 [19.8] months) and 69 children were uninjured controls (mean [SD] age, 39.7 [20.8] months). No meaningful differences were found between the concussion and comparison groups in retrospective preinjury PCS. Significant group differences were found for total PCS at the initial ED visit (concussion vs OI: odds ratio [OR], 4.33 [95% CI, 2.44-7.69]; concussion vs control: OR, 7.28 [95% CI, 3.80-13.93]), 10 days (concussion vs OI: OR, 4.44 [95% CI, 2.17-9.06]; concussion vs control: OR, 5.94 [95% CI, 3.22-10.94]), 1 month (concussion vs OI: OR, 2.70 [95% CI, 1.56-4.68]; concussion vs control: OR, 4.32 [95% CI, 2.36-7.92]), and 3 months (concussion vs OI: OR, 2.61 [95% CI, 1.30-5.25]; concussion vs control: OR, 2.40 [95% CI, 1.36-4.24]). Significant group differences were also found for domain-level scores (cognitive, physical, behavioral) at various time points.

Conclusions and relevance: In this early childhood cohort study, concussion was associated with more PCS than OIs or typical development up to 3 months after injury. Given the limited verbal and cognitive abilities typical of early childhood, using developmentally appropriate manifestations and behaviors is a valuable way of tracking PCS and could aid in concussion diagnosis in young children.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Tang reported receiving personal fees from CHU Sainte-Justine during the conduct of the study. Dr Gagnon reported receiving grants from Canadian Institutes of Health Research (CIHR) and grants from Fonds de recherche du Québec (FRQS) outside the submitted work. Dr Yeates reported receiving grants from CIHR during the conduct of the study. Dr Rose reported receiving grants from Dale Jr Foundation during the conduct of the study. Dr Gravel reported grants from CIHR during the conduct of the study. Dr. Burstein reported receiving a career award from the Quebec Health Research Fund. Dr Zemek reported receiving grants from CIHR, Ontario Neurotrauma Foundation, Physician Services Incorporated Foundation, CHEO Foundation, Ontario Brain Institute, National Football League, Ontario Ministry of Health, Public Health Agency of Canada, Health Canada, Parachute Canada and Ontario SPOR Support Unit; personal fees from University of Ottawa; and serving on the board of directors for North American Brain Injury Society and as a founding partner and a minority shareholder of 360 Concussion Care outside the submitted work. Dr Beauchamp reported grants from CIHR during the conduct of the study; and personal fees from Guilford Press Book outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Trends for Scale- and Domain-Level Postconcussive Symptoms (PCS) by Injury Group
Estimated trajectories from model fits (estimated mean of PCS over time) at the scale (total symptoms) and domain-level (cognitive, physical, behavioral symptoms) by group. ED indicates emergency department; OI, orthopedic injury. Adjusted to age (34 months) and female sex.
See this image and copyright information in PMC

References

    1. Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic brain injury–related emergency department visits, hospitalizations, and deaths—United States, 2007 and 2013. MMWR Surveill Summ. 2017;66(9):1-16. doi:10.15585/mmwr.ss6609a1 - DOI - PMC - PubMed
    1. Haarbauer-Krupa J, Haileyesus T, Gilchrist J, Mack KA, Law CS, Joseph A. Fall-related traumatic brain injury in children ages 0-4 years. J Safety Res. 2019;70:127-133. doi:10.1016/j.jsr.2019.06.003 - DOI - PMC - PubMed
    1. Rose SC, Levine DA, Shi J, et al. . Emergency department visits for mild traumatic brain injury in early childhood. Am J Emerg Med. 2023;65:36-42. doi:10.1016/j.ajem.2022.12.035 - DOI - PubMed
    1. Taylor HG, Dietrich A, Nuss K, et al. . Post-concussive symptoms in children with mild traumatic brain injury. Neuropsychology. 2010;24(2):148-159. doi:10.1037/a0018112 - DOI - PMC - PubMed
    1. Polinder S, Cnossen MC, Real RGL, et al. . A multidimensional approach to post-concussion symptoms in mild traumatic brain injury. Front Neurol. 2018;9:1113. doi:10.3389/fneur.2018.01113 - DOI - PMC - PubMed

Publication types

Grants and funding