Predicting Recovery After Concussion in Pediatric Patients: A Meta-Analysis

Abstract

Context: Prognostic prediction models (PPMs) can help clinicians predict outcomes.

Objective: To critically examine peer-reviewed PPMs predicting delayed recovery among pediatric patients with concussion.

Data sources: Ovid Medline, Embase, Ovid PsycInfo, Web of Science Core Collection, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Google Scholar.

Study selection: The study had to report a PPM for pediatric patients to be used within 28 days of injury to estimate risk of delayed recovery at 28 days to 1 year postinjury. Studies had to have at least 30 participants.

Data extraction: The Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies checklist was completed.

Results: Six studies of 13 PPMs were included. These studies primarily reflected male patients in late childhood or early adolescence presenting to an emergency department meeting the Concussion in Sport Group concussion criteria. No study authors used the same outcome definition nor evaluated the clinical utility of a model. All studies demonstrated high risk of bias. Quality of evidence was best for the Predicting and Preventing Postconcussive Problems in Pediatrics (5P) clinical risk score.

Limitations: No formal PPM Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) process exists.

Conclusions: The 5P clinical risk score may be considered for clinical use. Rigorous external validations, particularly in other settings, are needed. The remaining PPMs require external validation. Lack of consensus regarding delayed recovery criteria limits these PPMs.