Results suggest that children who sustain concussion may need greater than three months to be considered optimally recovered across physical, cognitive, socioemotional, and resilience domains. Most children in the study reached optimal functioning within three to six months.
Issue 34.3
In the study,“ Optimal Recovery Following Pediatric Concussion,” published in JAMA Network Open, researchers conducted a prospective cohort study to document the timeframe of recovery to optimal functioning, defined comprehensively across motor-physical, cognitive, socioemotional, and resilience-support domains, in children aged 8 to 16 years.
Participants included 967 children, with 633 in the concussion group and 334 in the orthopedic injury group. Recruitment occurred between September 2016 and July 2019 during acute emergency department visits at five Pediatric Emergency Research Canada network sites.
Children in the concussion group sustained a blunt head trauma resulting in at least one of the following criteria, consistent with the World Health Organization mild traumatic brain injury definition: observed loss of consciousness, or Glasgow Coma Scale score of 13 to 14, or at least one acute sign or symptom of concussion including posttraumatic amnesia, focal neurological deficits, skull fracture, posttraumatic seizure, vomiting, headache, dizziness, or other mental status changes.
Children in the orthopedic injury group sustained non-head-related upper or lower extremity fracture, sprain, or strain secondary to blunt force trauma, associated with an abbreviated injury scale score of 4 or less.
Participants completed assessments approximately 10 days, three months, and six months after injury. The overall optimal functioning score was computed for 824 participants at 10 days, 725 participants at three months, and 697 participants at six months.
For the orthopedic injury group, the median score was 6.0 at 10 days, 7.0 at three months, and 7.0 at six months. For the concussion group, the median score was 4.0 at 10 days, 6.0 at three months, and 7.0 at six months.
Time was the strongest factor associated with optimal functioning. At the 10-day follow-up, concussion was associated with lower optimal functioning than orthopedic injury among females( odds ratio, 0.24) and males( odds ratio, 0.37). This difference persisted for females at three months( odds ratio, 0.57) but was not present in males. Optimal functioning was comparable at six months.
Across time points, optimal functioning increased in the orthopedic injury group among females( odds ratio, 2.38) and males( odds ratio, 3.65). In the concussion group, optimal functioning increased for females( odds ratio, 8.75) and males( odds ratio, 11.58).
Males with concussion had greater odds of exhibiting higher optimal functioning than females at three months( odds ratio, 2.49) and six months( odds ratio, 1.75). In the orthopedic injury group, the odds of males having greater optimal functioning than females were not significant at any time point.
Results suggest that children who sustain concussion may need greater than three months to be considered optimally recovered across physical, cognitive, socioemotional, and resilience domains. Most children in the study reached optimal functioning within three to six months. Data further suggest that females may take longer than males to achieve comparable recovery levels.
According to the authors, these findings may help to explain why some children, especially girls, take longer to feel as though they are well, even though subjective and objective assessments of symptoms or specific functions indicate absence of problems. g
Results suggest that children who sustain concussion may need greater than three months to be considered optimally recovered across physical, cognitive, socioemotional, and resilience domains. Most children in the study reached optimal functioning within three to six months.
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