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Natural Progression of Symptom Change and Recovery from Concussion in a Pediatric Population
Andrée-Anne Ledoux, PhD
The expected duration for recovery after pediatric concussions is broad, ranging from days to months and even years. However, the epidemiology of the natural progression of recovery remains poorly described through childhood and adolescence. Our study goal was to examine the progression of self-reported recovery following a pediatric concussion over the initial three months after injury. We studied the recovery patterns and their associations with sex and age.
In this study, we prospectively enrolled 3,063 children and adolescents who presented within 48 hours of injury at nine emergency departments across Canada and who were diagnosed with a concussion. Participants were aged 5 to 18 years old with an acute concussion, enrolled from August 2013 to May 2015. Recovery was measured with a validated tool (Post-Concussion Symptom Inventory) in the emergency department and at 1-, 2-, 4-, 8- and 12-weeks post-injury.
Results demonstrated that for all ages, the greatest recovery gains occurred primarily in the 1st week, with modest gains in the 2nd week. Beyond two weeks, symptom recovery significantly slows. Recovery curves in adolescent boys plateaued between 2- and 4- weeks compared to adolescent girls where recovery curves plateaued between 4- and 8- weeks. While the majority of adolescent boys recovered to baseline within four weeks, the majority of adolescent girls still exhibited post-concussion symptoms beyond twelve weeks after the initial injury. Recovery sex differences are likely multifactorial, and might be explained by anthropometric, axonal size, and pubertal hormonal differences, and higher rates of injury and symptom reporting in girls. In conclusion, recovery differs by both age and sex; both of these factors must be considered when informing families of expected recovery and to personalize concussion management.
References
Ledoux AA, Tang K, et al. Natural Progression of Symptom Change and Recovery from Concussion in a Pediatric Population. JAMA Pediatrics. 2019;173(1):e183820. DOI:10.1001/jamapediatrics.2018.3820
Author Bio
Andrée-Anne Ledoux, PhD, is a Scientist for the Children’s Hospital of Eastern Ontario Research Institute (CHEO), Assistant Professor for the Department of Cellular Molecular Medicine and Adjunct Professor for the School of Psychology at University of Ottawa and Adjunct Professor in the Department of Neuroscience at Carleton University. Andrée-Anne completed an MA/PhD in Experimental Psychology and Behavioural Neuroscience from University of Ottawa in 2013. She completed a Postdoctoral Fellowship, studying pediatric concussion recovery trajectories at CHEO in 2019. With state-of-the-art neuroimaging techniques she studies neural correlates of recovery patterns in pediatric concussion.
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