Different trajectories of post-concussive symptom subscales after pediatric mild traumatic brain injury: Data from a prospective longitudinal study

Martina Studer; Lara Mischler; Fabrizio Romano; Karen Lidzba; Sandra Bigi

doi:10.1016/j.ejpn.2024.05.003

Different trajectories of post-concussive symptom subscales after pediatric mild traumatic brain injury: Data from a prospective longitudinal study

Eur J Paediatr Neurol. 2024 May 8:51:9-16. doi: 10.1016/j.ejpn.2024.05.003. Online ahead of print.

Authors

Martina Studer¹, Lara Mischler², Fabrizio Romano³, Karen Lidzba², Sandra Bigi⁴

Affiliations

¹ Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital Basel (UKBB), Basel, Switzerland; Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland. Electronic address: martina.studer@ukbb.ch.
² Division of Neuropediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland.
³ Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland.
⁴ Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland; Division of Pediatric Neurology, Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.

PMID: 38744052
DOI: 10.1016/j.ejpn.2024.05.003

Abstract

Purpose: The aim of this study was to investigate the trajectory of parent-rated post-concussive symptoms (PCS), attentional performance and participation within 6 months in children after mild traumatic brain injury (mTBI).

Methods: For this prospective longitudinal study, we included data on 64 children after mTBI and 57 healthy control children (age 8-16 years). Parents rated PCS using the Post-Concussion Symptom Inventory (PCSI) immediately (T0), 1 week (T1), and 3-6 months after injury (T2). Attentional performance (alertness, selective and divided attention) was measured using the Test of Attentional Performance (TAP) at T1 and T2 and participation was measured using the Child and Adolescent Scale of Participation (CASP) at T2.

Results: Friedman tests showed different trajectories of PCS subscales over time: Compared to pre-injury level, the amount of somatic and cognitive PCS was still elevated at T1, while emotional PCS at T1 were already comparable to pre-injury level. The rating of sleep-related PCS at T2 was significantly elevated compared to the pre-injury rating. Quade ANCOVAs indicated group differences in PCS subscales between patients and controls at T1, but not at T2. Patients and controls showed a similar performance in tests of attention at T1 and T2, but parental rating of participation at school was significantly reduced. Although cognitive PCS and attention were not correlated, there were significantly negative Spearman correlations between participation at home and pre-injury and concurrent PCS at T2.

Conclusions: Our data imply that sleep-related PCS are still elevated weeks after injury and are thus a target for interventions after mTBI.

Keywords: Attentional performance; Concussion; Home and school participation; post-concussive symptoms.