Monday, June 01, 2015
Study shows younger children recover quicker from concussions than adolescents
Children aged 10 years and younger appear to recover faster from concussion than those older than 10, study findings indicate.
The difference may be related to symptom severity, mechanism of injury, or a lower incidence of premorbid conditions, according to Rejean M. Guerriero, DO, of Boston Children's Hospital and Harvard Medical School, who reported the findings during a session at the American Academy of Neurology 2015 Annual Meeting.
It's well understood that young adults have slower neurocognitive recovery compared to adults, however there's little data on children in the 5- to 10-year range. Using a Standardized Clinical Assessment and Management Plan, Guerriero and colleagues collected data on 466 patients who presented at a pediatric neurology clinic with concussion, including 93 patients 10 years or younger and 373 patients aged 10 to 21. Data included demographics, clinical presentation, premorbid conditions, diagnostic testing, and treatments.
Overall, premorbid conditions were more common among older patients than younger patients, especially headache (14.37 versus 12.77 years, P<0.001) and psychiatric comorbidities (22.9% anxiety, 8.9% depression, 15.6% attention problems vs. 9.8%, 0%, 7.3%, respectively), while learning disabilities and ADHD/ADD were equally as common among both older and younger populations, particularly in a pediatric neurology practice.
Children 10 years and under had significantly lower scores on the post-concussion symptom scale across all domains — headache, vestibular, cognitive, and sleep — than older children, except for emotional symptoms. Younger children also recovered more quickly from concussion (mean 61 days for ≤10 vs. 74 days for >10, P=0.01). Guerriero noted that while the data from the study can be applied to all children, the younger children in this unique population (neurology practice vs. primary care/clinic/ED) took longer than typical to recover from concussion: 14 – 30 days for standard recovery vs. 60 days in the study.
“It's hard to know whether (comorbidities) affect susceptibility,” Guerriero said, referencing the younger population's seeming ability to recover from concussion faster. “It's certainly well known that learning disabilities, migraine headaches, and behavioral issues are all risk factors for prolonged neurocognitive symptoms, but at this point it seems less likely that those characteristics put patients at greater risk for concussion.”
The researchers also suggested that the similar emotional symptom scores in both younger and older children may reflect the post-concussion symptom scale's inability to detect subtle emotional symptoms in younger children.
“Younger kids may be more resilient or they may not know better, so they bounce back (from injury) and think, ‘What do I have to be anxious about? It's fine and I feel better,' where as older kids, who may watch the news or have other exposures, think ‘Jeez, am I going to have chronic brain problems now?'”
While children 10 and under may be more resilient in terms of knowledge of injury and brain health baseline, Guerriero stressed that physicians need to be more conscious of subtle changes in behavior that may not be self-reported by younger children or their parents.
“There are other scales specifically geared toward identifying emotional issues in younger children that highlight trouble with transitions and irritability, which physicians can use in younger patients that may be more sensitive than aspects of the post-concussive symptom score.”
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