Objective To assess the co-occurrence and clustering of post-concussive symptoms in children, and to identify distinct patient phenotypes based on symptom type and severity.
Methods We performed a secondary analysis of the prospective, multicentre Predicting and Preventing Post-concussive Problems in Pediatrics (5P) cohort study, evaluating children 5–17 years of age presenting within 48 hours of an acute concussion. Our primary outcome was the simultaneous occurrence of two or more persistent post-concussive symptoms on the Post-Concussion Symptom Inventory at 28 days post-injury. Analyses of symptom and patient clusters were performed using hierarchical cluster analyses of symptom severity ratings.
Results 3063 patients from the parent 5P study were included. Median age was 12.1 years (IQR: 9.2–14.6 years), and 1857 (60.6%) were male. Fatigue was the most common persistent symptom (21.7%), with headache the most commonly reported co-occurring symptom among patients with fatigue (55%; 363/662). Headache was common in children reporting any of the 12 other symptoms (range: 54%–72%). Physical symptoms occurred in two distinct clusters: vestibular-ocular and headache. Emotional and cognitive symptoms occurred together more frequently and with higher severity than physical symptoms. Fatigue was more strongly associated with cognitive and emotional symptoms than physical symptoms. We identified five patient groups (resolved/minimal, mild, moderate, severe and profound) based on symptom type and severity.
Conclusion Post-concussive symptoms in children occur in distinct clusters, facilitating the identification of distinct patient phenotypes based on symptom type and severity. Care of children post-concussion must be comprehensive, with systems designed to identify and treat distinct post-concussion phenotypes.
- brain concussion
Data availability statement
Data are available upon reasonable request. Data for this manuscript are stored and available online in BrainCode and are available upon reasonable request.
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Correction notice This article has been corrected since it published Online First. The abstract has been amended.
Collaborators For the Pediatric Emergency Research Canada 5P Concussion Team.
Contributors TWL, RM, KT and RZ designed the study and performed and interpreted data analyses. KY, GS, EB, DB, AD, WC, KB, MO, GG and RZ supervised data collection at the participating sites. TWL, RM and RZ drafted the manuscript. All authors critically reviewed and revised the manuscript and contributed to the final submission. TWL is responsible for the overall content as guarantor.
Funding This study was supported by operating grant (126197) and planning grant (MRP: #119829) from the Canadian Institutes of Health Research and grant (TM1:#127047) from the Canadian Institutes of Health Research–Ontario Neurotrauma Foundation Mild Traumatic Brain Injury Team. The funders played no role in the design and conduct of the study; collection, management, analysis or interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
Competing interests GG is an author of the Post-Concussion Symptom Inventory (PCSI) used in this study. The PCSI is freely available and he receives no financial benefit from its use.
Provenance and peer review Not commissioned; externally peer reviewed.
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