March 10, 2016
Risk Score Could Much better Predict Postconcussive Symptoms in Children
A novel clinical risk score Much better predicted postconcussive symptoms in pediatric patients compared to doctor judgement, outcomes from a prospective, multicenter cohort study indicate.
Nearly one-3rd of pediatric concussion patients experience persistent postconcussive symptoms (PPCS), including somatic, cognitive, and psychological or behavioral symptoms, but no validated tools exist to identify high-risk patients.
Using readily offered clinical features, researchers led by Roger Zemek, MD, of Children’s Hospital of Eastern Ontario at the University of Ottawa in Ottawa, Canada, specified out to validate the risk score, defined as 3 or much more brand-new or worsening symptoms based on patient-reported Postconcussion Symptom Inventory compared along with recall of their say of being prior to injury. From 4six potential variables, the researchers identified 9 easily obtainable factors highly associated along with PPCS that accounted for demographics, history, very first symptoms, cognitive complaints, and bodily examination.
In total, 3063 patients (median age, 12 years; 39% girls) were enrolled (n=200six in derivation cohort; n=1057 in validation cohort), of whom 2584 (n=1701 derivation; n=883 validation) completed follow-up 28 days after injury. PPCS were present in 31% of patients (n=801).
The 12-point PPCS risk score model for the derivation cohort included variables for female sex, age 13 years or older, physician-diagnosed migraine history, prior concussion along with symptoms long lasting much longer compared to 1 week, headache, noise sensitivity, fatigue, answering questions slowly, and 4 or much more errors on the Balance Error Scoring System tandem stance. The location under the curve was 0.71 (95% CI, 0.69-0.74) for the derivation cohort and 0.68 (95% CI, 0.65-0.72) for the validation cohort. Based on the 12-point scoring system, the researchers proposed 3 levels of risk: reasonable risk, along with probability of PPCS ranging from 4.1%-11.8%; medium risk, along with probability of PPCS ranging from 16.4%-47.6%; and higher risk, along with probability of PPCS ranging from 57.1%-80.8%.
The risk score showed modest discrimination to stratify PPCS risk at 28 days post-injury.
“Even though the clinical utility of the PPCS risk score will certainly should be assessed in an externally validated implementation study prior to adoption in to schedule practice, the risk stratification score has actually the potential to individualize concussion care through excellent symptom management and proper follow-up,” the authors wrote. “Therefore, future research has to figure out if the moderate test characteristics of the PPCS risk score permit for clinicians to confidently offer reassurance, transform management plans, or both.”
Utilizing the risk score in the future Could permit physicians to not just identify patients in demand of further screening or evaluation, however likewise identify those that Could reward from emerging treatments, noted Lynn Babcock, MD, MS, and Brad G. Kurowski, MD, MS, that authored an accompanying editorial.
“Thinking about the variant in personal symptom profiles and trajectories, personalized patient-oriented methods to ongoing assessments and delivery of post-injury interventions are called for to assist in recovery in these vulnerable Youngsters and adolescents.”
References
- Zemek R, Barrowman N, Freedman SB, et al. Clinical Risk Score for Persistent Postconcussion Symptoms Among Youngsters along with Acute Concussion in the ED. JAMA. 2016;315(10):1014-1025. doi:10.1001/jama.2016.1203.
- Babcock L, Kurowski BG. Determining Youngsters and Adolescents at Risk for Persistent Postconcussion Symptoms.JAMA. 2016;315(10):987-988. doi:10.1001/jama.2016.1276.