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How is health-related quality of life for kids with postconcussion symptoms?

October 24, 2016

Children with persistent postconcussion symptoms reported lower overall, physical, emotional, social and school quality of life for at least 12 weeks after concussion than children whose concussion symptoms resolved more quickly, although even those children reported lower school quality of life, according to a new article published online by JAMA Pediatrics.

Concussion is a major public health concern in children because as many as 30 percent will experience persistent postconcussion symptoms (PPCS) for a least a month to years after the head injury. PPCS can include ongoing physical symptoms, cognitive problems, decreased mood and behavior changes.

Roger L. Zemek, M.D., of the Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada, and coauthors examined the association between PPCS and health-related quality of life after concussion in children 5 through 18.

Health-related quality of life was measured with an assessment tool at four, eight and 12 weeks after head injury. Patients 8 and older completed the child version of the assessment, while parents completed a version for younger children. This was a planned secondary analysis of the data from the Predicting Persistent Postconcussive Problems in Pediatrics study conducted from August 2013 through September 2014. That study enrolled children with acute concussion who reported to nine pediatric emergency departments in Canada.

The current analysis included 1,667 children with completed quality of life assessments at all three time points. Of these children, the 510 (30.6 percent) children with PPCS had lower overall scores than children without PPCS whose symptoms had resolved within four weeks after concussion.

At four, eight and 12 weeks, the children with PPCS also had lower physical, emotional, social and school quality of life scores. They also had lower quality of life scores compared with published normative data for healthy children.

Those children who recovered quickly from concussion also continued to have difficulty. The children reported lower health-related quality of life for weeks following concussion compared with published normative data for healthy children.

All children, regardless of PPCS, reported lower school functioning quality of life at all time points after concussion, the study reports.

Study limitations included the absence of a control group of children so the study cannot directly attribute PPCS and its effect on health-related quality of life to concussion. Also, the study relied on self-reports for PPCS and health-related quality of life.

"Results from our study provide insight into the psychosocial burden of pediatric concussion and may help identify patients and families requiring extra support or guidance regarding management of expectations and coping mechanisms after concussion. Finally, our results will help guide future interventions to reduce the effect of concussion on HRQoL [health-related quality of life]," the study concludes.
(JAMA Pediatr. Published online October 24, 2016. doi:10.1001/jamapediatrics.2016.2900. Available pre-embargo to the media at

Editor's Note: The article contains conflict of interest and funding/support disclosures. Please see article for additional information, including other authors, author contributions and affiliations, etc.

The JAMA Network Journals

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