The prediction of future persistent postconcussion symptoms (PPCS) by a clinical risk score developed among children presenting to an emergency department with a concussion was significantly better than by physician judgement, according to a study appearing in the Journal of the American Medical Association.
Roger Zemek, Children’s Hospital of Eastern Ontario, University of Ottawa, Canada, and colleagues conducted a study to derive and validate a clinical risk score to stratify PPCS risk occurring after acute concussion in youth using readily available clinical features. The study included children and adolescents from age five to 18 who presented within 48 hours of an acute head injury to a paediatric emergency department, with follow-up 28 days after the injury. The primary outcome for the study was PPCS risk score at 28 days, which was defined as three or more new or worsening symptoms using the patient-reported Postconcussion Symptom Inventory, compared with recalled state of being prior to the injury.
The PPCS risk score incorporates nine clinical variables containing information from demographics, history, initial symptoms, cognitive complaints, and physical examination.
In total, 3,063 patients (median age, 12 years; 39% girls) were enrolled (n=2,006 in the derivation cohort; n=1,057 in the validation cohort) and 2,584 of whom completed follow-up at 28 days after the injury. Persistent postconcussion symptoms were present in 801 patients (31%). The 12-point PPCS risk score model for the derivation cohort included the variables of female sex, age of 13 years or older, physician-diagnosed migraine history, prior concussion with symptoms lasting longer than one week, headache, sensitivity to noise, fatigue, answering questions slowly, and four or more errors on the Balance Error Scoring System tandem stance.
“Although the clinical utility of the PPCS risk score will need to be assessed in an externally validated implementation study prior to adoption into routine practice, the risk stratification score has the potential to individualise concussion care through optimal symptom management and appropriate follow-up. Therefore, future research needs to determine if the moderate test characteristics of the PPCS risk score allow for clinicians to confidently provide reassurance, alter management plans, or both. Future clinical benefits might include identifying high-risk individuals for further screening, prioritization for specialised concussion evaluations, and initiation of emerging treatments to prevent PPCS,” the authors write.