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Predicting Wellness After Pediatric Concussion

Published online by Cambridge University Press:  03 May 2019

Miriam H. Beauchamp*
Affiliation:
Department of Psychology, University of Montreal, Montreal, Quebec, Canada, H2V 2S9 Ste-Justine Hospital Research Center, Montreal, Quebec, Canada, H3T 1C5
Ken Tang
Affiliation:
Clinical Research Unit, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada, K1H 5B2
Keith Owen Yeates
Affiliation:
Departments of Psychology, Pediatrics, and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada, T2N 1N4 Alberta Children’s Hospital Research Institute, University of Calgary, Alberta, Canada, T3B 6A8 Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada, T2N 4N1
Peter Anderson
Affiliation:
Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada, K1H 8L1 Behavioral Neurosciences and Consultation-Liaison Program, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada, K1H 8L1
Brian L. Brooks
Affiliation:
Departments of Psychology, Pediatrics, and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada, T2N 1N4 Alberta Children’s Hospital Research Institute, University of Calgary, Alberta, Canada, T3B 6A8 Neuropsychological Service, Alberta Children’s Hospital, Calgary, Alberta, Canada, T3B 6A8
Michelle Keightley
Affiliation:
Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada, M4G 1R8 Departments of Occupational Science and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada, M5G 1V7
Naddley Désiré
Affiliation:
Alberta Children’s Hospital Research Institute, University of Calgary, Alberta, Canada, T3B 6A8
Kathy Boutis
Affiliation:
Department of Pediatrics, Hospital for Sick Children & University of Toronto, Ontario, Canada, M5G 1X8
Isabelle Gagnon
Affiliation:
Montreal Children’s Hospital, McGill University Health Center, Montreal, Quebec, Canada, H4A 3J1 School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada, H3G 1Y5
Jocelyn Gravel
Affiliation:
Ste-Justine Hospital Research Center, Montreal, Quebec, Canada, H3T 1C5
Alexander Sasha Dubrovsky
Affiliation:
Montreal Children’s Hospital, McGill University Health Center, Montreal, Quebec, Canada, H4A 3J1
Roger Zemek
Affiliation:
Clinical Research Unit, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada, K1H 5B2 Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ontario, Canada, K1Y 4E9
for the 5P PERC Concussion Team
Affiliation:
Department of Psychology, University of Montreal, Montreal, Quebec, Canada, H2V 2S9 Ste-Justine Hospital Research Center, Montreal, Quebec, Canada, H3T 1C5 Clinical Research Unit, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada, K1H 5B2 Departments of Psychology, Pediatrics, and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada, T2N 1N4 Alberta Children’s Hospital Research Institute, University of Calgary, Alberta, Canada, T3B 6A8 Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada, T2N 4N1 Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada, K1H 8L1 Behavioral Neurosciences and Consultation-Liaison Program, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada, K1H 8L1 Neuropsychological Service, Alberta Children’s Hospital, Calgary, Alberta, Canada, T3B 6A8 Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada, M4G 1R8 Departments of Occupational Science and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada, M5G 1V7 Department of Pediatrics, Hospital for Sick Children & University of Toronto, Ontario, Canada, M5G 1X8 Montreal Children’s Hospital, McGill University Health Center, Montreal, Quebec, Canada, H4A 3J1 School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada, H3G 1Y5 Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ontario, Canada, K1Y 4E9
*
Correspondence and reprint requests to: Miriam Beauchamp, Department of Psychology, University of Montreal, C.P. Succursale Centre-Ville, Montréal, Québec, Canada, H3C 3J7. E-mail: miriam.beauchamp@umontreal.ca

Abstract

Objective: Concussion in children and adolescents is a prevalent problem with implications for subsequent physical, cognitive, behavioral, and psychological functioning, as well as quality of life. While these consequences warrant attention, most concussed children recover well. This study aimed to determine what pre-injury, demographic, and injury-related factors are associated with optimal outcome (“wellness”) after pediatric concussion. Method: A total of 311 children 6–18 years of age with concussion participated in a longitudinal, prospective cohort study. Pre-morbid conditions and acute injury variables, including post-concussive symptoms (PCS) and cognitive screening (Standardized Assessment of Concussion, SAC), were collected in the emergency department, and a neuropsychological assessment was performed at 4 and 12 weeks post-injury. Wellness, defined by the absence of PCS and cognitive inefficiency and the presence of good quality of life, was the main outcome. Stepwise logistic regression was performed using 19 predictor variables. Results: 41.5% and 52.2% of participants were classified as being well at 4 and 12 weeks post-injury, respectively. The final model indicated that children who were younger, who sustained sports/recreational injuries (vs. other types), who did not have a history of developmental problems, and who had better acute working memory (SAC concentration score) were significantly more likely to be well. Conclusions: Determining the variables associated with wellness after pediatric concussion has the potential to clarify which children are likely to show optimal recovery. Future work focusing on wellness and concussion should include appropriate control groups and document more extensively pre-injury and injury-related factors that could additionally contribute to wellness. (JINS, 2019, 25, 375–389)

Type
Regular Research
Copyright
Copyright © The International Neuropsychological Society, 2019. 

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