Predicting Postconcussion Syndrome After Mild Traumatic Brain Injury in Children and Adolescents Who Present to the Emergency Department

OBJECTIVE: To determine the acute predictors associated with the development of postconcussion syndrome (PCS) in children and adolescents after mild traumatic brain injury. DESIGN: Retrospective analysis of a prospective observational study. SETTING: Pediatric emergency department (ED) in a children’s hospital. PARTICIPANTS: Four hundred six children and adolescents aged 5 to 18 years. MAIN EXPOSURE: Closed head trauma. MAIN OUTCOME MEASURES: The Rivermead Post Concussion Symptoms Questionnaire administered 3 months after the injury. RESULTS: Of the patients presenting to the ED with mild traumatic brain injury, 29.3% developed PCS. The most frequent PCS symptom was headache. Predictors of PCS, while controlling for other factors, were being of adolescent age, headache on presentation to the ED, and admission to the hospital. Patients who developed PCS missed a mean (SD) of 7.4 (13.9) days of school. CONCLUSIONS: Adolescents who have headache on ED presentation and require hospital admission at the ED encounter are at elevated risk for PCS after mild traumatic brain injury. Interventions to identify this population and begin early treatment may improve outcomes and reduce the burden of disease.