An otherwise healthy 11 year old boy is brought to the ED by his parent after “hitting his head pretty hard” during hockey practice. The child was “out of it” for a little while but did not lose consciousness. He seems foggy, complains of a headache and asks to turn off the lights. You diagnose a concussion. His parent wants to know how long before he will better.
A study in JAMA Pediatrics published in November 2018 (see reference) sought to find some concrete data in order to help patients and families know how long post concussive symptoms may last. Researchers performed a secondary analysis of a prospective, multicenter, cohort study which included data from 9 Canadian EDs and 3,063 children. They found that most children, regardless of sex, ages 5-7 years recovered within approximately 2 weeks. Approximately 80% of children ages 8-12 years, again regardless of sex, as well as boys ages 13-18 years recovered within approximately 4 weeks. Most girls ages 13-18 years had improved by 12 weeks but were not yet at baseline.
Image from the paper:
Giving patients and their parents a realistic idea of how long symptoms may last will help ensure a smoother recovery by avoiding frustration and false expectations. Keep in mind that, based on the data above, up to 20% of children older than 8 years may continue to have symptoms for at least a month, sometimes longer. That can feel like an eternity, even if the family knows it’s coming.
BONUS info:
Here is a link for providers and families to help ask the right questions about concussions, keep track of symptoms, and provide some further education about concussions. It’s short and worth glancing through.
https://www.cdc.gov/headsup/pdfs/providers/ace-a.pdf
Does your PEDs patient with head trauma need a scan? Check here first:
https://www.mdcalc.com/pecarn-pediatric-head-injury-trauma-algorithm
Want to read more about returning to activities after a concussion? Click here:
https://www.cdc.gov/headsup/providers/return_to_activities.html
Reference:
Natural Progression of Symptom Change and Recovery From Concussion in a Pediatric Population. JAMA Pediatr. 2018 Nov 5:e183820. doi: 10.1001/jamapediatrics.2018.3820.
