Concussion – Reasonable Estimates for Recovery

December 17, 2018

Visualmed: Have you seen Visualmed? It has beautiful infographics of major RCTs, hand-made by Usama Nasir (PGY3, IM, UConn). This makes complex trials simpler to understand, which is near to my heart. I have no financial or other interest. I just learned about this great resource and wanted to share it. Enjoy! You might like this one on PARAMEDIC2. There is also a free app.

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Written by Clay Smith

Spoon Feed
Most younger children 5-7 years old recover from concussion within 2 weeks. More than 80% of children 8-12 years old and boys 13-18 years old recovered within 4 weeks. Most teen girls had not recovered by week 12.

Why does this matter?
When kids have a concussion, we need to be able to give them and their parents a reasonable time estimate for recovery. The literature is all over the place on this, ranging from days to years to recover. What is the real answer?

They won’t be better in a week.
This was a secondary analysis of a prospective multicenter cohort study in 9 Canadian EDs, Predicting Persistent Postconcussive Problems in Pediatrics. They studied 3,063 children, of which 2,716 were included for the primary outcome. Children were 5-18 years of age with concussion and post-concussion symptom inventory at 1, 2, 4, 8, and 12 weeks post-injury. For the youngest age range, 5-7 years, most had resolution in the first 2 weeks. For children 8-12 years and boys 13-18 years old, over 80% recovered by 4 weeks. However, most girls age 13-18 years were improved but had not fully recovered by 12 weeks. Girls took longer to recover than boys at all ages, but this was most pronounced in adolescent girls. Another take home for me was that 10-15% of all children were not fully recovered by 12 weeks. That is higher than I would have expected. This information helps me set reasonable expectations for children and parents. If they think children are going to be 100% and able to fully return to normal in a week, they are going to be disappointed and frustrated.

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