INS NYC 2024 Program

Poster	Poster Session 10 Program Schedule 02/17/2024 09:00 am - 10:15 am Room: Shubert Complex (Posters 1-60) Poster Session 10: Neurodevelopmental \| Congenital Conditions Final Abstract #50 Predictors of Protracted Recovery following Concussion in Pediatric Patients aged 5-9 Years Nathan Kegel, University of Pittsburgh Medical Center, Pittsburgh, United States Aaron Zynda, University of Pittsburgh, Pittsburgh, United States Cyndi Holland, University of Pittsburgh, Pittsburgh, United States Michael Collins, University of Pittsburgh Medical Center, Pittsburgh, United States Anthony Kontos, University of Pittsburgh, Pittsburgh, United States Alicia Trbovich, University of Pittsburgh Medical Center, Pittsburgh, United States Category: Concussion/Mild TBI (Child) Keyword 1: concussion/ mild traumatic brain injury Keyword 2: computerized neuropsychological testing Keyword 3: pediatric neuropsychology Objective: The majority of research on pediatric concussion is focused on adolescents aged 12-18 years, despite estimates that approximately 1/3 of injuries occur in young children aged 5-11 years. Although neuropsychological and other assessments are available for younger pediatric patients, there is limited empirical evidence to support their use and few tools are specific to concussion. The objective of this study was to determine which components from a multi-domain assessment best predict protracted recovery following concussion in pediatric patients aged 5-9 years. Participants and Methods: This study involved a prospective cohort of patients aged 5-9 years presenting to a concussion specialty clinic within 30 days of injury. Participants provided demographic and medical history information, and completed a clinical examination, the Child Sport Concussion Assessment Tool 5 (SCAT5) including symptom reports and balance assessment, the Vestibular/Ocular Motor Screen-Child (VOMS-C), and the Pediatric Immediate Post-concussion Assessment and Cognitive Testing (ImPACT). Participants were categorized into normal (<30 days) and protracted (>30 days) recovery groups based on date of medical clearance for full return to activity. Mann-Whitney U tests were used to evaluate group differences on continuous variables and χ² analyses with odds ratios (ORs) and 95% confidence intervals (CI) were used for categorical variables. The univariate results were then used to inform forward stepwise logistic regressions (LR) to identify the best predictors of protracted recovery. Results: Sixty-eight participants (7.52 + 2.3 years, 56% male) including 36 (52.9%) in the normal and 32 (47.1%) in the protracted recovery group were in the study. The protracted recovery group was 1 year younger (p=0.02) and presented to the clinic later (9.5 vs. 6 days, p=0.002). The protracted recovery group reported a higher number of symptoms on the Child SCAT5 (10 vs. 6, p=0.02), Parent SCAT5 (9 vs. 5, p=0.03), and Parent SCAT5 symptom severity (13 vs. 7.5, p=0.03). Symptom provocation on >1 VOMS-C item was associated with a 5.33 increased likelihood (95% CI, 1.8-15.7, p<0.01) of a protracted recovery. Results of a forward stepwise LR to identify protracted from normal recovery using variables identified in the univariate analyses was significant (χ² = 22.81, df = 2, p<0.001) and accounted for 38.5% of the variance. The model was able to accurately identify protracted from normal recovery in 77.6% of patients, with 77.4% sensitivity for protracted recovery and 77.8% specificity. Days to first clinic visit (Adj OR=1.2, p=0.003) and VOMS-C symptom provocation (Adj OR=8.3, p<0.001) were significant predictors in the model. Conclusions: Days to first clinic visit and provocation of symptoms on the VOMS-C were the most robust predictors of protracted recovery in young pediatric patients following concussion. The findings highlight the importance of these factors for identifying at-risk pediatric patients who might benefit from earlier and more targeted intervention following concussion.

Poster

02/17/2024
09:00 am - 10:15 am
Room: Shubert Complex (Posters 1-60)

Poster Session 10: Neurodevelopmental | Congenital Conditions

Final Abstract #50

Predictors of Protracted Recovery following Concussion in Pediatric Patients aged 5-9 Years

Nathan Kegel, University of Pittsburgh Medical Center, Pittsburgh, United States
Aaron Zynda, University of Pittsburgh, Pittsburgh, United States
Cyndi Holland, University of Pittsburgh, Pittsburgh, United States
Michael Collins, University of Pittsburgh Medical Center, Pittsburgh, United States
Anthony Kontos, University of Pittsburgh, Pittsburgh, United States
Alicia Trbovich, University of Pittsburgh Medical Center, Pittsburgh, United States

Category: Concussion/Mild TBI (Child)

Keyword 1: concussion/ mild traumatic brain injury
Keyword 2: computerized neuropsychological testing
Keyword 3: pediatric neuropsychology

Objective:

The majority of research on pediatric concussion is focused on adolescents aged 12-18 years, despite estimates that approximately 1/3 of injuries occur in young children aged 5-11 years. Although neuropsychological and other assessments are available for younger pediatric patients, there is limited empirical evidence to support their use and few tools are specific to concussion. The objective of this study was to determine which components from a multi-domain assessment best predict protracted recovery following concussion in pediatric patients aged 5-9 years.

Participants and Methods:

This study involved a prospective cohort of patients aged 5-9 years presenting to a concussion specialty clinic within 30 days of injury. Participants provided demographic and medical history information, and completed a clinical examination, the Child Sport Concussion Assessment Tool 5 (SCAT5) including symptom reports and balance assessment, the Vestibular/Ocular Motor Screen-Child (VOMS-C), and the Pediatric Immediate Post-concussion Assessment and Cognitive Testing (ImPACT). Participants were categorized into normal (<30 days) and protracted (>30 days) recovery groups based on date of medical clearance for full return to activity. Mann-Whitney U tests were used to evaluate group differences on continuous variables and χ² analyses with odds ratios (ORs) and 95% confidence intervals (CI) were used for categorical variables. The univariate results were then used to inform forward stepwise logistic regressions (LR) to identify the best predictors of protracted recovery.

Results:

Sixty-eight participants (7.52 + 2.3 years, 56% male) including 36 (52.9%) in the normal and 32 (47.1%) in the protracted recovery group were in the study. The protracted recovery group was 1 year younger (p=0.02) and presented to the clinic later (9.5 vs. 6 days, p=0.002). The protracted recovery group reported a higher number of symptoms on the Child SCAT5 (10 vs. 6, p=0.02), Parent SCAT5 (9 vs. 5, p=0.03), and Parent SCAT5 symptom severity (13 vs. 7.5, p=0.03). Symptom provocation on >1 VOMS-C item was associated with a 5.33 increased likelihood (95% CI, 1.8-15.7, p<0.01) of a protracted recovery.

Results of a forward stepwise LR to identify protracted from normal recovery using variables identified in the univariate analyses was significant (χ² = 22.81, df = 2, p<0.001) and accounted for 38.5% of the variance. The model was able to accurately identify protracted from normal recovery in 77.6% of patients, with 77.4% sensitivity for protracted recovery and 77.8% specificity. Days to first clinic visit (Adj OR=1.2, p=0.003) and VOMS-C symptom provocation (Adj OR=8.3, p<0.001) were significant predictors in the model.

Conclusions:

Days to first clinic visit and provocation of symptoms on the VOMS-C were the most robust predictors of protracted recovery in young pediatric patients following concussion. The findings highlight the importance of these factors for identifying at-risk pediatric patients who might benefit from earlier and more targeted intervention following concussion.