Reduced quality of life in children and adolescents with post-concussion symptoms
As I discussed in part 1 of this article there is an increased general awareness regarding concussion and how concussion patients should be managed. We also looked at the number of children and adolescents suffering from Persistent Post-Concussion Symptoms (PPCS) and exactly what type of impairments they suffer from. The previous article drew attention to the high percentages of neck symptoms in PPCS patients.
This article, on the other hand, will be about the quality of life of children and adolescents with PPCS The findings below and discussion within deriving from a journal article written by a Canadian Paediatric concussion team published in the Journal of the American Medical Association in 2019. According to the article, before this paper was published there had been no large comprehensive studies that addressed the association between PPCS and health-related quality of life (HRQoL) in children implying a lack of understanding on this topic.
The objective of this study was to assess whether there is an association between the HRQoL and PPCS at 4 weeks, 8 weeks and 12 weeks after a concussion injury. In this study, 1667 children aged between 5 and 18 who had presented to the emergency department with a concussion completed a questionnaire that investigated their quality of life at 4, 8 and 12 weeks post-injury. Out of these 1667 children, 510 of them (30.6%) were suffering from PPCS at the time of enquiry. In total, the 510 PPCS children had a lower total quality of life scores on the questionnaires than those who did not suffer from PPCS. Furthermore, the children with PPCS had significantly lower physical, emotional, social and school quality of life scores for all time points at 4,8 and 12 weeks.
These results indicate just how common persistent post-concussion symptoms are, meaning that roughly a third of children who are concussed experience affects that measurably reduce their quality of life throughout the entire study. These affect a wide range of the child’s life and affect their physical, emotional, social and scholastic life.
Furthermore, children who had a concussion but had no persistent symptoms, essentially children that would have been considered recovered had lower HRQoL scores than children with no history of concussion at 4 and 8 weeks. At 12 weeks there was no significant difference indicating that in this research article it took the concussion group up to 12 weeks to return to the same HRQoL levels as normal.
The conclusions of this article were that Children with PPCS have a lower quality of life scores compared with those who have recovered from a concussion, yet deficits in quality of life are pervasive across all domains and may persist for months even in children whose symptoms have seemingly resolved.
So we now know from the last 2 articles that 30% of children who suffer a concussion injury can suffer from persistent post-concussion symptoms and that children can present with multiple impairments in their neck function. In part three of this series, we will discuss and explore research regarding how the treatment of the cervical spine can improve function and decrease pain.
Novak Z et al. Association of Persistent Post Concussion Symptoms with Pediatric Quality of Life. JAMA Pediatr. 2016 Dec 5, 170(12)