TY  - JOUR
PY  - 2016//
TI  - Association of persistent postconcussion symptoms with pediatric quality of life
JO  - JAMA pediatrics
A1  - Novak, Zuzana
A1  - Aglipay, Mary
A1  - Barrowman, Nick
A1  - Yeates, Keith O.
A1  - Beauchamp, Miriam H.
A1  - Gravel, Jocelyn
A1  - Freedman, Stephen B.
A1  - Gagnon, Isabelle
A1  - Gioia, Gerard
A1  - Boutis, Kathy
A1  - Burns, Emma
A1  - Ledoux, Andrée-Anne
A1  - Osmond, Martin H.
A1  - Zemek, Roger L.
SP  - e162900
EP  - e162900
VL  - 170
IS  - 12
N2  - IMPORTANCE: Persistent postconcussion symptoms (PPCS) pose long-term challenges and can negatively affect patients' health-related quality of life (HRQoL). To date, no large comprehensive study has addressed the association between PPCS and HRQoL. <br><br>OBJECTIVES: To determine the association between HRQoL and PPCS at 4 weeks after concussion and assess the degree of impairment of HRQoL in the subsequent 12 weeks. DESIGN, SETTING, AND PARTICIPANTS: In a prospective, multicenter cohort study (Predicting Persistent Postconcussive Problems in Pediatrics [5P]) from August 14, 2013, to September 30, 2014, children aged 5 to 18 years who presented to the emergency department within 48 hours after head injury and were considered to have an acute concussion were enrolled across 9 pediatric emergency departments within the Pediatric Emergency Research Canada Network. Persistent postconcussion symptoms were defined as 3 or more persistent symptoms on the validated Post-Concussion Symptom Inventory at 4 weeks. Linear mixed effects random coefficients models evaluated the association between PPCS and HRQoL, adjusting for potential confounders including age, sex, prior concussions, migraine, anxiety, learning disability, depression, and sleep disorder. MAIN OUTCOMES AND MEASURES: The primary outcome was HRQoL assessed with the validated Pediatric Quality of Life Inventory version 4.0 (PedsQL-4.0) at 4, 8, and 12 weeks after head injury. <br><br>RESULTS: Of 2006 children enrolled (median age, 11.8 years [interquartile range, 8.9-14.6 years]; 1241 boys and 765 girls), 1667 (83.1%) completed the PedsQL-4.0 at all 3 time points. Of these 1667 children, the 510 with PPCS (30.6%) had lower total PedsQL-4.0 scores (mean, 70.0) than did those without PPCS (mean, 80.3; mean difference, -10.3; 95% CI, -9.4 to -11.2). Patients with PPCS also had significantly lower physical, emotional, social, and school PedsQL-4.0 subscores at 4, 8, and 12 weeks. Patients with PPCS had lower HRQoL than published healthy norms at 4 weeks (mean difference, 13.89; 95% CI, 11.55-16.23), 8 weeks (mean difference, 11.63; 95% CI, 9.34-13.93), and 12 weeks (mean difference, 9.38; 95% CI, 7.01-11.75; P RESULTS:   RESULTS: < RESULTS:  .001). Patients who recovered from concussion also had lower HRQoL than norms at 4 weeks (mean difference, 3.56; 95% CI, 1.28-5.85) and 8 weeks (mean difference, 2.75; 95% CI, 0.48-5.02; P  RESULTS: < RESULTS:  .05). School functioning PedsQL-4.0 subscores were significantly lower for all children regardless of PPCS status at all time points. <br><br>CONCLUSIONS AND RELEVANCE: Children with PPCS have lower HRQoL compared with those who have recovered from concussion, yet deficits in HRQoL are pervasive across all domains and may persist for months even in children whose symptoms have resolved. Future interventional research should target the effect of concussion on HRQoL.<p />  <p>Language: en</p>
LA  - en
SN  - 2168-6211
UR  - http://dx.doi.org/10.1001/jamapediatrics.2016.2900
ID  - ref1
ER  -