Characteristics of concussion based on patient age and sex: a multicenter prospective observational study

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  • 1 Emergency Department, Royal Children’s Hospital, Melbourne;
  • | 2 Clinical Sciences, Murdoch Children’s Research Institute, Melbourne;
  • | 3 Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne;
  • | 4 Department of Neurosurgery, Austin and Cabrini Hospitals, Melbourne;
  • | 5 School of Psychological Sciences, University of Melbourne, Melbourne;
  • | 6 Psychology Service, Royal Children’s Hospital, Melbourne;
  • | 7 Emergency Department, Women’s & Children’s Hospital, Adelaide, Australia;
  • | 8 Faculty of Health & Life Sciences, University of the West of England, Bristol, United Kingdom;
  • | 9 Emergency Department, Queensland Children’s Hospital, Brisbane;
  • | 10 Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane;
  • | 11 Emergency Department, The Children’s Hospital at Westmead, Sydney;
  • | 12 Emergency Department, Monash Medical Centre, Melbourne, Australia;
  • | 13 Emergency Department, The Townsville Hospital, Townsville, Queensland;
  • | 14 Emergency Department, University Hospital Geelong, Geelong;
  • | 15 School of Medicine, Faculty of Health, Deakin University, Geelong, Australia;
  • | 16 Emergency Department, Kidzfirst Middlemore Hospital, Auckland, New Zealand;
  • | 17 Department of Women’s and Children’s Health, University of Padova, Padova, Italy;
  • | 18 Emergency Department, Starship Children’s Health, Auckland;
  • | 19 Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand;
  • | 20 Emergency Department, Perth Children’s Hospital, Perth, Australia; and
  • | 21 School of Medicine, Divisions of Emergency Medicine and Paediatrics, University of Western Australia, Perth, Australia
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OBJECTIVE

Children with concussion frequently present to emergency departments (EDs). There is limited understanding of the differences in signs, symptoms, and epidemiology of concussion based on patient age. Here, the authors set out to assess the association between age and acute concussion presentations.

METHODS

The authors conducted a multicenter prospective observational study of head injuries at 10 EDs in Australia and New Zealand. They identified children aged 5 to < 18 years, presenting with a Glasgow Coma Scale score of 13–15, presenting < 24 hours postinjury, with no abnormalities on CT if performed, and one or more signs or symptoms of concussion. They extracted demographic, injury-related, and signs and symptoms information and stratified it by age group (5–8, 9–12, 13 to < 18 years).

RESULTS

Of 8857 children aged 5 to < 18 years, 4709 patients met the defined concussion criteria (5–8 years, n = 1546; 9–12 years, n = 1617; 13 to < 18 years, n = 1546). The mean age of the cohort was 10.9 years, and approximately 70% of the patients were male. Sport-related concussion accounted for 43.7% of concussions overall, increasing from 19.1% to 48.9% to 63.0% in the 5–8, 9–12, and 13 to < 18 years age groups. The most common acute symptoms postinjury were headache (64.6%), disorientation (36.2%), amnesia (30.0%), and vomiting (27.2%). Vomiting decreased with increasing age and was observed in 41.7% of the 5–8 years group, 24.7% of the 9–12 years group, and 15.4% of the 13 to < 18 years group, whereas reported loss of consciousness (LOC) increased with increasing age, occurring in 9.6% in the 5–8 years group, 21.0% in the 9–12 years group, 36.7% in the 13 to < 18 years group, and 22.4% in the entire study cohort. Headache, amnesia, and disorientation followed the latter trajectory. Symptom profiles were broadly similar between males and females.

CONCLUSIONS

Concussions presenting to EDs were more sports-related as age increased. Signs and symptoms differed markedly across age groups, with vomiting decreasing and headache, LOC, amnesia, and disorientation increasing with increasing age.

ABBREVIATIONS

ED = emergency department; GCS = Glasgow Coma Scale; LOC = loss of consciousness; SRC = sport-related concussion; TBI = traumatic brain injury.

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