Grant: Team Grant: Mild Traumatic Brain Injury in Children and Youth - Ontario

Concussion, a mild traumatic injury common in children and adolescents, is a complex pathophysiological process affecting the brain. The lay press is inundated with reports of tragic consequences of concussion, and children are not immune. Persistent postconcussive symptoms (PCS) is defined as the persistence of somatic, cognitive, physical, psychological or behavioural changes lasting more than one month following injury. PCS significantly impacts children and their family's quality of life through school absenteeism, depressed mood and loss of activities. Validated, easy-to-use prognosticators do not exist for clinicians to identify children at highest risk for PCS. As a result, physicians cannot accurately inform children and parents if they should expect longer symptoms, nor initiate pharmacotherapy or other management to reduce the occurrence or severity of PCS. The objective of our research is to derive and validate a clinical prediction rule for the development of PCS in children and adolescents presenting to the emergency department (ED) following acute head injury. We have 3 specific aims: (1) determine PCS prevalence at one-month follow-up in children aged 5-17 who sustain a concussion, (2) derive a rule to predict PCS from variables in the history and physical examination, and (3) assess the accuracy, reliability and acceptability of the prediction rule in a subsequent cohort. Using a prospective, multicentre study across 10 large Canadian pediatric EDs, we will recruit the largest prospective epidemiological cohort of children with concussions in the literature. This work will provide rigorous evidence to determine PCS prevalence in children and its impact on quality of life. The results of this study will enable clinicians to identify children at highest risk for PCS, optimize treatment and provide families with realistic anticipatory guidance, and establish a strong and vital evidence base to advance concussion research.