Assessment of post-concussion emotional symptom load using PCSS and PROMIS instruments in pediatric patients

ABSTRACT

Objectives

The purpose of this study is to evaluate the utility of the Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depressive symptom domains in conjunction with the Post-Concussion Symptom Scale (PCSS)for identifying pediatric patients with emotional symptoms following a concussion, and to identify predictors of higher emotional symptom loads.

Methods

We recruited English-speaking patients aged 8–17 years presenting to a tertiary-care concussion clinic from 2014 to 2018 (n = 458). Demographics and clinical data including PCSS, injury date, previous history of anxiety/depression, and Vestibular/Ocular-Motor Screen (VOMS) were collected from patients’ electronic medical records. Participants completed surveys in the PROMIS^TM Pediatric Item Bank v1.1-Anxiety and Depressive Symptoms domains at their initial clinic visit. Multivariable linear regression identified predictors of higher emotional symptom loads.

Results

Overall, 425 (92.8%) reported ≥1 emotional symptom on either PROMIS or PCSS. Predictors of higher emotional symptom loads were abnormal VOMS, female sex, history of anxiety or depression, and longer time since injury.

Conclusion

Our results suggest that adding PROMIS anxiety and depressive symptom surveys to pediatric concussion evaluations may identify more children with emotional symptoms, allowing clinicians to better direct post-concussion treatment and incorporate psychological support for patients if necessary. Future studies should examine whether earlier identification of emotional symptoms with these tools facilitates recovery and improves short- and/or long-term psychological outcomes in pediatric concussion.

KEYWORDS:

• Concussion
• sports medicine
• pediatrics
• emotional health
• post-concussion

Disclosure statement

We have no conflicts of interest to disclose. This study was approved by our Institutional Review Board.

Previous abstracts published using data from this cohort

Presented at the American Academy of Pediatrics Exhibition in 2018: “Age group differences in pediatric concussion and risk factors for poorer emotional health post-injury.” Sina Malekian, BS, Jacob T. Wild, Jamie K. Burgess, PhD, Jane Philbin, BS, Kiana King, Kristi McCracken, ATC, Meghan Schmitt, BA, Jacqueline A. Turner, APN, Soyang Kwon, PhD, Cynthia R. LaBella, MD

Presented at the American Medical Society for Sports Medicine Annual Meeting in 2019: “PROMIS anxiety survey identifies more patients with anxiety symptoms than PCSS.” Meghan Schmitt, BA, Sina Malekian, BS, Jamie K. Burgess, PhD, Jane Philbin, BS, Kristi McCracken, ATC, Jacqueline A. Turner, APN, Soyang Kwon, PhD, Cynthia R. LaBella, MD

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.