A 12-point clinical score for children with concussion has been developed and shown in a new study to identify those who are more likely to have prolonged symptoms and therefore need closer follow-up. The study, published in the March 8 issue of JAMA, was conducted by a team led by Roger Zemek, MD, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada. “We have developed an easy-to-calculate clinical score which could potentially individualize concussion care in children, identifying those with high risk of prolonged symptoms who will need closer follow-up,” Dr Zemek told Medscape Medical News. “The first question parents ask is, ‘When is my child going to be better?’ But prior to this work we didn’t have any scientific basis to answer this question,” he said. He explained that concussion symptoms are prolonged for more than a month in about one third of cases. Such symptoms can include headache, dizziness, and difficulty concentrating, symptoms that have an adverse effect on quality of life and can affect school attendance and exam performance. “Currently we cannot tell which patients are more likely to have prolonged symptoms,” he said. “It is important to be able to provide the family with some realistic guidance on when the child is likely to recover and to be able to target specialist care to the higher-risk patients.”
The researchers looked at more than 70 possible variables and found 9 that seemed to be particularly independently associated with long-term symptoms: female sex, age 13 years or older, migraine history, previous concussion with symptoms lasting longer than 1 week, headache, sensitivity to noise, fatigue, answering questions slowly, and difficulty standing on a balance beam (4 or more errors on the Balance Error Scoring System). The researchers developed a scoring system; most of these factors were assigned 1 point, but age 13 or older , female sex, and fatigue were given 2 points because they were more strongly associated with long-term symptoms. This resulted in a 12-point scale, and the researchers designated a score of 9 to 12 as high risk, 0 to 3 as low risk, and 4 to 8 as intermediate risk. “Our results suggest that a score of 9 to 12 on this scale signifies a high risk of prolonged symptoms of concussion, with a 93% certainty: ie, the test has a 93% specificity,” Dr Zemek said. “We can also say that a score of 9 to 12 means that a child is three times more likely to have persistent symptoms than the standard score. And a score of 0 to 3 means they are three times less likely than a standard score to have prolonged issues.”