A secondary analysis of a recent trial conducted by the Children’s Hospital of Wisconsin (Milwaukee, WI, USA) has explored symptom spikes in children after concussion. The researchers suggest that symptom exacerbations following concussion are common but are largely transient, and highlight the need for further research into the cause and consequences of these spikes.
The 10-day analysis of clinical trial data involved 63 (mostly male) children who were approximately 14 years old. The children recorded their daily activities in diaries and completed a scale of symptoms following concussion. The trial authors defined symptom spikes as being an increase of ten or more points over consecutive days on the postconcussion symptom scale. The authors also measured the occurrence of the spikes. The children involved in the study did not have an abnormal CT scan or require hospitalization, but did sustain concussion.
The authors observed that approximately a third of the children experienced symptom spikes. A total of four children had a second spike, but no children were observed to have more than two. Within 24 hours, the symptom spikes tended to partially resolve. Although the risk of symptom spikes appeared to increase following a sudden increase in mental activity following school attendance or participation in extracurricular activities, the results indicated that most spikes did not occur after mental or physical strain.
The researchers concluded: “In the interim, our findings support continuing to advise children to return to activities gradually and in a manner that does not significantly exacerbate symptoms, because even a transient worsening might provoke anxiety and interfere with school reintegration.”
Although the results of the analysis suggest that postconcussion symptom exacerbations are customary, temporary and “not specific to a particular symptom domain”, the study did have limitations: small sample size and the use of diaries. The authors advise that further research is needed to “determine the causes and consequences of symptom spikes.”
Sources: Silverberg ND, Iverson GL, McCrea M, Apps JN, Hammeke TA, Thomas DG. Activity-related symptom exacerbations after pediatric concussion. JAMA Pediatr. doi:10.1001/jamapediatrics.2016.1187 (2016) (Epub ahead of print);