MedicalResearch.com Interview with:
Roger Zemek, MD, FRCPC
Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion, University of Ottawa
Director, Clinical Research Unit, Children’s Hospital of Eastern Ontario
Ottawa, ON
MedicalResearch.com: What is the background for this study?
Dr. Zemek: The number of concussions have dramatically increased over the past decade. Not only are children and adolescents are at highest risk for getting concussions, they also take longer to recover. As part of our background work, our team performed a systematic review (published in JAMA Pediatrics) confirming that validated, easy-to-use prognosticators did not exist for clinicians to identify children with concussion who are at the highest risk for persistent post-concussive symptoms (PPCS) and sequelae.
MedicalResearch.com: What are the main findings?
Dr. Zemek: In this, the largest concussion study in the world to-date, we derived and validated in a large, diverse cohort of children a clinical risk score that is significantly superior to clinicians’ ability to predict future PPCS at the time of ED presentation. Multivariate analysis revealed that age group, female sex, past history of migraine, prior concussion with symptom duration of >1 week, ED presentation with “answering questions slowly”, 4 or more errors on BESS Tandem stance, and the initial symptoms of headache, noise sensitivity and fatigue were all clinically significant and strongly associated with PCS at 1-month.
We assigned points based on the adjusted multivariate odds ratio, and the rule incorporating patient demographic factors, past history, early cognitive deficits, balance (an physical exam finding), and early symptoms. The rule has a maximum of 12 points. We selected two cut-off points in order to yield three clinically relevant (low, intermediate and high risk) categories for the development of PPCS at one month.
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