Clinical Score Improves Prediction of Concussion Outcomes in Children 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

Dr. Roger Zemek

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 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. 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. What should clinicians and patients take away from your report?

Dr. Zemek: This score has the potential to individualize concussion care through optimal symptom management and appropriate follow-up.   This will help guide clinicians to provide evidence-based anticipatory guidance.  We employed an easily calculable score that does not require summation of all items of symptom inventory since complex scale would introduce a barrier to adoption by acute care clinicians, and all the factors are clinically available (not requiring advanced neuroimaging or biomarkers). What recommendations do you have for future research as a result of this study?

Dr. Zemek: Future research should examine the effectiveness of this rule in implementation studies in various settings (e.g., general primary care) in children and teens, as well as across various ages (e.g., adults) with concussion.  Future research can also explore whether prediction rule can be further refined with advanced MRI neuroimaging and biomarkers.

This study was a necessary step in order to determine who may most benefit from future interventional studies designed to reduce the frequency and severity of PPCS versus the current standard treatment of rest. Thank you for your contribution to the community.


Roger Zemek, MD et al. Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED. JAMA, March 2016 DOI:10.1001/jama.2016.1203

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on

[wysija_form id=”5″]

Dr. Roger Zemek (2016). Clinical Score Improves Prediction of Concussion Outcomes in Children 

Last Updated on March 10, 2016 by Marie Benz MD FAAD