History of Somatization Is Associated with Prolonged Recovery from Concussion

doi:10.1016/j.jpeds.2016.03.020

The Journal of Pediatrics

Volume 174, July 2016, Pages 39-44.e1

https://doi.org/10.1016/j.jpeds.2016.03.020 Get rights and content

Objective

To determine the association between a history of somatization and prolonged concussion symptoms, including sex differences in recovery.

Study design

A prospective cohort study of 10- to 18-year-olds with an acute concussion was conducted from July 2014 to April 2015 at a tertiary care pediatric emergency department. One hundred twenty subjects completed the validated Children's Somatization Inventory (CSI) for pre-injury somatization assessment and Postconcussion Symptoms Scale (PCSS) at diagnosis. PCSS was re-assessed by phone at 2 and 4 weeks. CSI was assessed in quartiles with a generalized estimating equation model to determine relationship of CSI to PCSS over time.

Results

The median age of our study participants was 13.8 years (IQR 11.5, 15.8), 60% male, with separate analyses for each sex. Our model showed a positive interaction between total CSI score, PCSS and time from concussion for females P < .01, and a statistical trend for males, P = .058. Females in the highest quartile of somatization had higher PCSS than the other 3 CSI quartiles at each time point (B −26.7 to −41.1, P values <.015).

Conclusions

Patients with higher pre-injury somatization had higher concussion symptom scores over time. Females in the highest somatization quartile had prolonged concussion recovery with persistently high symptom scores at 4 weeks. Somatization may contribute to sex differences in recovery, and assessment at the time of concussion may help guide management and target therapy.

Section snippets

Methods

The project was approved by the university-affiliated institutional review board. Patients diagnosed with an acute concussion in our tertiary care pediatric emergency department were recruited to participate in a research study on concussions. Subjects were considered eligible to participate if they were 10-18 years old at the time of diagnosis and had an acute concussion within 48 hours of presentation. An acute concussion was defined as a positive head trauma with a key injury characteristic

Results

Table II shows the demographics, injury mechanisms and characteristics, and history of concussions and migraines of the 120 subjects enrolled in the study; 60% of our patient population was male and ∼60% of our patient population had sport- or recreation-related injuries.

PCSS scores were collected at enrollment and at 2- and 4-week follow-up phone calls (Table III; available at www.jpeds.com). According to normative data for Immediate Post-Concussion Assessment and Cognitive Testing v 2.0,

Discussion

Overall, our sample was consistent with previous studies on prolonged concussion symptoms4, 5; 42% of our subjects met criteria for a concussion by symptoms at 2 weeks and 31% met criteria at 4 weeks, with a higher percentage of females showing concussion symptoms at the 4-week interval compared with males.

As we hypothesized, our GEE model indicated that the somatization estimate (CSI score), had a significant positive relationship with total concussion symptoms score (PCSS) and time for

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: Supported by the National Institutes of Health (UL1TR000005 [to L.W. and D.W.]). A.K. is supported by the University of Pittsburgh from the National Institute on Deafness and Other Communication Disorders (1K01DC012332-01A1). The authors declare no conflicts of interest.

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Original ArticleHistory of Somatization Is Associated with Prolonged Recovery from Concussion

Objective

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

J Pediatr

Int J Dev Neurosci

J Am Acad Child Adolesc Psychiatry

Sleep Med

Pain

Neurobehavioral outcomes of mild head injury in children and adolescents

Pediatr Rehabil

High school concussions in the 2008-2009 academic year

Am J Sports Med

Examining recovery trajectories after sport-related concussion with a multimodal clinical assessment approach

Neurosurgery

Predictors of 1-month of 1-year neurocognitive functioning from the UCLA Longitudinal Mild, Uncomplicated, Pediatric Traumatic Brain Injury Study

J Int Neuropsychol Soc

Prolonged recovery of memory functioning after mild traumatic brain injury in adolescent athletes

J Neurosurg

Predicting postconcussion syndrome after mild traumatic brain injury in children and adolescents who present to the emergency department

JAMA Pediatr

Injury versus noninjury factors as predictors of post-concussive symptoms following mild traumatic brain injury in children

Neuropsychology

Incidence, clinical course, and predictors of prolonged recovery time following sport-related concussion in high school and college athletes

J Int Neuropsychol Soc

Postconcussive symptom exaggeration after pediatric mild traumatic brain injury

Pediatrics

Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study

JAMA

An algorithm for defining somatization in children

J Can Acad Child Adolesc Psychiatry

Abdominal pain in children and symptoms of somatization disorder

J Pediatr Psychol

Somatization symptoms in pediatric abdominal pain patients: relation to chronicity of abdominal pain and parent somatization

J Abnorm Child Psychol

Annual research review: functional somatic symptoms and associated anxiety and depression—developmental psychopathology in pediatric practice

J Child Psychol Psychiatry

Measurement of symptoms following sports-related concussion: reliability and normative data for the post-concussion scale

Appl Neuropsychol

Original Article
History of Somatization Is Associated with Prolonged Recovery from Concussion