5P Risk Classification Predicts Performance on Self-reported but Not Objective Clinical Outcomes at 4 Weeks Postconcussion in Children.

Abstract

To determine if performance on symptom, cognitive, balance, fatigue, physical activity, and quality of life outcomes at 4 weeks postinjury in children with concussion differs based on acute Predicting and Preventing Postconcussive Problems in Pediatrics (5P) risk classification. Prospective cohort. Laboratory. Sixty-two children (age: 13.27±2.50y; 29 [46.7%] women) with diagnosed concussion. Not applicable. Patient demographics and postinjury assessments were completed within 72 hours of concussion and used to classify patients as "high," "moderate," or "low" persistent postconcussion symptoms risk. Children then completed a multimodal assessment battery at 4 weeks postconcussion. Kruskal-Wallis assessments analyzed whether study outcomes differed between 5P risk groups. Significant group differences were observed in symptom (χ²(2)=9.76, P=.008), fatigue (χ²(2)=14.60, P<.001), physical activity (χ²(2)=15.76, P<.001), and quality of life (χ²(2)=7.82, P=.02) outcomes. The low-risk group had fewer symptoms and less fatigue but increased physical activity levels and quality of life compared with the high-risk group. No significant differences in cognitive or balance outcomes were observed (P>.05). The 5P rule provides clinicians with valuable prognostic information related to persistent postconcussion symptoms and self-reported outcomes 4 weeks postconcussion, but not objective cognitive or balance outcomes. This information may help clinicians prioritize treatment resources to children most at risk of prolonged concussion recovery.