Does Age Matter in Concussion Recovery?
When it comes to developing a treatment plan for concussion, specialists consider an enormous amount of information including medical history, prior concussions, and even cognitive and vision testing. But new research is putting a spotlight on the importance of accounting for age when it comes to better understanding concussions and its role in recovery.
According to a recent study published in JAMA Pediatrics, younger children are more likely to describe more severe symptoms of concussion, while expressing poorer balance scores when compared to older children or parental symptom reports.4 Additionally, symptoms such as irritability, cognitive difficulties and headaches can persist in up to 30% of children, versus most adults who typically recover within several days.1-2
Although sorting through this information has become an art, science is helping bridge the gap between knowledge and treatment through more readily available diagnostic tools and access to better "norms". Our researchers at the Rothman Concussion Network have focused on compiling normative data for a software-based balance test, Sway Medical, in children and adolescents over the last several years. Scores give way to similar patterns of steady performance that increase with age, leveling off around early adulthood.
Recent findings in the Journal JAMA Pediatrics indicate that injuries such as brain lesions detected on MRI are very rarely seen in sports concussion patients3, and that concussion diagnosis should instead be supported with assessment tools such as the SCAT-3 and Child SCAT-3 (or more recently the SCAT-5)4, which measure areas like memory, balance, vision and symptom severity. However, while most concussion assessments such as the SCAT incorporate some form of pre- and post-injury testing, many health care providers are relying more heavily on normative data (a collection of average scores) when "healthy" baseline reports, which can be difficult to obtain, are not readily available. New research is underscoring this need for precise, age-specific normative data when interpreting any type of concussion testing. Creating age-appropriate cognitive tests has not gone unnoticed by ImPACT Applications who developed an FDA-cleared children's version of their test last year complete with age- and gender- based data to better serve young patients.
Proper care early on and attention to developmental influences may be key to reducing the chance of long-term symptoms, and right now the growth of information is stacking the cards on our side.
- Eisenberg, MA, Meehan, WP, and Mannix, R (2014). Duration and course of post-concussive symptoms. Pediatrics 133, 999-1006.
- Meehan, WP, Mannix, RC, Stracciolini, A, Elbin, RJ, and Collins, MW (2013). Symptom severity predicts prolonged recovery after sport-related concussion, but age and amnesia do not. J. Pediatr. 163,721-725.
- Bonow RH, Friedman SD, Perez FA, Ellenbogen RG, Browd SR, Mac Donald CL, Vavilala MS, Rivara FP. Journal of Neurotrauma. July 2017, ahead of print. https://doi.org/10.1089/neu.2017.4970
- McCrory P, et al. Consensus statement on concussion in sport: the 5th International Conference on Concussion in Sport held in Berlin, October 2016. Br J Sports Med 2017; 0:1-10.
- Brooks MA, Snedden TR, Mixis B, Hetzel S, McGuine TA. Establishing baseline normative values for the child sport concussion assessment tool. JAMA Pediatr. 2017;171(7):670-677. doi:10.1001/jamapediatrics.2017.05922.