Predicting and preventing postconcussive problems in paediatrics (5P) study: protocol for a prospective multicentre clinical prediction rule derivation study in children with concussion

Roger Zemek, Martin H Osmond, Nick Barrowman, Pediatric Emergency Research Canada (PERC) Concussion Team, Peter Anderson, Karen Barlow, Miriam Beauchamp, Darcy Beer, Kathy Boutis, Brian L Brooks, Brian J Brooks, Emma Burns, William Craig, Carol Dematteo, Sasha Dubrovsky, Ken Farion, Stephen Freedman, Isabelle Gagnon, Jocelyn Gravel, Blaine Hoshisaki, Michelle Keightley, Terry Klassen, William Meehan, Willem Meeuwisse, Angelo Mikrogianakis, Lawrence Richer, Gurinder Sangha, Michael Vassilyadi, Roger Zemek, Martin H Osmond, Nick Barrowman, Pediatric Emergency Research Canada (PERC) Concussion Team, Peter Anderson, Karen Barlow, Miriam Beauchamp, Darcy Beer, Kathy Boutis, Brian L Brooks, Brian J Brooks, Emma Burns, William Craig, Carol Dematteo, Sasha Dubrovsky, Ken Farion, Stephen Freedman, Isabelle Gagnon, Jocelyn Gravel, Blaine Hoshisaki, Michelle Keightley, Terry Klassen, William Meehan, Willem Meeuwisse, Angelo Mikrogianakis, Lawrence Richer, Gurinder Sangha, Michael Vassilyadi

Abstract

Introduction: Persistent postconcussive symptoms (PCSs) is the persistence of somatic, cognitive, physical, psychological and/or behavioural changes lasting more than 1 month following concussion. Persistent concussion impacts the quality of life through impaired cognition, memory and attention affecting school performance, mood and social engagement. No large epidemiological studies have determined the true prevalence of persistent concussion symptoms. Validated, easy-to-use prognosticators do not exist for clinicians to identify children at highest risk. The goal of Predicting and Preventing Postconcussive Problems in Pediatrics study is to derive a clinical prediction rule for the development of persistent postconcussion symptoms in children and adolescents presenting to emergency department following acute head injury.

Methods and analysis: This study is a prospective, multicentre cohort study across nine academic Canadian paediatric emergency departments. We will recruit the largest prospective epidemiological cohort of children with concussion. Eligible children will be followed using Post-Concussion Symptom Inventory, a validated tool in children as young as 5 years. Patients will follow-up at 1, 2, 4, 8 and 12 weeks postinjury. The main outcome will be the presence/absence of PCSs defined as three or more persistent concussion symptoms 1 month following the injury. 1792 patients provide adequate power to derive a clinical decision rule using multivariate analyses to find predictor variables sensitive for detecting cases of persistent postconcussion symptoms.

Ethics and dissemination: Results of this large prospective study will enable clinicians to identify children at highest risk, optimise treatment and provide families with realistic and appropriate anticipatory guidance. Ethics has been obtained through the Children's Hospital of Eastern Ontario Research Ethics Board. Results will be disseminated at international conferences and in four manuscripts to peer-reviewed journals.

Trial registration: This study is registered at Clinicaltrials.gov through the US National Institute of Health/National Library of Medicine (NCT01873287; https://ichgcp.net/clinical-trials-registry/NCT01873287).

Keywords: Accident & Emergency Medicine; Epidemiology; Paediatrics; Sports Medicine.

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