Preventing Symptom Spikes in Pediatric Concussion

HealthDay News — About one-third of pediatric patients will experience spikes in concussion symptoms days after the injury, according to a study published in JAMA Pediatrics.

Noah D. Silverberg, PhD, from the University of British Columbia in Vancouver, Canada, and colleagues characterized the incidence, course, and clinical significance of symptom exacerbations in children after concussion. Data were analyzed for 63 eligible participants (41 boys, 22 girls) who were asked to complete a post-concussion symptom scale and record their activities for 10 days.

The researchers found that about one-third of the sample (31.7%) had symptom spikes, which tended to partially resolve within 24 hours. The risk of symptom spike was increased with an abrupt increase in mental activity (i.e., returning to school and extracurricular activities) from one day to the next (relative risk, 0.81; 95% confidence interval, 0.21 to 3.21), but there was no documented increase in physical or mental energy preceding most symptom spikes. Patients with symptom spikes were more symptomatic in the emergency department and through the observation period, but there was no difference in cognition or balance 10 days following injury for those with and without symptom spikes.

“The present findings support clinical guidelines for adolescents to return to school and activities gradually after concussion,” the authors write.


Silverberg ND, Iverson GL, McCrea M, Apps JN, Hammeke TA, Thomas DG. Activity-Related Symptom Exacerbations After Pediatric Concussion. JAMA Pediatr. 2016; doi:10.1001/jamapediatrics.2016.1187.