PMID- 24127708
OWN - NLM
STAT- MEDLINE
DCOM- 20140619
LR  - 20211015
IS  - 1553-2712 (Electronic)
IS  - 1069-6563 (Linking)
VI  - 20
IP  - 10
DP  - 2013 Oct
TI  - Parental anxiety at initial acute presentation is not associated with prolonged 
      symptoms following pediatric concussion.
PG  - 1041-9
LID - 10.1111/acem.12220 [doi]
AB  - OBJECTIVES: Anxiety modulates symptom perception in adults following concussion, 
      prolonging the time to full recovery. The authors sought to determine whether 
      parental anxiety was associated with persistent postconcussive symptoms (PCS) in 
      their children following concussion. METHODS: A prospective observational cohort 
      with 98 children aged 5 to 17 years following concussion participated from a 
      tertiary pediatric emergency department (ED). The main exposure was parental 
      anxiety at the time of acute presentation following pediatric concussion, 
      measured using the self-administered, validated Spielberger State-Trait Anxiety 
      Inventory-State Anxiety Scale (STAI-S). The primary outcome measured was presence 
      of PCS in the child at 1 month, per the validated Post-Concussive Symptom 
      Inventory (PCSI). Secondary outcome measures included parental anxiety score over 
      time, school absenteeism, and return to sports. Data were collected during the 
      initial ED visit and at 3-day, 7-day, 2-week, 1-month, and 3-month follow-ups. 
      RESULTS: Of 98 children enrolled, 27% (95% confidence interval [CI] = 19% to 36%) 
      developed PCS at 1 month. No significant associations were detected between 
      parental anxiety at the index visits and the number of previous pediatric 
      concussions (p = 0.73), sex (p = 0.61), loss of consciousness (p = 0.43), history 
      of migraines (p = 0.31), or history of anxiety diagnosed in the patients 
      (p = 0.09). A significant association was noted between patient diagnosis of 
      attention deficit hyperactivity disorder (ADHD) and parental anxiety at the index 
      visits (p = 0.001). Parental anxiety at acute presentation was not associated 
      with children's prolonged symptoms at 1 month (p = 0.63). Parental anxiety 
      remained elevated in parents whose children had prolonged symptoms compared to 
      those parents whose children's symptoms resolved (median = 30, interquartile 
      range [IQR] = 22 to 44; and median = 21, IQR = 20 to 25, respectively; 
      p < 0.001). Initial parental anxiety presentation was not associated with school 
      absenteeism (p = 0.23) or not returning to sport or gym class (p = 0.89). There 
      were no significant effects involving ADHD alone (p = 0.44) or together with 
      baseline parental anxiety (p = 0.36 for ADHD and p = 0.55 for anxiety) using 
      logistic regression analysis to examine potential predictive effects of child's 
      ADHD combined with parental anxiety at the index visit on persistent symptoms at 
      1 month. CONCLUSIONS: Parental anxiety at time of acute presentation does not 
      appear to be associated with prolongation of postconcussive symptoms in their 
      children. However, parents of persistently symptomatic children remain 
      significantly more anxious than those whose children's symptoms have resolved. 
      Future research should attempt to reduce the familial burden of concussion 
      through expectation management strategies.
CI  - (c) 2013 by the Society for Academic Emergency Medicine.
FAU - Zemek, Roger
AU  - Zemek R
AD  - Division of Pediatric Emergency Medicine, Children's Hospital of Eastern Ontario, 
      Ontario; Department of Pediatrics, University of Ottawa, Ontario; Children's 
      Hospital of Eastern Ontario Research Institute, Ontario.
FAU - Clarkin, Chantalle
AU  - Clarkin C
FAU - Farion, Ken J
AU  - Farion KJ
FAU - Vassilyadi, Michael
AU  - Vassilyadi M
FAU - Anderson, Peter
AU  - Anderson P
FAU - Irish, Brendan
AU  - Irish B
FAU - Goulet, Kristian
AU  - Goulet K
FAU - Barrowman, Nick
AU  - Barrowman N
FAU - Osmond, Martin H
AU  - Osmond MH
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Acad Emerg Med
JT  - Academic emergency medicine : official journal of the Society for Academic 
      Emergency Medicine
JID - 9418450
SB  - IM
MH  - Adolescent
MH  - Anxiety/*psychology
MH  - Brain Concussion/*diagnosis
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Humans
MH  - Male
MH  - Parents/*psychology
MH  - Post-Concussion Syndrome/diagnosis
MH  - Prospective Studies
EDAT- 2013/10/17 06:00
MHDA- 2014/06/20 06:00
CRDT- 2013/10/17 06:00
PHST- 2013/02/04 00:00 [received]
PHST- 2013/04/26 00:00 [revised]
PHST- 2013/05/22 00:00 [revised]
PHST- 2013/06/05 00:00 [accepted]
PHST- 2013/10/17 06:00 [entrez]
PHST- 2013/10/17 06:00 [pubmed]
PHST- 2014/06/20 06:00 [medline]
AID - 10.1111/acem.12220 [doi]
PST - ppublish
SO  - Acad Emerg Med. 2013 Oct;20(10):1041-9. doi: 10.1111/acem.12220.