The 5P Study: Predicting and Preventing Post-Concussive Problems in Pediatrics

The 5P Study: Predicting and Preventing Post-Concussive Problems in Pediatrics

Lead Researcher:  Dr. Roger Zemek, Emergency Department Physician and Lead Scientist at the Children’s Hospital of Eastern Ontario, Associate Professor at the University of Ottawa.

Co-funded by the Canadian Institutes of Health Research (CIHR) and the Ontario Neurotrauma Foundation (ONF)

A new study based on the largest prospective cohort of children with concussion in the world was published in the Journal of the American Medical Association (JAMA) in March of 2016. The study introduces a validated clinical prediction score that will help health providers and researchers to predict the duration of pediatric concussion symptoms.

The published abstract and article can be found at: http://jama.jamanetwork.com/article.aspx?articleid=2499274

The highest incidence of concussion is found among children and adolescents.   One-third of them experience ongoing symptoms beyond one month, known as persistent post-concussion symptoms (PPCS).  These can include physical symptoms (e.g., headache or dizziness), cognitive symptoms (e.g., difficulty concentrating or feeling in a fog), emotional symptoms or behavioral symptoms). Consequences may include missed school, depressed mood, loss of social and physical activities, and lower quality of life. 

The 5P study: Predicting and Preventing Post-concussive Problems in Pediatrics, led at CHEO and including nine pediatric emergency departments across Canada, enrolled over 3,000 children. All participants were aged 5-18 years old and evaluated within the first 48-hours after head injury (with most patients presenting within 3 hours of their injury). 

Experts from across Canada and the United States developed a PPCS risk score that when applied to a child within 48-hours of their head injury, was proven to be significantly better than the child’s physician was at predicting future PPCS. The score incorporates nine clinical variables containing information from demographics, history, initial symptoms, cognitive complaints, and a physical examination.

The 5P study unveiled a number of findings. For instance, while boys sustained more concussions, girls had twice the odds of boys for having symptoms last at least one month. In addition, older children and teens have a higher risk of PPCS than children under 8 years old do. 

“By predicting high or low risk of post-concussion symptoms, we can be more efficient in arranging follow-up.  Those at low risk may not need specialty referral, whereas those at high risk could be prioritized for early follow-up with concussion specialists,” said Dr.Roger Zemek. “This study will be a cornerstone for future concussion treatment; researchers now have the ability to target high risk children for novel interventions with the goal of preventing PPCS.”

5P sites include the Children’s Hospital of Eastern Ontario, Stollery Children’s Hospital, Alberta Children’s Hospital Research Institute, Children’s Hospital of Winnipeg, Hospital for Sick Children, Children’s Hospital of Western Ontario, CHU Sainte-Justine, Montreal Children’s Hospital, and IWK Health Sciences Centre.

Future directions:

Before this score is adopted in clinical practice, further research is needed for external validation, assessment of accuracy in an office setting, and determination of clinical utility. The 5P team is also working on over a dozen related sub-studies including quality of life following concussion, effect of rest/physical activity following concussion, neuropsychological outcomes following concussion, and the biomechanics of injury.