JNNP: Concussion symptoms and rehabilitation in children and adolescents with anxiety disorders.

Concussion, also known as mild brain trauma (mTBI), is a major public health problem in the United States.
estimates that more than one in a million children receive concussion treatment in the emergency room each year.
most injured children and adolescents usually disappear within four weeks, 25 to 40 per cent of the experience will return to a period of several months to several years.
a growing body of research has identified risk factors for concussion recovery in young people, including injury-related factors (e.g., more serious injury mechanisms) and injury-related factors (e.g., age and gender).
, current treatment guidelines include a general classification of "pre-injury nervous system and mental illness" as risk factors.
is a subset of this larger category due to its high prevalence among children (estimated at about 8 per cent, range: 2 to 24 per cent).
7, however, there is little literature on the role of pre-existing anxiety disorders in rehabilitation.
currently has no studies to assess differences in the trajectory of concussion symptoms for anxiety disorders of current age, nor does it provide a measure of the association between anxiety disorders in children and adolescents and mTBI recovery.
: A retrospective study of continuous patients aged 5-17 was conducted in a multidisciplinary practice at the Minnesota Children's Concussion Clinic between April 1, 2018 and March 31, 2019.
To keep track of patients from initial visits until discharge, the clinic uses the Acute Concussion Assessment List, a proven concussion data collection tool that can be used in children and adolescents between the ages of 3 and 18 to collect information about patient demographics, medical history, injury characteristics, and injury-related symptoms.
visual symptoms are assessed through a validated symptom survey (CISS).
used standardized templates to collect data in the provision of medical services.
data are extracted from electronic medical records by trained personnel and entered into the REDCap database.
use standard procedures to check for inaccurate/unreasonable values of variables and correct them appropriately.
: A total of 798 patients were examined at three concussion clinics during the 12-month study period.
of the 667 eligible patients, 637 had previously agreed and were included in the study.
age of patients included in the IQR was 13 years (IQR 11-15 years), with 47% male.
patients received an average of 2 clinical visits (IQR 1-3).
155 patients (24%) reported pre-existing anxiety disorders.
Some of the symptoms that are more common in patients with pre-existing anxiety disorders are more common in patients who visit for the first time, including neck pain, difficulty falling asleep, increased neurotic/anxiety disorders, sensory slowness, and decreased attention/attention (all p.lt;0.002, online supplement table 1).
, patients with anxiety disorders had higher scores for medium visual symptoms (30 to 21 points, p.lt;0.001), reflecting greater visual impairment.
pre-existing anxiety disorders are associated with more symptoms and longer recovery times in children and adolescents after concussion.
From a clinical perspective, providing patients and their families with accurate recovery estimates at first visits can normalize longer recovery expectations, and timely targeted treatment can promote more effective recovery for these patients.
further work is needed to identify potential biological and psychosocial mechanisms that cause increased symptoms and longer recovery times in children and adolescents with anxiety disorders.
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