Association of Preinjury Medical Diagnoses With Pediatric Persistent Postconcussion Symptoms in Electronic Health Records. Issue 2 (21st March 2022)

• Record Type: Journal Article
• Authors: Yengo-Kahn, Aaron M.; Hibshman, Natalie; Bonfield, Christopher M.; Torstenson, Eric S.; Gifford, Katherine A.; Belikau, Daniil; Davis, Lea K.; Zuckerman, Scott L.; Dennis, Jessica K.
• Is Part Of: Journal of head trauma rehabilitation. Volume 37:Issue 2(2022)
• Page Start: E80
• Page End: E89
• Publication Date: 2022-03-21
• Subjects: brain trauma -- case-control studies -- pediatric -- risk factors in epidemiology; Brain damage -- Patients -- Rehabilitation -- Periodicals; Brain damage -- Periodicals; 617.4810443
• DOI: 10.1097/HTR.0000000000000686
• Languages: English
• ISSNs: 0885-9701

Abstract

Abstract : Objective: To identify risk factors and generate hypotheses for pediatric persistent postconcussion symptoms (PPCS). Setting: A regional healthcare system in the Southeastern United States. Participants: An electronic health record–based algorithm was developed and validated to identify PPCS cases and controls from an institutional database of more than 2.8 million patients. PPCS cases ( n = 274) were patients aged 5 to 18 years with PPCS-related diagnostic codes or with PPCS key words identified by natural language processing of clinical notes. Age, sex, and year of index event–matched controls ( n = 1096) were patients with mild traumatic brain injury codes only. Patients with moderate or severe traumatic brain injury were excluded. All patients used our healthcare system at least 3 times 180 days before their injury. Design: Case-control study. Main Measures: The outcome was algorithmic classification of PPCS. Exposures were all preinjury medical diagnoses assigned at least 180 days before the injury. Results: Cases and controls both had a mean of more than 9 years of healthcare system use preinjury. Of 221 preinjury medical diagnoses, headache disorder was associated with PPCS after accounting for multiple testing (odds ratio [OR] = 2.9; 95% confidence interval [CI]: 1.6-5.0; P = 2.1e-4). Six diagnoses were associated with PPCS at a suggestive threshold for statistical significance (false discovery rate P < .10): gastritis/duodenitis (OR = 2.8; 95% CI: 1.6-5.1; P = 5.0e-4), sleep disorders (OR = 2.3; 95% CI: 1.4-3.7; P = 7.4e-4), abdominal pain (OR = 1.6; 95% CI: 1.2-2.2; P = 9.2e-4), chronic sinusitis (OR = 2.8; 95% CI: 1.5-5.2; P = 1.3e-3), congenital anomalies of the skin (OR = 2.9; 95% CI: 1.5-5.5; P = 1.9e-3), and chronic pharyngitis/nasopharyngitis (OR = 2.4; 95% CI: 1.4-4.3; P = 2.5e-3). Conclusions: These results support the strong association of preinjury headache disorders with PPCS. An association of PPCS with prior gastritis/duodenitis, sinusitis, and pharyngitis/nasopharyngitis suggests a role for chronic inflammation in PPCS pathophysiology and risk, although results could equally be attributable to a higher likelihood of somatization among PPCS cases. Identified risk factors should be investigated further and potentially considered during the management of pediatric mild traumatic brain injury cases.