Reuter-Rice Submits Application For Study of Postconcussive Symptoms in Children

Kudos to Karin Reuter-Rice, associate professor, and her entire team for the submission of her NIH/NINR R01 application entitled “Risk Stratification of Postconcussive Symptoms in Children to Promote Health Outcomes and Academic Performance." This proposal requests funding for a five-year period with a start date of July 4, 2021.

Concussions are occurring at an alarming rate among American schoolchildren. Currently, one in five children is diagnosed with a concussion before the age of 16 years. These head injuries account for more than 1 million emergency department visits each year—a 50% increase over the past decade—and cost the US healthcare system $1 billion annually. Compared to adults, concussed children experience more and longer lasting symptoms. Up to 60% of children remain symptomatic 1 month after their injury; 25% remain symptomatic after 12 months. Persistent symptoms result in increased school difficulties, social isolation, psychological distress, and fewer future vocational opportunities. One poorly understood symptom is persistent fatigue, which impacts up to 73% of children after a traumatic brain injury (TBI). Early evidence suggests this fatigue is caused by genetic inflammation resulting from concussion. Other common TBI symptoms include depression, cognitive problems, anxiety, and sleep disorders. Despite the significant threat these symptoms pose to children’s health and wellbeing, no diagnostic tool exists to help clinicians predict who is at highest risk for ongoing physical and emotional problems after a concussion. To address this public health need, this project will enroll 300 children aged 11-17 years who recently suffered a concussion. Participants will be recruited and assessed at two university-based sports concussion clinics. For 12 months following initial assessment, we will measure symptom trajectories using NIH patient reported outcomes (PROs). By allowing patients to speak in their own words, PROs provide unique insight into how concussed children experience fatigue and other symptoms in their daily lives. In addition, saliva samples will be collected and later analyzed at Duke University’s Molecular Physiology Institute for markers of inflammation as a result of the concussion. The project will use the NIH Symptom Science Model to identify specific symptom trajectories at six time points over the 12-month assessment period. Using growth mixture modelling, children will be grouped into distinct symptom-based categories (typologies). These typologies will be combined with inflammatory biomarker data to develop a new risk stratification prediction tool. For the first time, health and academic professionals will be able to identify children at highest risk for persistent concussion symptoms. This novel combination of subjective PROs and objective biologic information can help clinicians develop improved treatment plans for this vulnerable patient population. With the rate of pediatric concussions on the rise, this study and the resulting risk prediction tool risk will provide researchers and clinicians with a new evidence-based means of identifying children who require special attention to reduce the negative health, psychosocial, and academic consequences of concussions. It also could reduce the substantial socioeconomic burden on families, school districts, and healthcare systems across the United States.