Association of Preinjury Medical Diagnoses With Pediatric Persistent Postconcussion Symptoms in Electronic Health Records.
J Head Trauma Rehabil
; 37(2): E80-E89, 2022.
Article
em En
| MEDLINE
| ID: mdl-33935230
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. MAINMEASURES:
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.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Concussão Encefálica
/
Nasofaringite
/
Síndrome Pós-Concussão
/
Duodenite
/
Gastrite
Tipo de estudo:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Child
/
Humans
Idioma:
En
Revista:
J Head Trauma Rehabil
Assunto da revista:
REABILITACAO
/
TRAUMATOLOGIA
Ano de publicação:
2022
Tipo de documento:
Article