The Characteristics and Criteria Used to Define Persisting Symptoms in Children with Concussion: A Scoping Review

Abstract

The objective was to characterize the definitions and criteria used to determine persisting symptoms after concussion in children. This scoping review followed a five-step framework. Four databases (PubMed, Scopus, PsychInfo, and Web of Science) were searched using the concepts of concussion, children, and persisting symptoms. Articles were included if they were (1) original peer-reviewed articles, (2) written in English or French, (3) exclusively sampled children and adolescents (≤19 years old) with persisting symptoms after concussion, and (4) provided an operational definition of persisting symptoms after concussion. Forty-seven studies were included. The term for labeling persisting symptoms after concussion has evolved over time. The most common term used to describe this phenomenon in children with concussion was persistent postconcussion symptoms (n = 26), first appearing in 2016 and peaked in the early 2020s. Persisting symptoms after concussion is an emerging term that debuted in 2022. The most used threshold was reporting ≥1 concussion symptoms (n = 30), followed by ≥3 new or worsening concussion symptoms (n = 14) relative to pre-injury levels. The most common minimum threshold to classify persisting symptoms was 1 month after concussion (n = 38). Only 6 studies directly cited clinical diagnostic criteria to justify their definition of persisting symptoms, while 12 studies cited another peer-reviewed article. Current definitions for defining persisting symptoms after concussion rely solely on self-reported symptoms but vary in relation to the term used and the number of symptoms/amount of time following concussion required. A more holistic, standardized definition for persisting symptoms should be adopted for better consistency in research and clinical practice.