Reducing persisting symptoms following child concussion: a randomised controlled clinical trial

Despite being an increasing public health concern, and a 40 percent rate of debilitating, persisting post-concussive symptoms (PCS), current knowledge regarding child and adolescent concussion is inadequate to direct effective, timely, low cost treatment. To date, clinical management has failed to recognise the vastly different needs of the individual child.

Project Lead

Professor Vicki Anderson

Lead partner

Murdoch Children’s Research Institute

MACH PARTNERS

Austin Health; Florey Institute;  Royal Children’s Hospital; University of Melbourne

In the majority of children and adolescents (up to 60 percent) PCS resolve spontaneously within four weeks. Persisting PCS however impede safe return to academic and sport/leisure activities in the remaining 40 percent. Untreated, they can cause low tolerance for academic and sport/leisure activities, and disruptions to education, fitness and mental health. Despite their debilitating impact, PCS management is inconsistent and the few clinical trials conducted fail to account for individual symptom profiles.

The overarching objective of our study is to halve the rate of children with persisting PCS at three months post-injury by delivering Concussion Essentials (CE), an evidence-based, personalised medicine intervention.

CE is an innovative, multimodal intervention, integrating acute management, novel technologies and symptom-targeted treatment to accelerate PCS recovery and safe return to normal activities. CE was developed to be delivered within the Medicare Better Access program, and so will be readily accessible throughout the community. We have established clinical, industry, national and international peak body partnerships to ensure effective translation of our findings into routine practice.

 

This project is supported by the Australian Government’s Medical Research Future Fund (MRFF) as part of the Rapid Applied Research Translation program.

Our pilot data is promising: 85 percent of children receiving CE showed symptom resolution and return to activity by three months (compared to 30 percent of UC participants), suggesting that CE can reduce missed school and parent workdays, prevent secondary mental health problems and provide an integrated, accessible, cost-effective treatment.

 

HeadCheck, the app developed through this project, has provided an innovative approach to deliver an accessible, free resource for informing the community about accurately identifying concussion and guiding its acute management (HeadCheck recognition), as well as expanding community capacity to engage with and use evidence-based recovery management guidelines (HeadCheck Recovery) to reduce unnecessary health utilisation. HeadCheck has had > 70,000 downloads and is an integral part of AFL community football policy to better manage concussion.

The ongoing impacts of this project include:

  1. Better recognition and management of child concussion
  2. Increasing community knowledge and thus reducing child and family anxiety
  3. Reducing unnecessary heath care utilisation
  4. Improving the quality of information regarding concussion management via the RCH clinical guidelines resource.

  • Davis GA, Rausa VC, Babl FE, Davies K, Takagi M, Crichton A, McKinlay A, Anderson N, Hearps SJC, Clarke C, Pugh R, Dunne K, Barnett P, Anderson V. (2022) Improving subacute management of post-concussion symptoms: a pilot study of the Melbourne Paediatric Concussion Scale parent report.  7(1) doi: 10.2217/cnc-2021-0007
  • Anderson V, Rausa VC, Anderson N, Parkin G, Clarke C, Davies K, McKinlay A, Crichton A, Davis GA, Dalziel K, Dunne K, Barnett P, Hearps SJC, Takagi M, Babl F. (2021) Protocol for a randomized clinical trial of multimodal post-concussion symptom treatment and recovery: The Concussion Essentials Study.  BMJ Open, 11(2), e041458, doi:  1136/bmjopen-2020-041458
  • Clarke C, Anderson V, Babl FE, Rausa VC, Davis GA, Barnett P, Crichton A, Takagi M, Hearps SJC, Davies K, McKinlay A, Anderson N, Kwan V, Kanagalingam S, Ceregra G, Petris A, Darling S, Clifton P, Harcourt P. (2020) Child concussion recognition and recovery:  a community delivered, evidence-based solution. Annals of Translational Medicine.  8(9), 595, doi:  21037/atm.2020.03.50
  • Gornall A, Takagi M, Clarke C, Babl FE, Davis GA, Dunne K, Anderson N, Hearps S, Demaneuf T, Rausa V, Anderson V. (2019) Behavioural and emotional functioning following paediatric concussion. Journal of Neurotrauma, 37(1), 163-169, doi: 1089/neu.2018.6235
  • Anderson V, Davis G, Takagi M, Dunne K, Clarke C, Anderson N, Rausa V, Doyle M, Parkin G, Truss K, Thompson E, Bressan S, Hearps S, Babl F. (2020) Trajectories and predictors of physician-determined recovery after child concussion. Journal of Neurotrauma. 37, 1392-1400, doi: 1089/neu.2019.6683
  • Haran H, Bressan S, Oakley E, Davis G, Anderson V, Babl F. (2016) On-field management and return-to-play in sports-related concussion in children: Are children managed appropriately? Journal of Science and Medicine in Sport, 19(3), 194-199 doi: 1016/j.jsams.2015.02.009

 

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