561 - Impact of embedding a psychologist in a pediatric concussion program.
Saturday, April 26, 2025
2:30pm – 4:45pm HST
Publication Number: 561.5558
Luisa Fernanda Atunes Ortega, Boston Children's Hospital, boston, MA, United States; Laura Goldstein, Boston Medical Center, Medford, MA, United States; Alex S.. Aguirre, Boston Children's Hospital, Brookline, MA, United States; Relfa Proano, Boston University School of Medicine, Coral Springs, FL, United States; Alcy Torres, Boston University School of Medicine, WELLESLEY, MA, United States
Research Fellow Boston Children's Hospital Boston, Massachusetts, United States
Background: Postconcussive syndrome is a collection of symptoms that some people experience after a concussion a mild traumatic brain injury (TBI). While most people recover from a concussion within a few weeks, those with PCS may have symptoms that last for weeks, months, or even longer after the initial injury. Mood and behavioral problems are very common and usually signal worse prognosis. Objective: Determine the efficacy of early psychological intervention (PI) in children and adolescents with PCS. Design/Methods: We performed a retrospective chart review of patients aged 8 to 21 years old evaluated at Boston Medical Center (BMC) Concussion Clinic (CC) between 01/2013 and 11/2023. We included data on 26 children with PCS treated by a psychologist in the CC at the time of the diagnosis and 15 patients with PCS who were referred to psychiatry but were only able to see them weeks later as control group. Clinical data from the time of the diagnosis in the CC to the last follow-up visit was manually extracted from the electronic medical records. We recorded the severity of the symptoms with The Sport Concussion Assessment Tool (SCAT 3-6), the characteristics of the traumatic brain injury mechanism TBIM and PIs. Results: The median age was 17 years (8-21); 54% female]. TBIM was 33% sports, 26.7% motor vehicle accident, 16.7% fall and hit head, 10% direct, blunt trauma, and 13.3% others. Patients who were seen at their initial presentation received earlier interventions (EI) consisting of screening for mood symptoms, psychiatric diagnosis and therapeutic plan. When samples were adjusted to age, sex, type and severity of injury, insurance, and time of recovery, there was a significant difference between the two groups. Of 26 patients in the study group (CG), 65% had a good outcome, 35% moderate improvement, and 0% without changes after psychological intervention, while in the control group, 13% of patients without improvement, 60% moderate, and 27% had good outcome. Median severity of SCAT 3-6: 32 (8-121). Median total days treated by the CC in the CG was 192 days (3-778), while the control group referred to psychiatry 330 days (49-1204). The group with EI recovered in average 4 months earlier, demonstrating the value of including a psychologist in the concussion multidisciplinary team. This study is limited by the sample size.
Conclusion(s): Early PI for concussion patients significantly accelerates their recovery. Larger prospective studies should be carried out to corroborate these findings. The inclusion of a psychologist in the CI might significantly impact the care and outcomes of these patients.
