P0193 - Utility of PROMIS in Conjunction with PCSS for Identifying Post-Concussion Emotional Symptoms in Pediatric Patients

Background/Purpose
We aimed to evaluate the utility of the Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depressive symptom domains in conjunction with the Post-Concussion Symptom Scale (PCSS) for identifying pediatric patients with emotional symptoms following a concussion.

Methods
English-speaking patients ages 8-17 presenting to a tertiary-care pediatric concussion clinic from August 2014 to February 2018 were invited to participate. Patients were excluded if they had structural abnormalities on neuroimaging. Demographic information (age, sex, date of injury) and PCSS scores were collected from the electronic medical record (EMR). Participants also completed surveys in the PROMIS Pediatric Item Bank v1.1–Anxiety and Depressive Symptoms domains at their initial clinic visit.

Results
Of 500 participants enrolled, 458 (91.6%) had complete data for analysis. Mean age was 14.1 ± 2.3 years and 42.4% were male. Median time between injury and initial clinic visit was 17 days (range = 1 - 362). Of these 458 participants, 387 (84.5%) reported ≥ 1 symptom (i.e. score > 0) on the PROMIS anxiety symptom survey, 354 (77.3%) reported ≥ 1 symptom on the PROMIS depressive symptom survey, and 284 (62.0%) reported ≥ 1 emotional symptom on the PCSS (irritability, more emotional than usual, sadness, and/or nervousness). Overall, 425 (92.8%) reported ≥ 1 symptom on one of the PROMIS surveys or the PCSS. PROMIS surveys identified 127 (27.7%) participants with anxiety symptoms and 111 (24.2%) participants with depression symptoms who reported no emotional symptoms on PCSS (see Figures 1 and 2). In comparison, 24 participants (5.2%) reported emotional symptoms on PCSS but no symptoms on the PROMIS anxiety survey and 41 participants (9%) reported emotional symptoms on PCSS but no symptoms on the PROMIS depressive symptom survey.

Conclusion
We identified 425 patients (92.8%) experiencing some emotional symptoms post-concussion. Using the PROMIS anxiety and depressive assessments in conjunction with PCSS identifies more patients with emotional symptoms than using PCSS alone. Our results suggest adding PROMIS anxiety and depressive symptom surveys to concussion evaluations may identify more children with emotional symptoms, allowing clinicians to better direct treatment. Future studies should continue to examine the clinical utility of PROMIS in concussion care.