Parent-Child Agreement on Postconcussion Symptoms in the Acute Postinjury Period

Pediatrics. 2020 Jul;146(1):e20192317. doi: 10.1542/peds.2019-2317. Epub 2020 Jun 4.


Objectives: To evaluate parent-child agreement on postconcussion symptom severity within 48 hours of injury and examine the comparative predictive power of a clinical prediction rule when using parent or child symptom reporting.

Methods: Both patients and parents quantified preinjury and current symptoms using the Postconcussion Symptom Inventory (PCSI) in the pediatric emergency department. Two-way mixed, absolute measure intraclass correlation coefficients were calculated to evaluate the agreement between patient and parent reports. A multiple logistic regression was run with 9 items to determine the predictive power of the Predicting and Preventing Postconcussive Problems in Pediatrics clinical prediction rule when using the child-reported PCSI. Delong's receiver operating characteristic curve analysis was used to compare the area under the curve (AUC) for the child-report models versus previously published parent-report models.

Results: Overall parent-child agreement for the total PCSI score was fair (intraclass correlation coefficient = 0.66). Parent-child agreement was greater for (1) postinjury (versus preinjury) ratings, (2) physical (versus emotional) symptoms, and (3) older (versus younger) children. Applying the clinical prediction rule by using the child-reported PCSI maintained similar predictive power to parent-reported PCSI (child AUC = 0.70 [95% confidence interval: 0.67-0.72]; parent AUC = 0.71 [95% confidence interval: 0.68-0.74]; P = .23).

Conclusions: Overall parent-child agreement on postconcussion symptoms is fair but varies according to several factors. The findings for physical symptoms and the clinical prediction rule have high agreement; information in these domains are likely to be similar regardless of whether they are provided by either the parent or child. Younger children and emotional symptoms show poorer agreement; interviewing both the child and the parent would provide more comprehensive information in these instances.

Trial registration: NCT01873287.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Diagnostic Self Evaluation*
  • Female
  • Humans
  • Male
  • Parents*
  • Post-Concussion Syndrome / diagnosis*
  • Retrospective Studies
  • Severity of Illness Index
  • Symptom Assessment / statistics & numerical data*
  • Time Factors

Associated data