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Quantitative Volumetric Imaging and Clinical Outcome Characterization of Symptomatic Concussion in 10- to 14-Year-Old Adolescent Athletes

Mac Donald, Christine L. PhD; Barber, Jason MS; Wright, Jason MD; Coppel, David PhD; De Lacy, Nina MD; Ottinger, Steve BS; Peck, Suzanne BA; Panks, Chris BS; Zalewski, Kody BS; Sun, Samantha; Temkin, Nancy PhD

The Journal of Head Trauma Rehabilitation: November/December 2018 - Volume 33 - Issue 6 - p E1–E10
doi: 10.1097/HTR.0000000000000381
Focus on Clinical Research and Practice

Objective: Prior work suggests that younger athletes may be more vulnerable to postconcussive syndrome. We investigated measures of clinical outcome and quantitative volumetric imaging in 10- to 14-year-old adolescent athletes to better understand the impact of concussion on this younger population.

Setting: Outpatient clinics.

Participants: Ten- to 14-year-old symptomatic pediatric sports concussion patients and typically developing active controls.

Design: Prospective, observational multiclinic study.

Main Measures: Demographics, magnetic resonance imaging, clinical assessments (neurocognitive function, postconcussive symptoms, mental health symptoms, quality of life).

Results: Neuropsychological performance was comparable between groups while symptoms of mental health were discriminating and comprised the top regression model describing factors related to overall health behavior impairment. Concussion patients had smaller total brain volume as well as total intracranial volume in comparison with controls even though there was no difference on measures of natural development (age, height, weight, education, gender, and handedness).

Conclusions: Findings indicate that 10- to 14-year-old concussion patients symptomatic at 1 month more likely exhibit mental health symptoms impairing health behavior than cognitive dysfunction. There may be a vulnerability for those with smaller brain volumes at the time of the exposure. The study provides new data to support further investigation into risk factors for prolonged symptoms in this younger athlete population.

Departments of Neurological Surgery (Drs Mac Donald, Coppel, and Temkin, Messrs Barber, Panks, and Zalewski, and Ms Sun) and Biostatistics (Dr Temkin), University of Washington, Seattle; Departments of Radiology (Dr Wright) and Psychiatry and Behavioral Health (Dr De Lacy), Seattle Children's Hospital, Seattle, Washington; and Seattle Children's Research Institute, Seattle, Washington (Mr Ottinger and Ms Peck).

Corresponding Author: Christine L. Mac Donald, PhD, Department of Neurological Surgery, University of Washington, 352 9th Ave, Box 359924, Seattle, WA 98104 (

The authors thank the families, patients, and participants without whom this study would not be possible. The authors are grateful for the assistance of the University of Washington Diagnostic Imaging Sciences team including Serena Bennett, Tim Wilbur, and Liza Young for their support with the imaging acquisition and logistical planning.

Funding for this research was provided by the Seattle Pediatric Concussion Research Collaborative.

The authors declare no conflicts of interest.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.