In Reply In their letter, Mr Young and Dr Tsao suggest that epidemiological studies are urgently required to accurately determine the incidence of PPCS to better allocate resources, educate patients, and manage expections—we fully agree.
Participants in our pan-Canadian study were recruited in the emergency department, thus introducing a potential selection bias, such that they might be at higher risk for PPCS compared with the many children treated in primary care clinics or who do not seek medical care after concussion. Our study also included children with concussions sustained through both sport and nonsport mechanisms; those who were injured in falls or motor vehicle crashes may have incurred more severe injuries than those generally seen in sports. Nonetheless, the overall observed rate of PPCS in our cohort of school-aged children and adolescents is similar to rates observed in studies of participants who were recruited in sideline and clinic settings.
Zemek RL, Yeates KO. Rates of Persistent Postconcussive Symptoms. JAMA. 2017;317(13):1375–1376. doi:10.1001/jama.2017.1327
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