The MPCETT: Assessing the Safety and Utility of Exercise Tolerance Testing in Children With Concussion Ages 6 to 12.

Objective: Treadmill test protocols for concussion assessment have been validated for patients aged 13 years and older; however, no evidence-based guidelines exist for younger children. We designed and assessed the safety and utility of the Morahan Pediatric Concussion Exercise Tolerance Test (MPCETT) for assessing exercise tolerance in symptomatic children (SC) and recovered, asymptomatic children (AC) from 6 to 12 years of age.

Design: Retrospective case series.

Setting: Secondary care center.

Participants: Children were diagnosed with concussion using consensus guidelines. At assessment, SC [n = 17; median (range) 10 (6-12) years; 18% female; 28 (13-50) days since injury] had persistent concussive symptoms, while AC [n = 24; 9 (7-12) years; 21% female; 21 (8-37) days since injury] required assessment for return to activity.

Interventions: The MPCETT is a modified Buffalo Concussion Treadmill Test for pediatric populations. The test was administered to establish exercise tolerance and was terminated for increased symptoms or self-reported exhaustion.

Main outcome measures: Presence of adverse events and exercise intolerance.

Results: The number of adverse events was 0 in both groups. Exercise intolerance occurred in 64.7% (95% CI, 38.3%-85.8%) of children within the SC group versus 12.5% (95% CI, 2.7%-32.4%) within the AC group (P < 0.001).

Conclusions: Pediatric exercise tolerance testing is safe and effective for assessing exercise intolerance in concussed children.