Specific Factors Influence Postconcussion Symptom Duration among Youth Referred to a Sports Concussion Clinic

J Pediatr. 2016 Jul;174:33-38.e2. doi: 10.1016/j.jpeds.2016.03.014. Epub 2016 Apr 4.

Abstract

Objective: To identify the clinical factors that influence the duration of postconcussion symptoms among youth referred to a sports concussion clinic.

Study design: A retrospective cohort study was conducted to evaluate several potential predictors of symptom duration via a Cox proportional hazards analyses. The individual postconcussion symptom scores were highly correlated, so these symptoms were analyzed in the statistical model as coefficients derived from principal component analyses.

Results: Among 1953 youth with concussion, 1755 (89.9%) had dates of reported symptom resolution. The remainder (10.1%) were lost to follow-up and censored. The median time to recovery was 18 days (range 1-353 days). By 30 days, 72.6% had recovered; by 60 days, 91.4% had recovered; and by 90 days, 96.8% had recovered. Several variables in a multivariate Cox model predicted postconcussion symptom duration: female sex (P < .001, hazard ratio [HR] = 1.28), continued activity participation (P = .02, HR = 1.13), loss of consciousness (P = .03, HR = 1.18), anterograde amnesia (P = .04, HR = 1.15), premorbid headaches (P = .03, HR = 1.15), symptom components from the day of concussion (emotion, P = .03, HR = 1.08), and the day of clinic evaluation (cognitive-fatigue, P < .001, HR = 1.22; cephalalgic, P < .001, HR = 1.27; emotional, P = .05, HR = 1.08; arousal-stimulation, P = .003, HR = 1.1). In univariate analyses, greater symptom scores generally predicted longer symptom durations. Worsening of symptoms from the day of concussion to the day of clinic evaluation also predicted longer recovery (P < .001, HR = 1.59).

Conclusions: Several factors help to predict protracted postconcussion symptom durations among youth referred to a sports concussion clinic.

Keywords: TBI; adolescent; mTBI; pediatric; traumatic brain injury.

MeSH terms

  • Adolescent
  • Age Factors
  • Ambulatory Care Facilities
  • Athletic Injuries / complications*
  • Athletic Injuries / psychology*
  • Child
  • Female
  • Humans
  • Male
  • Post-Concussion Syndrome / complications*
  • Post-Concussion Syndrome / psychology*
  • Principal Component Analysis
  • Proportional Hazards Models
  • Recovery of Function*
  • Referral and Consultation
  • Retrospective Studies
  • Risk Factors
  • Time Factors