Risk Factors for Prolonged Symptoms of Mild Traumatic Brain Injury: A Pediatric Sports Concussion Clinic Cohort

Clin J Sport Med. 2019 Jan;29(1):11-17. doi: 10.1097/JSM.0000000000000494.


Objective: To examine predictors of prolonged symptom duration from mild traumatic brain injury (mTBI) in a pediatric sports medicine specialty clinic cohort as these predictors may be distinct in this population.

Design: Retrospective chart review.

Setting: Outpatient specialty clinic.

Patients: Charts of 549 patients (age range: 10-18 years) with concussions were reviewed in an outpatient clinic that predominantly managed sports-related injuries (77.3%). Patients (n = 431) included in the final analysis met the criteria for mTBI and were symptomatic at their first visit.

Assessment of risk factors: Patient history, injury, and recovery variables were evaluated.

Main outcome measures: Predictors of prolonged time to reach self-reported symptom recovery were evaluated using Cox proportional hazards.

Results: Median time to symptom recovery of the 431 patients who presented to clinic with symptoms was 40 days (full clinic sample median = 34 days). Analyses identified 3 unique predictors of symptom recovery: loss of consciousness (LOC) [hazard ratio (HR) = 0.56, P < 0.0001], female sex (HR = 0.57, P < 0.0001), and concussion symptom score at first clinic visit (HR = 0.76, P < 0.0001).

Conclusions: Prolonged duration of mTBI symptoms in patients who present to a pediatric sports-based concussion clinic is related to initial symptom severity, female sex, and LOC.

MeSH terms

  • Adolescent
  • Ambulatory Care Facilities
  • Athletic Injuries / diagnosis*
  • Athletic Injuries / physiopathology
  • Brain Concussion / diagnosis*
  • Brain Concussion / physiopathology
  • Child
  • Female
  • Humans
  • Male
  • Post-Concussion Syndrome / diagnosis*
  • Post-Concussion Syndrome / physiopathology
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Youth Sports / injuries*