Elsevier

The Journal of Pediatrics

Volume 163, Issue 3, September 2013, Pages 721-725
The Journal of Pediatrics

Original Article
Symptom Severity Predicts Prolonged Recovery after Sport-Related Concussion, but Age and Amnesia Do Not

https://doi.org/10.1016/j.jpeds.2013.03.012Get rights and content

Objective

To identify predictors of prolonged symptoms in athletes who sustain concussions.

Study design

This was a multicenter prospective cohort study of patients in 2 sport concussion clinics. Possible predictors of prolonged symptoms from concussion were compared in 2 groups, those whose symptoms resolved within 28 days and those whose symptoms persisted beyond 28 days. Candidate predictor variables were entered into a logistic regression model that was used to generate aORs.

Results

A total of 182 patients met the inclusion criteria during the study period. The mean patient age was 15.2 ± 3.04 years. More than one-third of the patients (n = 65) underwent computerized neurocognitive testing on their initial visit. On univariate analyses, Post-Concussion Symptom Scale (PCSS) score and all composite scores on computerized neurocognitive testing were apparently associated with prolonged symptom duration. Sex, age, loss of consciousness at time of injury, and amnesia at time of injury were not associated with prolonged symptom duration. After adjusting for potential confounding, only total PCSS score was associated with the odds of suffering prolonged symptoms.

Conclusion

Further efforts to develop clinical tools for predicting which athletes will suffer prolonged recoveries after concussion should focus on initial symptom score.

Section snippets

Methods

This was a multicenter prospective cohort study of patients seen in 2 sport concussion clinics, Boston Children's Hospital and University of Pittsburgh Medical Center, Bethel Park location. Both hospitals are located in urban setting and receive referrals from a variety of sources, including emergency departments, primary care physicians, and directly from athletic trainers and team physicians. Most of the patients resided in an urban or suburban setting, although each hospital cares for a

Results

Although 266 participants had sustained a sport-related concussion, completed all forms, and were recovered by the end of the study period, 84 were not seen in the clinic until more than 3 weeks since the time of injury and were excluded, leaving 182 patients for analysis. The majority of these patients (n = 172) sustained their injury while playing organized sports, and 9 had injury mechanisms and forces similar to those occurring in sports, but were not participating in organized athletics at

Discussion

Our study shows that after adjusting for potential confounding variables, only total PCSS score is independently associated with prolonged symptoms after concussion. The odds of prolonged symptom duration increased with increasing PCSS score. No other possible predictor variables included in our investigation were independently associated with symptoms persisting for more than 28 days.

Although crucial for patients who suffer prolonged symptoms, medical interventions, academic accommodations,

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  • Cited by (0)

    Funded by the National Institutes of Health (T32 HD040128-06A1 [to W.M.] and K12 HD052896-01A1 [to R.M.]). M.C. is codeveloper of the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) software used in this study and is co-owner of ImPACT Applications (the company that distributes the ImPACT program). The other authors declare no conflicts of interest.

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