Specific Factors Influence Postconcussion Symptom Duration among Youth Referred to a Sports Concussion Clinic
Heyer GL., Schaffer CE., Rose SC., Young JA., McNally KA., Fischer AN. J Pediatr. 2016: ahead of print
Take Home Message: Clinical factors that related with persistent postconcussion symptoms were sex, greater worsening symptoms from day of concussion to first concussion evaluation, continued activity participation, loss of consciousness, anterograde amnesia, and premorbid headaches, emotional symptoms on the day of concussion, and greater symptoms the day of the clinical examination.
Recovery following a concussion is still largely understood. Previous researchers suggest clinical factors (for example, concussion history, specific symptoms, sex) are associated with protracted recovery; however, due to inconsistencies and the variety of research designs it is difficult to determine if these patterns truly exist. Therefore, the authors reviewed medical records to identify clinical factors that influence the duration of postconcussion symptoms among youth referred to a sports concussion clinic between June 2012 and September 2014. The authors analyzed 1,953 electronic medical records. These patients were included based on 2 primary criteria: they were between 10 to 19 years of age and the initial concussion evaluation was performed within 30 days of injury. Among the 1,953 patients, 1,755 (89%) had symptom resolution dates. The median time for symptom resolution was 18 days. By 30 days, 72% of the patients recovered and by 60 days 91% of the patients recovered. One of the largest risk factors for persistent postconcussion symptoms was sex. A female was 28% more likely to have protracted concussion symptoms than a male patient. Other clinical factors that related with persistent postconcussion symptoms were greater worsening symptoms from day of concussion to first concussion evaluation, continued activity participation, loss of consciousness, anterograde amnesia, and premorbid headaches, emotional symptoms on the day of concussion, and greater symptoms the day of the clinical examination (excluding vomiting or somatic symptoms).
The authors assessed medical records from a large cohort of youth patients with concussions, and found several clinical factors that were related with protracted concussion symptom duration. The authors found several clinical factors that are similar to previous reports. One of the most consistent factors for protracted concussion symptom duration is postconcussion signs and symptoms. The authors of the current study also found that emotional symptoms (sadness, feeling more emotional, irritability, nervous) at the time of injury were related with prolonged recovery. Returning to activity was also a clinical risk factor for prolonged symptom duration. It is important to point out that this is the only clinical factor that could potentially be prevented. Therefore, this suggests that protracted concussion symptoms could be alleviated with proper education about what youth athletes should do following a potential concussion event. Lastly, one of the largest risk factors was female sex. Although other studies have found female sex to be a predictor of protracted symptoms there is little explanation that suggests why. We also need to acknowledge that this study found clinical factors that may make someone more likely to have a protracted recovery. However, it is unclear how accurate these factors would be at predicting who would have a protracted recovery. Medical professionals should be aware of these clinical factors, which relate with a protracted symptom duration, and discuss the potential for a slower recovery process with patients that have one or more of these clinical factors.
Questions for Discussion: Would knowing these clinical factors change or alter your concussion assessment and return to play protocol? Do these clinical factors align with what you see in your concussion population with prolonged symptom recovery?
Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban
Typical vs Prolonged Recovery Time and Predictors Following Concussion in High Schooland College Athletes