Association of Concussion History and Prolonged Recovery in Youth.
Chizuk HM, Cunningham A, Horn EC, Thapar RS, Willer BS, Leddy JJ, Haider MN. Clin J Sport Med. 2022;32(6):e573-e579. doi:10.1097/JSM.0000000000001044
Athletes with three or more prior concussions were more likely to develop persistent postconcussive symptoms and take longer to recover than peers with fewer previous concussions.
Persistent postconcussive symptoms are defined in adults as symptoms lasting longer than 10 to 14 days; in children, it has been defined as taking longer than one month to recover. A history of three or more concussions is associated with a longer recovery in adults. However, it remains unclear if this is true among pediatric patients.
The authors investigated if a greater number of prior concussions increased the risk of persistent postconcussive symptoms in pediatric patients.
The authors collected patient records prospectively from three sports medicine clinics near Buffalo, New York. Patients were between 8 and 18 years old, diagnosed with a concussion within 14 days of the injury, had a documented number of prior concussions, and were treated until clinically recovered. The researchers defined recovery as symptoms returning to normal at rest, normal physical exam, and the ability to exercise and return to school without symptom exacerbation. The researchers calculated recovery time as the difference between days from injury and when participants recovered. Physicians recorded the number of physician-diagnosed concussions or undiagnosed concussions that they deemed reliable based on a patient’s history.
The authors recruited 284 children, with 270 used in the final analysis. Fifteen children had three or more prior concussions. While 32 to 38% of youth with a history of 0 to 2 prior concussions developed persistent symptoms, two-thirds of those with 3 or more concussions developed persistent symptoms. The researchers found that a cut point of ≥ 3 or ≥4 concussions had the best prediction rate of who would eventually develop persistent symptoms.
These results demonstrate that pediatric patients with a history of 3 or more concussions are more likely to develop persistent symptoms. It will be interesting to see if these findings can be replicated in a study with more people with 3 or more concussions. However, these findings may hold up well because they agree with previous research among adults who have experienced concussions.
Clinicians should use this information to educate patients, particularly those who have sustained multiple concussions, that their recovery is more likely to take longer than their previous concussions. It may be helpful to inform school-based clinicians and administrators that a patient has a history of multiple concussions and may need a longer time to recover and additional academic accommodations.
Questions for Discussion
- Do other preinjury history factors influence a patient’s likelihood of sustaining a concussion?
Written by Mitchell Barnhart
Reviewed by Jeffrey Driban
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I think something that would be interesting to look into is how young athletes sustain 3 or more concussions playing sports. Are there things we need to do to improve youth sports safety so that concussions are less prevalent? Since young athletes risk experiencing long-lasting symptoms with the more concussions they sustain, then we should focus on finding ways in which to avoid this, so that younger athletes can have the opportunity not only to play their sports for a long duration but also live a healthy life both in school and society.
One preinjury history factor that could influence a patient’s likelihood of sustaining a concussion could be the number of times a young athlete has sustained any hit or blow to the head, whether it results in a concussion or not because undiagnosed concussions/head trauma could increase the risk of an athlete, especially a younger athlete of sustaining a concussion.
This is very interesting to see how progressive persistent symptoms are from 2-3 prior concussions in children. The statistical jump is extremely alarming and shows a great area for research to be done. I am intrigued to know if certain symptoms were more predominant than others as well as if some symptoms lead to other issues within the body, especially due to the age of the population. One area I would like to know more about is the normal physical exam. What did this exam specifically entail? I grew up in New York and when I was in school, I remember the annual physical exam I had to participate in. Although, I do not remember it having much to do with head injuries and mental health. I am also very curious to know how long it took to find all participants and how close to Buffalo the participants are. As you start to expand away from the city, the population starts to get dramatically smaller. Those numbers of 2-3+ concussions would seem very high and alert me for additional issues. Really well researched and I am very interested to continue to analyze similar results.
Preinjury history factors may influence a patient’s likelihood of sustaining a concussion. Some studies have suggested that certain factors, such as previous concussions, a history of migraines, or a family history of brain injuries, may increase a person’s risk of sustaining a concussion.
In addition, engaging in activities that carry a high risk of concussion, such as contact sports or high-risk occupations, may also increase a person’s likelihood of sustaining a concussion. It is important for patients to be aware of these risk factors and take steps to protect themselves, such as wearing protective gear or avoiding certain activities.
It is also important for healthcare providers to consider a patient’s preinjury history when evaluating them for a concussion. This information can help the provider determine the appropriate course of treatment and make recommendations to help the patient reduce their risk of future concussions.
It is very interesting to read that children experience concussion symptoms longer than adults. I am very curious how symptoms are being recorded. Are the children self-reporting their symptoms, or are they doing a baseline and follow up questioning pre and post-concussion? If they are self-reporting, do the children truly know what each concussion symptom means or are they exaggerating. I feel like there are many factors that play in to the children experiencing concussion symptoms longer. I am also curious to know what types of sports these kids are playing where they are suffering from a concussion at 8 years old. Are there safety precautions taken from the adults running these sport clubs to reduce the number of adolescent injuries?
I think this is a super interesting topic to look into and dive deeper into and investigate what preinjury history factors could affect individuals in sustaining concussions.
This brings me to wonder how individuals who sustain frequent migraines, have sleep deficiencies, and/or have mental health concerns compared to those who have none when undergoing concussion rehabilitation. Do these types of brain and body complications affect the time a concussion is sustained? This would be interesting to look into, so we can maybe place a closer eye on specific groups of people who have a concussion and inform them and parents, coaches, etc. that their return to activity may be a bit extended.
Another thing to consider regarding preinjury history is the initial testing environment. Were there people or noises that were distracting for the individual? Were they unable to focus well due to stress, anxiety, ADHD, headaches, or migraines? All of those factors should be considered when performing the concussion baseline and post-injury screening.
As someone who has persistent concussion symptoms as an adult, I love that research is being done on the effect of concussions in children. Concussions are so subjective and no two people deal with them the same. That makes it that much harder with children who don’t know how to adequately explain what they are feeling or stop themselves when it is too painful. Looking into family history of concussions is also so important with children because that means that they might be that much more likely to sustain them in future. Being able to observe children and recognize a concussion is important in getting them proper healthcare that prevents these persistent symptoms later in life
Working with children, this type of research is absolutely essential. Understanding the impact concussions can have on them and effects of symptoms. What I found interesting was that over 2/3 of the subjects that had 3 or more concussions said they had persistent symptoms. Knowledge like this is crucial especially with pre screening and understanding when a concussion arrives with an athlete. This may aid in knowing when to put an athlete back in.