Objective Sleep disturbance following concussion has been linked to more severe symptoms and longer recovery times. However, it is unclear whether this association may be affected by pre-injury and mood factors. This study examines whether acute symptom severity was associated with poorer sleep quality among recovered vs not-yet-recovered adolescents at 3-months following injury after adjusting for age, sex and anxiety. Method Adolescents aged 12–18 (N = 449) presenting □7 days to ConTex specialty concussion clinics were studied. Of these, 60 reported not being recovered at 3-month follow-up (Mage = 15.23, Nmales = 27, Nfemales = 33). Participants completed the Sport Concussion Assessment Tool-3rd Edition (SCAT-3) Symptom Checklist, Pittsburgh Sleep Quality Index (PSQI), and General Anxiety Disorder-7 (GAD-7). Hierarchical linear regressions assessed if initial symptoms as measured by the SCAT-3 total symptom score, predicted sleep quality at 3-month follow-up, controlling for initial data of age, sex, PSQI, and GAD-7. Results Initial total symptom scores did not predict higher PSQI scores at 3-months for either recovered or non-recovered subjects [F (1, 362, p = .550 and F (1,48), p = .307, respectively]. For recovered subjects, initial sleep ratings (p < .001) predicted 3-month sleep quality, while there was a trend for age (p = .054). For non-recovered subjects, only sex was associated with lower sleep quality at 3-months (p = .034). Conclusions Sleep disturbance was not associated with severity of concussion symptoms when accounting for age, sex, and initial sleep quality. These findings do suggest, however, that females were more likely to report lower sleep quality when experiencing longer recovery.
Objective Inclusion of broad age ranges in most pediatric concussion studies limits understanding of recovery in elementary-age children. This study’s aim was to investigate the most commonly reported symptoms at 3-months post-concussion in children age 6–10 and determine if factors from initial clinic visit predict prolonged recovery. Methods Participants (n = 73) age 6–10 who reported to clinic within 30 days of concussion (M = 10.4, SD = 7.8 days) were selected from the North Texas Concussion Registry (ConTex). Chi-square and independent t-test were used to examine symptoms at 3 months. Participants were then divided into early (14 days post-injury, n = 29) and late (1 month post-injury, n = 35) recovery groups based on days to symptom resolution. Logistic regression was used to identify significant predictors for prolonged recovery. Variables considered for the final model included sex, ethnicity, presence of LD/ADHD, mechanism of injury, and initial post-concussive symptoms. Results For the late recovery group, total symptom score at 3 months was 8.3/132 (SD = 14.8, Range = 0–61). The most common symptoms were heightened emotionality (34.3%), headache (31%), and noise sensitivity (31%). The final logistic regression model (2 = 15.7(3), p = .003) included mechanism of injury and initial emotional symptoms as significant predictors for prolonged recovery. For every 1-point (out of 5) increase in emotional symptoms, participants were 1.4x more likely to be in the late recovery group. Concussions sustained by hit or fall were 6x more common in the late recovery group (p = .006). Conclusions Similar to adolescents, emotional symptoms play a role in predicting delayed recovery in elementary-age children. Mechanism of concussion may also impact recovery.
ObjectiveTo identify differences in symptoms following sports-related concussion (SRC) on natural grass vs artificial turf in youth and adolescent football players.BackgroundThere is continued interest in reducing risk of SRC in football, with playing surface being one potentially modifiable factor. It is estimated that 15–30% of concussions result from helmet-to-ground contact, and some studies have suggested a higher incidence of SRC on grass in competitive contact sports compared to turf. To our knowledge, our study is the first to investigate reported post-concussive symptoms after SRC as they relate to playing surface.Design/MethodsData were prospectively collected from the North Texas Concussion Registry (ConTex), a longitudinal multi-institutional concussion database. We selected male football players between the ages of 10 and 24 who sustained a helmet-to-ground SRC (GCS 13–15) on either grass or turf. Pre-injury information and post-concussive symptoms (Graded Symptom Checklist from the SCAT-5) were collected at an initial in-person visit within 2 weeks of injury and via electronic follow up at 3 months.ResultsFifty-eight participants were included (grass = 32, turf = 26), and groups were similar in age (p = 0.089), time since injury (p = 0.500), history of headache (χ2 = 0.167), and prior history of concussion (χ2 = 0.868). Athletes who sustained SRC on grass reported significantly higher scores on the Graded Symptom Checklist (p = 0.018, mean 26.0 vs 11.4) and higher numbers of distinct symptoms (p = 0.013, mean 10.2 vs 5.5) compared to those who sustained SRC on turf. Symptoms that were rated significantly higher after SRC on grass included headache (p = 0.010), phonophobia (p = 0.014), dizziness (p = 0.001), fatigue (p = 0.021), blurred vision (p = 0.001), feeling “in a fog” (p = 0.014), difficulty remembering (p = 0.004), and feeling emotional (p = 0.041).ConclusionsYouth and adolescent football players who sustain SRC on grass report higher post-concussive symptom severity and burden. Elucidating differential effects of SRC on grass vs turf is important, as competitive playing surface is a modifiable risk factor.
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