Association of Time Since Injury to the First Clinic Visit With Recovery Following Concussion

Abstract

IMPORTANCE Recovery after concussion varies, with adolescents taking longer (approximately 30 days) than adults. Many factors have been reported to influence recovery, including preinjury factors, perceptions about recovery, comorbid conditions, and sex. However, 1 factor that may play a role in recovery but has received little attention from researchers is the timeliness of clinical evaluation and care. OBJECTIVE To investigate the association of time since injury with initiation of clinical care on recovery time following concussion. DESIGN, SETTING, AND PARTICIPANTS This retrospective, cross-sectional study was conducted in a sports medicine clinic between August 2016 and March 2018. Eligible participants were aged 12 to 22 years and had a diagnosed, symptomatic concussion; patients were excluded if recovery data were incomplete. Participants were divided into 2 groups: those seen within 7 days of the injury (early) vs between 8 and 20 days of the injury (late). Data were analyzed between June 2019 and August 2019. EXPOSURES Time from injury (concussion) to initiation of clinical care. MAIN OUTCOMES AND MEASURES Recovery time; testing with the Post-Concussion Symptom Scale, Immediate Post-Concussion Assessment and Cognitive Testing, and Vestibular/Ocular Motor Screening instruments; demographic factors, medical history, and injury information. RESULTS A total of 416 individuals were eligible, and 254 (61.1%) were excluded, leaving 162 (38.9%) in analyses. The early group (98 patients) and late group (64 patients) did not differ in age (mean [SD] age, early, 15.3 [1.6] years; late, 15.4 [1.6] years), number of female patients (early, 51 of 98 [52.0%]; late, 40 of 64 [62.5%]), or other demographic, medical history, or injury information. The groups also were similar on symptom severity, cognitive, ocular, and vestibular outcomes at the first clinic visit. Results from a logistical regression supported being in the late group (adjusted odds ratio, 5.8 [95% CI, 1.9-17.6]; P = .001) and visual motion sensitivity symptoms greater than 2 (adjusted odds ratio, 4.5 [95% CI, 1.1-18.0]; P = .04) as factors significantly associated with recovery time.CONCLUSIONS AND RELEVANCE Findings suggest that earlier initiation of clinical care is associated with faster recovery after concussion. Other factors may also influence recovery time. Further research is needed to determine the role of active rehabilitation and treatment strategies, as well as demographic factors, medical history, and injury characteristics on the current findings.

Provider Training in the Management of Headache Following Concussion Clinical Recommendation: Promoting a Standardized Means for Efficient Patient Recovery and Timely Return to Duty

“…Further, some reported challenges in care and factors that contribute to differences in care (e.g., patientand military-related factors) were no longer reported after training, which may have endorsed greater frequency of followup in a timely manner, as well as reserving referrals based on patient need. Follow-up care has been shown associated with positive health outcomes (30,31). Done frequently and in a timely manner, this may potentially shorten recovery time (31) as patient symptoms, along with progression of treatment response, are more closely monitored to determine if changes in treatment are necessary.…”

“…Sub-optimal force readiness places both the injured SM and members of his or her unit at risk. Timely and accurate intervention following concussion promotes expedited recovery of concussion symptoms (31) and enables SMs a more timely and safe return to duty.…”

“…Follow-up care has been shown associated with positive health outcomes ( 30 , 31 ). Done frequently and in a timely manner, this may potentially shorten recovery time ( 31 ) as patient symptoms, along with progression of treatment response, are more closely monitored to determine if changes in treatment are necessary. As previously mentioned, our study found CR+ patients to more frequently engage in follow-up for their head injury and at an earlier time (i.e., within 1 week post-enrollment vs. 1 month) compared to CAU patients.…”

Mild TBI/Concussion Clinical Tools for Providers Used Within the Department of Defense and Defense Health Agency

“…[16][17][18] Prompt diagnosis, patient education, and early initiation to treatment may help optimize triage to care, mitigate prolonged symptoms by educating the patient on what to expect, and target specific symptoms early. 8,10 Beyond the health outcomes of an individual SM, TBI recovery impacts unit readiness and consequently force readiness. As such, health outcomes and medical readiness are a priority of the Defense Health Agency (DHA).…”

“…Studies found that early intervention after concussion may aid in expediting recovery, stressing the importance of identifying concussion as promptly as possible. 8,9 Active treatment is centered on patient education and symptom management, in addition to a progressive return to activities, as tolerated. Patient education may help validate the symptoms of some patients, as well as help to reattribute the symptoms to benign causes, leading to better outcomes.…”