Clinical Outcomes of Pediatric Acute Sport- and Non-Sport-Related Concussions

Abstract

Objectives: The objectives were to examine clinical characteristics, length of recovery, and the prevalence of delayed physician-documented recovery, compare clinical outcomes among those with sport-related concussion (SRC) and non-sport-related concussion (nSRC), and identify risk factors for delayed recovery. Methods: Included patients (8–18 years) were assessed ≤14 days post-injury at a multidisciplinary concussion program and diagnosed with an acute SRC or nSRC. Physician-documented clinical recovery was defined as returning to pre-injury symptom status, attending full-time school without symptoms, completing Return-to-Sport strategy as needed, and normal physical examination. Delayed physician-documented recovery was defined as >28 days post-injury. Results: Four hundred and fifteen patients were included (77.8% SRC). There was no difference in loss of consciousness (SRC: 9.9% vs nSRC: 13.0%, p = 0.39) or post-traumatic amnesia (SRC: 24.1% vs SRC: 31.5%, p = 0.15) at the time of injury or any differences in median Post-Concussion Symptom Scale scores (SRC: 20 vs nSRC: 23, p = 0.15) at initial assessment. Among those with complete clinical follow-up, the median physician-documented clinical recovery was 20 days (SRC: 19 vs nSRC: 23; p = 0.37). There was no difference in the proportion of patients who developed delayed physician-documented recovery (SRC: 27.7% vs nSRC: 36.1%; p = 0.19). Higher initial symptom score increased the risk of delayed physician-documented recovery (IRR: 1.39; 95% CI: 1.29, 1.49). Greater material deprivation and social deprivation were associated with an increased risk of delayed physician-documented recovery. Conclusions: Most pediatric concussion patients who undergo early medical assessment and complete follow-up appear to make a complete clinical recovery within 4 weeks, regardless of mechanism.

Acute evaluation of sport-related concussion and implications for the Sport Concussion Assessment Tool (SCAT6) for adults, adolescents and children: a systematic review

“…Of the 77 studies included, only six studies focused on the cervical spine 112 124–128. Findings were heterogeneous and evaluated a variety of cervical spine outcomes (cervical spine range of motion, tenderness on palpation, muscle spasm, joint position sense, cervical flexion rotation test, cervical flexor endurance, cervical spine strength, and head perturbation test) either as part of an overall clinical evaluation,124 125 independently112 126 127 or evaluated changes with physical exertion 128.…”

“…Of the 77 studies included, only six studies focused on the cervical spine 112 124–128. Findings were heterogeneous and evaluated a variety of cervical spine outcomes (cervical spine range of motion, tenderness on palpation, muscle spasm, joint position sense, cervical flexion rotation test, cervical flexor endurance, cervical spine strength, and head perturbation test) either as part of an overall clinical evaluation,124 125 independently112 126 127 or evaluated changes with physical exertion 128. One cohort study of acceptable quality identified that cervical spine testing (cervical flexion rotation test, cervical flexor endurance, cervical spine strength, and a head perturbation test) were significantly worse following concussion compared with preseason 112.…”