Clinical predictors of symptom resolution for children and adolescents with sport-related concussion

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The goal of this study was to determine which variables assessed during an initial clinical evaluation for concussion are independently associated with time until symptom resolution among pediatric patients.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Data collected from a prospective clinical registry of pediatric patients with concussion were analyzed. The primary outcome variable was time from injury until symptom resolution. Predictor variables assessed within 10 days after injury included preinjury factors, Health and Behavior Inventory scores, headache severity, and balance, vestibular, and oculomotor test performances. The researchers used univariate Cox proportional models to identify potential predictors of symptom resolution time and constructed a multivariate Cox proportional hazards model in which total duration of concussion symptoms remained the outcome variable.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The sample consisted of 351 patients (33% female, mean age 14.6 ± 2.2 years, evaluated 5.6 ± 2.6 days after concussion). Univariate Cox proportional hazards models indicated that several variables were associated with a longer duration of symptoms, including headache severity (hazard ratio [HR] 0.90 [95% CI 0.85–0.96]), headache frequency (HR 0.83 [95% CI 0.71–0.96]), confusion (HR 0.79 [95% CI 0.69–0.92]), forgetfulness (HR 0.79 [95% CI 0.68–0.92]), attention difficulties (HR 0.83 [95% CI 0.72–0.96]), trouble remembering (HR 0.84 [95% CI 0.72–0.98]), getting tired often (HR 0.86 [95% CI 0.76–0.97]), getting tired easily (HR 0.86 [95% CI 0.76–0.98]), dizziness (HR 0.86 [95% CI 0.75–0.99]), and abnormal performance on the Romberg test (HR 0.59 [95% CI 0.40–0.85]). A multivariate Cox proportional hazards model indicated that an abnormal performance on the Romberg test was independently associated with a longer duration of symptoms (HR 0.65 [95% CI 0.44–0.98]; p = 0.038).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>For children and adolescents evaluated within 10 days after receiving a concussion, abnormal performance on the Romberg test was independently associated with a longer duration of symptoms during recovery. In line with findings of other recent studies investigating predictors of symptom resolution, postural stability tests may provide useful prognostic information for sports medicine clinicians.</jats:p></jats:sec>

Systematic Review of Pre-injury Migraines as a Vulnerability Factor for Worse Outcome Following Sport-Related Concussion

“…Similarly, a prospective cohort study that examined symptom recovery time in high school and college athletes did not find an association between pre-injury history of migraines and time to recover ( 21 ). In specialty sport concussion clinic studies, pre-injury migraines were not associated with a longer recovery [i.e., >28 days ( 14 , 34 , 35 ); self-reported symptom recovery ( 36 – 39 )] with the median recovery time for the entire sample being between 23 and 40 days across three studies ( 37 – 39 ). Pre-injury migraines were, however, associated with prolonged vestibular-ocular difficulties at 11–21 days following concussion ( 40 ).…”

Time-to-Event Analyses: Return to Unrestricted Participation After Sport-Related Concussion in a Cohort of High School Athletes

“…At 21 days after an SRC, a longer symptom duration in adolescent patients was associated with more severe somatic and vestibular-ocular symptoms. 19 Further, predictors of delayed recovery, or prolonged symptoms during recovery, have been identified in youth and adolescent patients who performed poorly on the Romberg test (.10 days) 20 and those who scored below average on the Sport Concussion Assessment Tool2 (.28 days). 21 Although we did not have symptom profiles or the results from diagnostic tools to support the time-loss findings, examinations of symptoms as benchmarks and clinical predictors in high school-aged athletes could help to explain the time-loss patterns.…”

Association of Preinjury Medical Diagnoses With Pediatric Persistent Postconcussion Symptoms in Electronic Health Records

“…9,12,13 Nonetheless, models of mTBI recovery remain only modestly predictive, 9,14 highlighting the need for further research. While several strong studies exist and have included up to 3000 patients with mTBI, 6,9 most previous research has been restricted to a small or moderate number of patients with mTBI drawn from specialty concussion clinics 12,15 or from a single institution emergency department, 16 with dropout rates as high as 40%. 14 Electronic health record (EHR)-wide investigations utilizing algorithm-based case selection offer at least 2 major advantages in the search for PPCS risk factors.…”