Derivation of the Buffalo Concussion Physical Examination risk of delayed recovery (RDR) score to identify children at risk for persistent postconcussive symptoms

Abstract

ObjectiveThe Buffalo Concussion Physical Examination (BCPE) is a brief, but pertinent physical examination designed for the subacute, outpatient assessment of concussion. The purpose of this study was to perform the BCPE on a larger sample and derive a scoring system to identify children at risk for Persistent Post-Concussive Symptoms (PPCS, recovery ≥30 days).MethodsThis prospective, observational cohort study from September 2016 to March 2019 was performed at three university-affiliated concussion clinics. Male and female children (n=270, 14.92±1.86 years, range 8–18, 38% female) were diagnosed with a concussion within 14 days of injury and followed-up until recovery. Logistic regression was used with history and physical examination variables to predict PPCS and a weighted scoring metric was derived.ResultsOut of 15 predictor variables, the main effects of 1 preinjury variable (≥3 previous concussions), 2 injury characteristic variables (days-since-injury and type-of-injury), 3 physical examination variables (orthostatic intolerance (OI), vestibulo-ocular reflex (VOR) and tandem gait) and 2 interaction terms (OI/VOR and tandem gait/type-of-injury) produced a score that was 85% accurate for identifying children with low-risk, medium-risk and high-risk for PPCS on cross-validation.ConclusionThe Risk for Delayed Recovery (RDR)-Score allows physicians in an outpatient setting to more accurately predict which children are at greater risk for PPCS early after their injury, and who would benefit most from targeted therapies. The RDR-Score is intended to be used as part of a comprehensive assessment that should include validated symptom checklists, mental health history and adjunct testing (eg, cognitive or physical exertion) where clinically indicated.

Evaluation and Utility of the King-Devick With Integrated Eye Tracking as a Diagnostic Tool for Sport-Related Concussion

“…The value of using or measuring oculomotor function with SRC may be growing, and it has recently been reported in a large cohort study that impaired oculomotor function (impaired/symptomatic vestibular ocular reflex) is a factor associated with prolonged recovery from concussion in adolescents. 13 While this is important, it must be noted that the K-D ET was not included in that particular study, and there is a paucity of empirical evidence to support tools such as the K-D ET in identifying those with SRC or at high risk of a poor prognosis post-SRC. Nonetheless, the findings from the present study may guide future studies that would in turn be used to examine the utility of the K-D ET in the assessment of oculomotor function after SRC.…”

Association of Concussion History and Prolonged Recovery in Youth

“…Linear regression for log of recovery time and logistic regression for PPCS were each performed with number of prior concussions as the predictor variable as conducted in previous research. 29 To generate a decision rule, a Fisher exact test was used to determine cut-points for the number of prior concussions associated with a statistically significant increase in the risk of PPCS. The misclassification error rate was calculated for each prior concussion cut-point, plotted on a graph, and visually inspected.…”

Early Identification and Management of Cervical Impairments in Pediatric Patients With Concussion May Reduce Risk of Delayed Recovery

“…This study was part of a larger Concussion Patient Registry that focused on physical examination findings in children with concussion 19 and was reviewed by the University at Buffalo Institutional Review Board.…”