Symptom Severity Predicts Prolonged Recovery after Sport-Related Concussion, but Age and Amnesia Do Not

Abstract

Objective To identify predictors of prolonged symptoms for athletes who sustain concussions. Study design We conducted a multi-center, prospective, cohort study of patients in 2 sport concussion clinics. Possible predictors of prolonged symptoms from concussion were compared between two groups: those whose symptoms resolved within 28 days and those whose symptoms persisted beyond 28 days. Candidate predictor variables were entered into a logistic regression model that was used to generate adjusted odds ratios. Results During the study period, 182 patients met inclusion criteria. The mean age was 15.2 years (SD 3.04 years). Over a third (N=65) of patients underwent computerized neurocognitive testing on their initial visit. In univariate analyses, Post Concussion Symptom Scale (PCSS) score and all composite scores on computerized neurocognitive testing appeared to be associated with prolonged symptom duration. Sex, age, loss of consciousness at time of injury and amnesia at time of injury were not associated with prolonged symptom duration. After adjusting for potential confounding, however, only total score on the PCSS score was associated with the odds of suffering prolonged symptoms. Conclusions After adjusting for other potential confounding variables, only total score on the PCSS was associated with the odds of suffering prolonged symptoms from sport-related concussions; age and amnesia were not. Further efforts to develop clinical tools for predicting which athletes will suffer prolonged recoveries after concussion should focus on initial symptom score.

Acute Concussion Symptom Severity and Delayed Symptom Resolution

“…A prospective cohort study of youth athletes evaluated in sports concussion clinics in the first 3 weeks after a concussion demonstrated that increasing initial graded symptom inventory scores were associated with increased odds of symptom resolution occurring beyond 28 days. 20 Similarly, pediatric ED patients who had high symptom levels measured in the early weeks after a concussion had significantly higher odds of symptoms persisting for up to 1 year. 18 In both studies, initial symptom inventories were obtained an average of 11 days after concussion.…”

“…Recent research among youth athletes who have sports-related concussion supports this concept. 20 DSR is a defining feature of postconcussive syndrome (PCS). However, it is important to highlight that there is no universally accepted definition of PCS.…”

Psychiatric outcomes after pediatric sports-related concussion

“…Although injury severity has been identified as a key predictor of NPD development in the TBI literature, 20,22,36 the severity of concussion is difficult to assess clinically among children and adolescents. The mean or median PCSS score has been used in previous pediatric SRC studies as a measure of concussion severity, 8,10,43,44 whereas the use of the emotional PCSS subscore as a measure of psychological health has not been well studied. In this study, patients who reported sadness, nervousness, and feeling more emotional at initial presentation were more likely to develop postinjury psychiatric outcomes.…”

“…These findings suggest that symptom checklists are insufficient screening tools for postinjury psychiatric outcomes in children and adolescents with SRC and underscore the need for physicians to inquire about symptoms of depression and anxiety, as well as suicidal ideation, during the clinical evaluation irrespective of symptom inventory scores. Injury severity as measured by the initial PCSS score has also been associated with prolonged recovery and the development of PCS in pediatric SRC, 8,10,43,44 which itself may play an important role in the development of psychiatric outcomes. In this study 90% of patients who developed postinjury psychiatric outcomes also met the ICD-10 criteria for PCS at the time of diagnosis.…”

“…Tertiary concussion clinics may include patients with more severe injuries who are more likely to develop long-term comorbidities associated with TBI, including PCS and psychiatric disorders. These clinics also experience high rates of patients who are lost to follow-up, 8,44 which can have an impact on study results. In addition, patients are often evaluated at various levels of acuity and are seen in follow-up depending on the severity of their symptoms, trajectory of recovery, and availability and not according to a controlled research protocol.…”