Predictors of persisting symptoms after concussion in children and adolescents
ABSTRACT
Objectives:
To determine predictors of persisting symptoms after concussion (PSaC) in children and adolescents ages 8–18 presenting to a community practice setting.
Setting:
Community practice clinics.
Participants:
Children and adolescents (n=236; Mage=14.3±2.1 years; 97 females) who sustained sport or recreation-related concussions.
Design:
Prospective cohort study. Individuals reported to community practice clinics within 72 hours of sport- or recreation-related concussion. At this initial visit, parents/guardians provided information about demographic factors, their child's behavior following the injury, injury characteristics, and symptom reports. Approximately one month later (median=36 days after injury, IQR=31–41 days), parents/guardians were contacted to provide information about PSaC, indexed using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ).
Main Outcome Measure(s):
Factors provided at initial visit (demographic information, parent-reported behavior, injury characteristics, symptom reports) were examined as predictors of the presence of PSaC (endorsement of 3 or more RPQ symptoms as being worse than pre-injury) at one month using univariate logistic regressions. Significant univariate predictors (p<.05) were then entered into a multivariable model. Secondary analyses examined which factors were predictors of endorsing more (3+) versus fewer (1–2) persisting symptoms on the RPQ.
Results:
Female gender, parent reports of acting abnormally, parent reports of lethargy, and initial total symptom score were significant predictors of PSaC (p's≤.027). Acting abnormally was the only significant predictor of endorsing more versus fewer persisting symptoms (p=.025).
Conclusions:
Children and adolescents who are female, whose parents report their acting abnormally and/or being lethargic, and/or those with higher initial total symptom score within 72 hours of injury may be at increased risk of experiencing PSaC. Acting abnormally post-injury may also be a risk factor for endorsing a greater number of PSaC. These findings provide information about potential indicators of children and adolescents who may benefit from early, targeted clinical intervention to reduce persisting symptom burden following sport- or recreation-related concussion.
Contributor Notes
This study was funded in part by the National Operating Committee on Standards for Athletic Equipment (NOCSAE).
JB, JF, and KR were employed at the study setting during the time of data collection. JRM reports grants from the National Football League, Department of Defense, NATA Foundation, and Centers for Disease Control and Prevention outside the submitted work and is a Member of USA Football's Football Development Council. Additionally, a family member of JRM, the principal investigator on this study, has received funding to her institution from NOCSAE for work that is not part of this current study. JRM's spouse has received a grant review panel stipend from NOCSAE unrelated to the current work. MC and BI have no conflicts of interest to disclose.
Brittany M. Ingram: Assistant Professor, Department of Kinesiology, North Carolina Agricultural & Technical State University, 1601 E Market Street, Corbett Sports Center, Greensboro, NC 27411. Email: bmingram2@ncat.edu
Josh Bloom: Physician, Carolina Family Practice & Sports Medicine, 3700 NW Cary Parkway, Suite 110, Cary, NC 27513. Telephone: 919-238-2000. Email: ojbloom@novanthealth.org
Janna Fonseca: Athletic Trainer, Carolina Family Practice & Sports Medicine, 3700 NW Cary Parkway, Suite 110, Cary, NC 27513. Telephone: 919-238-2000. Email: jfonseca15@gmail.com
Kristen Ramsey: Athletic Trainer, Carolina Family Practice & Sports Medicine, 3700 NW Cary Parkway, Suite 110, Cary, NC 27513. Telephone: 919-238-2000. Email: kristen.ramsey@novanthealth.org
Valerie J. De Maio: Physician, Department of Emergency Medicine, The University of North Carolina at Chapel Hill, 170 Manning Dr., CB# 7594, Chapel Hill, NC 27599. 919-966-6442. Email: vdemaio67@gmail.com
Johna K. Register-Mihalik: Associate Professor, The University of North Carolina at Chapel Hill, Matthew Gfeller Center, 2207 Stallings-Evans Sports Medicine Center, Campus Box 8700, Chapel Hill, NC 27599. Telephone: 919-962-0409. Email: johnakay@email.unc.edu