A - 08 Within Subjects Comparison of Clinical Outcomes After First, Second, and Third Concussions in Adolescents

Abstract

Abstract Objective The objective of the current study was to examine differences in clinical outcomes between adolescents’ first, second, and third concussions. Methods We conducted a retrospective medical chart review of adolescents (n = 40) aged 10–19 years-old (M = 13.0;SD = 1.9;56% male) who presented for evaluation of concussion at a specialty clinic for their first (Concussion 1 = C1), second (C2), and third (C3) concussions. Clinical outcomes included Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Post-Concussion Symptom Scale (PCSS), Vestibular/Ocular-Motor Screening (VOMS) scores from the first clinic visit for each injury, recovery time, and days between injuries. Paired samples t-tests were conducted to compare outcomes between concussions. Results When comparing initial presentation between C1 and C2, participants demonstrated no significant differences in ImPACT, PCSS (t[38] = 0.85, p = 0.402) or VOMS (t[34] = −0.75, p = 0.461), with the exception of faster Visual Motor Speed for C2 (t[38] = −3.45, p = 0.001). Participants demonstrated improved performance from C1 to C3 on ImPACT composites of Verbal Memory (t[38] = −4.22, p < 0.001), Visual Memory (t[38] = −2.99, p = 0.005), Visual Motor Speed (t[38] = −5.14, p < 0.001) and Reaction Time (t[38] = 0.11, p = 0.001). Symptom report was consistent on PCSS (t[38] = 1.80, p = 0.081) and VOMS (t[30] = −0.12, p = 0.903) between C1 and C3. Recovery time was similar comparing C1 to C2 (t[36] = −0.35,p = 0.725) and C1 to C3 (t[34] = 1.74,p = 0.090). Conclusions The results suggest adolescents demonstrate similar levels of symptoms, VOMS, and recovery time after first, second, and third concussions. Neurocognitive performance improved across C1 to C3, suggesting possible learning effect or improved performance with cognitive development. These results provide additional support for similarity between an athlete’s first and second concussion with further initial evidence that a third concussion does not result in worse outcomes.