A-20 Factors Associated with Additional Clinic Visits in the Treatment of Sports-Related Concussion

Abstract

Abstract Purpose: To determine the variables associated with additional concussion clinic visits before discharge to athletic trainer (AT). Methods: This retrospective cohort study was performed at a multi-disciplinary sports concussion center. Patients were eligible if they were ages 12–23, sustained a SRC and were seen by a clinic provider between 11/01/2017 and 10/01/2020 for concussion (n = 1504), presented to clinic within 3 months of sustaining a concussion, and had negative acute head imaging. Of 524 patients, 236 were discharged to AT after the initial clinic visit, while 288 patients required additional clinic visits. The following independent variables were assessed: age, sex, initial visit symptom score, history of prior concussions, psychiatric disorders, migraines, ADHD, and learning disorders, head imaging following concussion, family history of psychiatric disorders and migraines, and ED/Urgent Care visit. The primary disposition was patients being discharged to an AT following the initial clinic visit vs. having additional clinic visits prior to discharge to an AT. Results: The additional visit group had higher initial visit symptom scores (p = 0.002), head imaging performed more frequently (p < 0.02), a family history of psychiatric disorders and/or migraines (p < 0.001), more often reported a prior concussion (p = 0.02), and was younger (p = 0.014) compared to athletes with only one clinic visit. In a multiple variable model, family history of psychiatric disorders (OR = 3.12 [95%CI 1.53–6.34], p = 0.002), prior concussions (OR = 1.39 [95%CI 1.02–1.89], p = 0.037), greater initial symptom score (OR = 1.05 [95%CI 1.03–1.06], p < 0.001), and younger age (OR = 0.87 [95%CI 0.77–0.98], p = 0.021) were strongly associated with additional visits. Conclusions: Among athletes treated at a regional sports concussion center, we determined that family history of psychiatric disorders, increased symptom score at initial visit, prior concussions, and younger age were each uniquely associated with needing additional clinic visits. Understanding these variables may guide treatment protocols to optimize efficiency.