Abstract
BackgroundRisk factors for prolonged recovery after concussion have been well researched, but specific objective clinical examination findings have not. This study examined whether clinical examination results could predict delayed recovery (DR) in individuals with concussion diagnosis. A secondary aim explored the influence of early examination on individual prognosis.MethodsThe study was a retrospective, observational cohort design that included 163 individuals seen at a concussion clinic who were followed longitudinally until cleared for sports activity. Cognitive, visual, balance, vestibular, and cervical clinical testing and symptom assessment were performed at initial evaluation. DR was calculated by taking the median value associated with time to clearance for activity. Bivariate logistic regression analysis was calculated to determine odds ratios (and 95% confidence intervals) for the odds of DR with presence or absence of each clinical finding. Multivariate analyses were used to define the best predictors of DR.Results80 of 163 individuals were considered delayed in their clearance to activity. Cognitive impairments (OR = 2.72; 95%CI = 1.40, 5.28), visual exam findings (OR = 2.98; 95%CI = 1.31, 6.80), and vestibular exam findings (OR = 4.28; 95%CI = 2.18, 8.43) all increased the odds of a DR. Multivariate modeling retained cognitive symptoms and clinical examination-vestibular testing as predictors of delayed recovery. Time to examination after injury was a mediator for DR.ConclusionsThe clinical examination provides value in identifying individuals who are likely to exhibit a delayed clearance. In particular, vestibular impairments identified clinically at initial evaluation and cognitive symptoms were associated with increased odds of a DR to return to activity. Our data support that early implementation of a standardized clinical examination can help to identify individuals who may be more at risk of prolonged recovery from concussion.
Highlights
Risk factors for prolonged recovery after concussion have been well researched, but specific objective clinical examination findings have not
The incidence of sports-related concussion (SRC) in high school and collegiate athletes is reported to be 0.11 and 0.28, respectively, per 1000 athlete-exposures, a number that has steadily risen over the last decade [1]
This condition is commonly referred to as post-concussion syndrome (PCS), a term used to describe the presence of nonspecific signs and symptoms that are linked to several possible causes that do not necessarily reflect ongoing physiological brain injury [6]
Summary
Risk factors for prolonged recovery after concussion have been well researched, but specific objective clinical examination findings have not. The incidence of sports-related concussion (SRC) in high school and collegiate athletes is reported to be 0.11 and 0.28, respectively, per 1000 athlete-exposures, a number that has steadily risen over the last decade [1] This accounts for an estimated 1.6 to 3.8 million concussions annually [2] and equates to approximately 5% of the total number of injuries across different sports with American football, girls’ soccer, boys’ soccer, and girls’ basketball resulting in the majority of concussion in high school athletes [1]. A recent 4-year study following NCAA athletes found that most symptoms associated with concussion resolved within 1 week (60.1%); 6.2% had a resolution of symptoms of over 4 weeks, and 8.9% of concussions required over 4 weeks before return to play [2]
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