Clinical Predictors Of Prolonged Recovery From Sport-related Concussion: Importance Of Early Clinical Care

Abstract

Initiation of clinical care may play a critical role in promoting recovery following sport-related concussion (SRC). There has been no research on the role of time to first clinic visit on recovery following SRC in pediatric athletes. Rapid recovery may be especially important in pediatric populations, as prolonged recovery may lead to developmental challenges and/or impact schoolwork and learning capacity. PURPOSE: To investigate the association of time to first clinic visit (≤7 days compared to 8-20 days from injury) in relation to other pre- (e.g., sex; concussion, migraine history) and post-injury (e.g., symptoms, impairment) predictors to prolonged recovery (>30 days) in pediatric athletes with SRC. METHODS: This study was a retrospective review of medical records from a concussion-specialty clinic representing 164 pediatric athletes (aged 12-17) with diagnosed SRC between April 2016-January 2019. Participants were separated into EARLY (≤7 days) and LATE (8-20 days) time to first clinic visit cohorts. Participants completed the Post-concussion Symptom Scale (PCSS), Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), Vestibular/Ocular Motor Screening (VOMS), and demographics/medical history. Adjusted odds ratios (OR) were derived from a backwards stepwise logistic regression (LR) with normal (≤30 days) or prolonged (>30 days) recovery as the outcome. Time to first clinic visit, pre-injury factors, and post-injury clinical assessments were included as predictors. RESULTS: There were no differences in age or cognitive performance between EARLY and LATE. EARLY had a higher PCSS score (29.4±19.6) than LATE (22.2±18.3; p=0.018). LATE had a higher proportion of females (55%) than EARLY (28%; p<0.001). The LR (R2=0.14, p<0.001) identified days to first clinic visit (OR=2.9; p=0.007), as the strongest predictor of recovery >30 days. Vestibular dysfunction (OR=1.1; p=0.040) and PCSS score (OR=1.04; p=0.004) were also predictors of recovery >30 days. CONCLUSIONS: Among all pre- and post-injury predictors, days to first clinic visit was the most robust predictor of prolonged recovery. Vestibular dysfunction and PCSS score also predicted prolonged recovery. The findings highlight the importance of early intervention and care following SRC in pediatric populations.