Abstract
Objective: (1) To examine the prevalence of delayed symptom onset (DSO) among pediatric sport-related concussion (SRC) patients as well as the effect of symptom onset on initial symptom severity, length of recovery, and development of delayed recovery; (2) to evaluate the impact of symptom onset on sideline management.Methods: We conducted a prospective study of pediatric SRC patients (<20 years of age) evaluated at a multi-disciplinary concussion program. Patients underwent initial medical assessment by a single neurosurgeon and a structured interview by a research assistant. Patients were classified as experiencing early symptom onset (symptom onset <15 min from the time of the suspected injury; ESO) or DSO (≥15 min from the time of the suspected injury).Results: A total of 144 SRC patients (61.1% male; mean age 14.6 years, SD 1.8) evaluated a median of 5.0 days (IQR 4.0, 9.0) post-injury were included in the study. Among these patients, 120 (83.3%) reported experiencing ESO while 24 (16.7%) experienced DSO following injury. Among those that experienced DSO the median length of time from the suspected injury to symptom onset was 60.0 min (IQR 20.0, 720.0). No significant differences were observed in symptom severity at initial medical assessment (median Post-Concussion Symptom Scale score 20.0 vs. 18.0, p = 0.35), length of physician-document clinical recovery (median 22.0 vs. 24.0 days; p = 0.46) or the proportion of those who developed delayed physician-documented clinical recovery (34.4 vs. 42.1%, p = 0.52) among patients with ESO or DSO. Patients who reported experiencing ESO were significantly more likely to be immediately removed from play at the time of their suspected injury compared to those who experienced DSO (71.6% vs. 29.2%; p < 0.0001).Conclusions: This study suggests that an important proportion of children and adolescents who sustain an acute SRC experience DSO. DSO is associated with lower rates of immediate removal from play at the time of suspected injury. Secondary study findings highlight the need for improved sport stakeholder concussion education and standardized concussion protocols that mandate the immediate and permanent removal of all youth with a suspected concussion until they undergo medical assessment.
Highlights
Concussion is a condition caused by the transmission of biomechanical forces to the brain leading to temporary impairments in neurological functioning that often resolve spontaneously [1]
Previous studies have examined clinical outcomes among athletes who continued to play despite a symptomatic sport-related concussion (SRC) [8, 9], little research attention has been paid to athletes who experience delayed symptom onset (DSO) and may be at risk of additional injury during continued sport participation [10,11,12]
Afterwards, consented patients completed a structured 20-min oral interview that included open and closed-ended questions that allowed researchers to collect details regarding the mechanism of injury, symptom onset, whether, and how timely they were removed from play, how truthful they were during sideline assessment, whether they returned to play, and if they sustained additional instances of body or head contact
Summary
Concussion is a condition caused by the transmission of biomechanical forces to the brain leading to temporary impairments in neurological functioning that often resolve spontaneously [1]. In order to prevent these adverse outcomes, current national, and international guidelines recommend that all youth athletes who sustain a suspected concussion during a sporting activity be immediately removed from play and undergo standardized sideline assessment by a licensed healthcare professional [1, 5,6,7]. Previous studies have examined clinical outcomes among athletes who continued to play despite a symptomatic sport-related concussion (SRC) [8, 9], little research attention has been paid to athletes who experience delayed symptom onset (DSO) and may be at risk of additional injury during continued sport participation [10,11,12]. No prospective studies have examined the prevalence of DSO among children and adolescents with acute SRC and its effect on clinical outcomes and athlete sideline management
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