Factors that Influence Recovery From Concussion in Young Children and Preadolescents

Abstract

Objective: To examine differences in the presentation and management of concussion in younger children (aged 4–8 years) versus preadolescents (9–12 years) and identify factors that influence recovery time. Design: Retrospective analysis of prospectively collected data. Setting: Pediatric sports medicine and orthopedics clinic. Patients: Three hundred seventy-five patients aged 4 to 12 years diagnosed with concussion between 2020 and 2022. Independent Variables: Age, gender, race/ethnicity, mechanism of injury (sport vs nonsport related), neurodevelopmental or psychiatric diagnosis, concussion history, Post-Concussion Symptom Scale (PCSS) score, and Vestibular Ocular Motor Screening (VOMS) overall change scores. Main Outcome Measures: Days since injury (DSI) to initial visit, total number of visits, recovery time (days). Results: Groups significantly differed in DSI (P = 0.01) and overall VOMS change score (P = 0.03). No differences were observed between groups on total number of visits or recovery time. Patients with fewer DSI [odds ratio (OR) = 1.15], less change in overall VOMS score (OR = 1.02), lower PCSS scores (OR = 1.02), and who were injured in sport were less likely to experience a protracted recovery. Conclusions: Younger children with concussion may be appropriately treated with a similar approach to preadolescent patients despite greater DSI and differences in VOMS change scores, without sacrificing overall recovery time. Consistent with research in older cohorts, protracted recovery was seen in nonsport patients, and patients seen sooner at a specialty concussion clinic were less likely to experience a protracted recovery, endorsed lower PCSS scores, and had lower overall VOMS change scores. Further research is needed to solidify a child-specific paradigm to concussion management.