HEALTH-RELATED QUALITY OF LIFE FOLLOWING ADOLESCENT SPORTS-RELATED CONCUSSION OR FRACTURE: A PROSPECTIVE COHORT STUDY

Abstract

Background: Sport-related concussion is a form of traumatic brain injury that often presents with a combination of symptoms that reflect disturbances in physical, cognitive, sleep, and emotional functioning. The longitudinal effects of adolescent sports-related concussion (SRC) on health-related quality of life (HRQOL) remain poorly understood. The objectives of this study were to 1) compare HRQOL outcomes among adolescents with an acute SRC or sports-related extremity fracture (SRF) who were followed until physician-documented clinical recovery and 2) to identify the clinical variables associated with worse HRQOL among adolescent SRC patients. Methods: We conducted a prospective cohort study of adolescents with acute isolated SRC or SRF who underwent clinical assessment within 30 days post injury and follow-up at tertiary sub-specialty clinics. Longitudinal patient-reported HRQOL was measured at initial assessment and at each follow-up appointment using the adolescent version (age 13-18) Pediatric Quality of Life Inventory generic core scale and Cognitive Functioning scale. Demographic characteristics were collected from the medical charts. Results: Participants in this study included 135 patients with SRC (60.0% male; mean age 14.7 years; time from injury to initial assessment 6 days) and 96 with SRF (59.4% male, mean age 14.1 years; time from injury to initial assessment 8 days). At initial assessment, SRC patients reported significantly worse cognitive, school and overall HRQOL compared to SRF patients with no differences in physical, emotional and social HRQOL. Clinical variables associated with worse HRQOL among SRC patients differed by domain but were significantly impacted by initial symptom burden and the development of delayed physician-documented clinical recovery (> 28 days post-injury). Overall, 132 (97.8%) SRC patients and all SRF patients achieved physician-documented clinical recovery during the study period. The median days until physician-documented clinical recovery for the SRC patients was 26 days (IQR: 17, 49) and this was not significantly different than SRF patients (31 days, IQR: 23, 42; p=0.12). At the time of physician-documented clinical recovery, patients with SRC did not have persistent impairments in HRQOL. Conclusions: Adolescent SRC is associated with temporary impairments in HRQOL that resolve in patients followed until physician-documented clinical recovery. Compared to SRF, adolescent SRC patients experience significantly greater impairments in cognitive, school, and overall HRQOL. The degree of impairment experienced by adolescent SRC patients across HRQOL domains is impacted by initial symptom burden and length of clinical recovery. Future studies are needed to identify the clinico-pathological features associated with impaired HRQOL and assess whether the initiation of multi-disciplinary targeted rehabilitation strategies lead to an improvement in HRQOL in acute SRC patients.