Risk Factors for Prolonged Symptoms of Mild Traumatic Brain Injury: A Pediatric Sports Concussion Clinic Cohort

• Published in: Clinical journal of sport medicine Vol. 29; no. 1; pp. 11 - 17
• Main Authors: Fehr, Shayne D, Nelson, Lindsay D, Scharer, Kyle R, Traudt, Elizabeth A, Veenstra, Joshua M, Tarima, Sergey S, Liu, Xue-Cheng, Walter, Kevin D
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-01-2019
• ISSN: 1050-642X; 1536-3724
• DOI: 10.1097/JSM.0000000000000494

OBJECTIVE:To examine predictors of prolonged symptom duration from mild traumatic brain injury (mTBI) in a pediatric sports medicine specialty clinic cohort as these predictors may be distinct in this population.
DESIGN:Retrospective chart review.
SETTING:Outpatient specialty clinic.
PATIENTS:Charts of 549 patients (age range10-18 years) with concussions were reviewed in an outpatient clinic that predominantly managed sports-related injuries (77.3%). Patients (n = 431) included in the final analysis met the criteria for mTBI and were symptomatic at their first visit.
ASSESSMENT OF RISK FACTORS:Patient history, injury, and recovery variables were evaluated.
MAIN OUTCOME MEASURES:Predictors of prolonged time to reach self-reported symptom recovery were evaluated using Cox proportional hazards.
RESULTS:Median time to symptom recovery of the 431 patients who presented to clinic with symptoms was 40 days (full clinic sample median = 34 days). Analyses identified 3 unique predictors of symptom recoveryloss of consciousness (LOC) [hazard ratio (HR) = 0.56, P < 0.0001], female sex (HR = 0.57, P < 0.0001), and concussion symptom score at first clinic visit (HR = 0.76, P < 0.0001).
CONCLUSIONS:Prolonged duration of mTBI symptoms in patients who present to a pediatric sports-based concussion clinic is related to initial symptom severity, female sex, and LOC.