Research Reports - Specific factors influence postconcussion symptom duration among youth referred to a sports concussion clinic
J Pediatr. 2016 Jul;174:33-38.e2. doi: 10.1016/j.jpeds.2016.03.014. Epub 2016 Apr
Heyer GL(1), Schaffer CE(2), Rose SC(3), Young JA(4), McNally KA(5), Fischer
OBJECTIVE: To identify the clinical factors that influence the duration of
postconcussion symptoms among youth referred to a sports concussion clinic.
STUDY DESIGN: A retrospective cohort study was conducted to evaluate several
potential predictors of symptom duration via a Cox proportional hazards analyses.
The individual postconcussion symptom scores were highly correlated, so these
symptoms were analyzed in the statistical model as coefficients derived from
principal component analyses.
RESULTS: Among 1953 youth with concussion, 1755 (89.9%) had dates of reported
symptom resolution. The remainder (10.1%) were lost to follow-up and censored.
The median time to recovery was 18 days (range 1-353 days). By 30 days, 72.6% had
recovered; by 60 days, 91.4% had recovered; and by 90 days, 96.8% had recovered.
Several variables in a multivariate Cox model predicted postconcussion symptom
duration: female sex (P < .001, hazard ratio [HR] = 1.28), continued activity
participation (P = .02, HR = 1.13), loss of consciousness (P = .03, HR = 1.18),
anterograde amnesia (P = .04, HR = 1.15), premorbid headaches (P = .03,
HR = 1.15), symptom components from the day of concussion (emotion, P = .03,
HR = 1.08), and the day of clinic evaluation (cognitive-fatigue, P < .001,
HR = 1.22; cephalalgic, P < .001, HR = 1.27; emotional, P = .05, HR = 1.08;
arousal-stimulation, P = .003, HR = 1.1). In univariate analyses, greater symptom
scores generally predicted longer symptom durations. Worsening of symptoms from
the day of concussion to the day of clinic evaluation also predicted longer
recovery (P < .001, HR = 1.59).
CONCLUSIONS: Several factors help to predict protracted postconcussion symptom
durations among youth referred to a sports concussion clinic.