Research Reports - Time interval between concussions and symptom duration

Pediatrics. 2013 Jul;132(1):8-17

Eisenberg MA, Andrea J, Meehan W, Mannix R.

OBJECTIVE: To test the hypothesis that children with a previous history of
concussion have a longer duration of symptoms after a repeat concussion than
those without such a history.
METHODS: Prospective cohort study of consecutive patients 11 to 22 years old
presenting to the emergency department of a children's hospital with an acute
concussion. The main outcome measure was time to symptom resolution, assessed by
the Rivermead Post-Concussion Symptoms Questionnaire (RPSQ). Patients and
providers completed a questionnaire describing mechanism of injury, associated
symptoms, past medical history, examination findings, diagnostic studies, and the
RPSQ. Patients were then serially administered the RPSQ for 3 months after the
concussion or until all symptoms resolved.
RESULTS: A total of 280 patients were enrolled over 12 months. Patients with a
history of previous concussion had a longer duration of symptoms than those
without previous concussion (24 vs 12 days, P = .02). Median symptom duration was
even longer for patients with multiple previous concussions (28 days, P = .03)
and for those who had sustained a concussion within the previous year (35 days, P
= .007) compared with patients without those risk factors. In a multivariate
model, previous concussion, absence of loss of consciousness, age ≥13, and
initial RPSQ score >18 were significant predictors of prolonged recovery.
CONCLUSIONS: Children with a history of a previous concussion, particularly
recent or multiple concussions, are at increased risk for prolonged symptoms
after concussion. These findings have direct implications on the management of
patients with concussion who are at high risk for repeat injuries.

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