Fehr SD, Nelson LD, Scharer KR, Traudt EA, Veenstra JM, Tarima SS, Liu XC, Walter KD. Clin. J. Sport. Med. 2019; 29(1): 11-17.
Affiliation
*Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; †Children's Hospital of Wisconsin, Milwaukee, Wisconsin; Departments of ‡Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin; and §Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
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 range: 10-18 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 recovery: loss 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.