Objective To identify predictors of prolonged symptoms for athletes who sustain concussions. Study design We conducted a multi-center, prospective, cohort study of patients in 2 sport concussion clinics. Possible predictors of prolonged symptoms from concussion were compared between two groups: those whose symptoms resolved within 28 days and those whose symptoms persisted beyond 28 days. Candidate predictor variables were entered into a logistic regression model that was used to generate adjusted odds ratios. Results During the study period, 182 patients met inclusion criteria. The mean age was 15.2 years (SD 3.04 years). Over a third (N=65) of patients underwent computerized neurocognitive testing on their initial visit. In univariate analyses, Post Concussion Symptom Scale (PCSS) score and all composite scores on computerized neurocognitive testing appeared to be associated with prolonged symptom duration. Sex, age, loss of consciousness at time of injury and amnesia at time of injury were not associated with prolonged symptom duration. After adjusting for potential confounding, however, only total score on the PCSS score was associated with the odds of suffering prolonged symptoms. Conclusions After adjusting for other potential confounding variables, only total score on the PCSS was associated with the odds of suffering prolonged symptoms from sport-related concussions; age and amnesia were not. Further efforts to develop clinical tools for predicting which athletes will suffer prolonged recoveries after concussion should focus on initial symptom score.

Systematic Review, Level III.

Sport specialization is a growing trend in youth athletes and may contribute to increased injury risk. The neuromuscular deficits that often manifest during maturation in young, female athletes may be exacerbated in athletes who specialize in a single sport. The purpose of this study was to investigate if sport specialization is associated with increased lower extremity biomechanical deficits pre- to post-puberty in adolescent female athletes. Seventy-nine sport-specialized female adolescent (Mean ± SD age = 13.4 ± 1.8 years) basketball, soccer, and volleyball athletes were identified and matched with seventy-nine multi-sport (soccer, basketball, and volleyball) female athletes from a database of 1,116 female adolescent basketball, soccer, and volleyball athletes who were enrolled in one of two large prospective, longitudinal studies. The athletes were assessed over two visits (Mean ± SD time = 724.5 ± 388.7 days) in which they were classified as pre-pubertal and post-pubertal, respectively. Separate 2 × 2 analyses of covariance were used to compare sport-specialized and multi-sport groups and dominant/non-dominant limbs with respect to pubertal changes in peak knee sagittal, frontal, and transverse plane joint angular measures and moments of force recorded while performing a drop vertical jump task. The sport-specialized group were found to exhibit significantly larger post-pubertal increases in peak knee abduction angle ( p = 0.005) and knee abduction moment ( p = 0.006), as well as a smaller increase in peak knee extensor moment ( p = 0.032) during landing when compared to the multi-sport group. These biomechanical changes are indicative of potentially compromised neuromuscular control that may increase injury risk pre- to post-puberty in sport-specialized female athletes. Consideration of maturation status may be an important factor in assessing the injury risk profiles of adolescent athletes who specialize in sport.

Sports injuries in young males and females differed by injury type, diagnosis, and body area. These results may be related to the referral patterns unique to the division of the hospital, including a high number of female dancers. Further investigation is required to better understand the injury risk in pediatric male and female athletes.