Incidence, Clinical Course, and Predictors of Prolonged Recovery Time Following Sport-Related Concussion in High School and College Athletes

McCrea, Michael; Guskiewicz, Kevin M.; Randolph, Christopher; Barr, William; Hammeke, Thomas A.; Marshall, Stephen W.; Powell, Matthew R.; Ahn, Kwang Woo; Wang, Yanzhi; Kelly, James P.

doi:10.1017/s1355617712000872

Cited by 388 publications

(288 citation statements)

References 33 publications

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“…These results are in agreement with other studies that have demonstrated alterations in accommodation, convergence, and saccades following concussion 22,30,31 and 1 study that found that abnormal convergence was associated with prolonged recovery following pediatric concussion. 8 Previous studies have also suggested that a preinjury mood disorder 8,29 and posttraumatic amnesia 23 are independent predictors of longer recovery following SRC.…”

Section: Discussionmentioning

confidence: 99%

Clinical predictors of vestibulo-ocular dysfunction in pediatric sports-related concussion

Ellis

Cordingley²,

Vis³

et al. 2017

PED

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OBJECTIVE There were 2 objectives of this study. The first objective was to identify clinical variables associated with vestibulo-ocular dysfunction (VOD) detected at initial consultation among pediatric patients with acute sports-related concussion (SRC) and postconcussion syndrome (PCS). The second objective was to reexamine the prevalence of VOD in this clinical cohort and evaluate the effect of VOD on length of recovery and the development of PCS. METHODS A retrospective review was conducted for all patients with acute SRC and PCS who were evaluated at a pediatric multidisciplinary concussion program from September 2013 to May 2015. Acute SRS was defined as presenting < 30 days postinjury, and PCS was defined according to the International Classification of Diseases, 10th Revision criteria and included being symptomatic 30 days or longer postinjury. The initial assessment included clinical history and physical examination performed by 1 neurosurgeon. Patients were assessed for VOD, defined as the presence of more than 1 subjective vestibular and oculomotor complaint (dizziness, diplopia, blurred vision, etc.) and more than 1 objective physical examination finding (abnormal near point of convergence, smooth pursuits, saccades, or vestibulo-ocular reflex testing). Poisson regression analysis was used to identify factors that increased the risk of VOD at initial presentation and the development of PCS. RESULTS Three hundred ninety-nine children, including 306 patients with acute SRC and 93 with PCS, were included. Of these patients, 30.1% of those with acute SRC (65.0% male, mean age 13.9 years) and 43.0% of those with PCS (41.9% male, mean age 15.4 years) met the criteria for VOD at initial consultation. Independent predictors of VOD at initial consultation included female sex, preinjury history of depression, posttraumatic amnesia, and presence of dizziness, blurred vision, or difficulty focusing at the time of injury. Independent predictors of PCS among patients with acute SRC included the presence of VOD at initial consultation, preinjury history of depression, and posttraumatic amnesia at the time of injury. CONCLUSIONS This study identified important potential risk factors for the development of VOD following pediatric SRC. These results provide confirmatory evidence that VOD at initial consultation is associated with prolonged recovery and is an independent predictor for the development of PCS. Future studies examining clinical prediction rules in pediatric concussion should include VOD. Additional research is needed to elucidate the natural history of VOD following SRC and establish evidence-based indications for targeted vestibular rehabilitation.

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Section: Discussionmentioning

confidence: 99%

Clinical predictors of vestibulo-ocular dysfunction in pediatric sports-related concussion

Ellis

Cordingley²,

Vis³

et al. 2017

PED

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“…Symptoms from most concussions resolve in <2 weeks [8]; however, for some athletes the symptoms can persist for longer than 1 month [9]. In that intervening period, athletes may experience a combination of cognitive, somatic and emotional symptoms [9,10] that can impair their ability to complete school or work obligations [11].…”

Section: Introductionmentioning

confidence: 99%

Social norms theory and concussion education

Kroshus¹,

Garnett²,

Baugh³

et al. 2015

Health Educ. Res.

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Secondary prevention of harm from sportrelated concussion is contingent on immediate removal from play post-injury. To-date, educational efforts to reduce the prevalent risk behavior of continued play while symptomatic have been largely ineffective. Social norms theory may hold promise as a foundation for more effective concussion education aimed at increasing concussion reporting. The primary objective of this study was to assess whether perceived team concussion reporting norms would be less supportive of an individual's safe concussion symptom reporting behavior than objective team norms. Participants were 328 male and female US collegiate athletes. Written surveys were completed in person during the spring of 2014. Among both male and female athletes, team concussion reporting norms were significantly misperceived, with athletes tending to think that they themselves have safer attitudes about concussion reporting than their teammates. Perceived norms were associated with symptom reporting intention, independent of the team's objective reporting norm. A social norms approach to concussion education, in which misperceived group norms are corrected and shifted in the direction of safety, is an important avenue for program development and evaluation research aimed at the secondary prevention of harm from concussion. Implications for the design of this type of educational programming are discussed.

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“…Estimates as to duration of postconcussive symptoms in children range widely, with reports showing as few as 10% of patients symptomatic 7 days after sport-related concussion 4 to as many as 43% still with symptoms 3 months after being hospitalized for mTBI. 5 One cohort study conducted in the emergency department (ED) setting showed 29.3% of children aged 5 to 18 years still symptomatic 3 months after sustaining a concussion, with the most common symptoms being headache, fatigue, and frustration.…”

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confidence: 99%

Duration and Course of Post-Concussive Symptoms

2014

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OBJECTIVES: To examine the incidence, duration, and clinical course of individual post-concussive symptoms in patients presenting to a pediatric emergency department (ED) with a concussion. METHODS: We conducted secondary analysis of a prospective cohort study of patients 11 to 22 years old presenting to the ED of a children’s hospital with an acute concussion. The main outcome measure was duration of symptoms, assessed by the Rivermead Post-Concussion Symptoms Questionnaire (RPSQ). Patients initially completed a questionnaire describing mechanism of injury, associated symptoms, past medical history, and the RPSQ, then were serially administered the RPSQ for 3 months after the concussion or until all symptoms resolved. RESULTS: Headache, fatigue, dizziness, and taking longer to think were the most common symptoms encountered at presentation, whereas sleep disturbance, frustration, forgetfulness, and fatigue were the symptoms most likely to develop during the follow-up period that had not initially been present. Median duration of symptoms was the longest for irritability (16 days), sleep disturbance (16 days), frustration (14 days), and poor concentration (14 days), whereas nausea, depression, dizziness, and double-vision abated most quickly. One month after injury, nearly a quarter of children still complained of headache, >20% suffered from fatigue, and nearly 20% reported taking longer to think. CONCLUSIONS: Among patients presenting to a pediatric ED after a concussion, physical symptoms such as headache predominate immediately after the injury, emotional symptoms tend to develop later in the recovery period, and cognitive symptoms may be present throughout.

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Incidence, Clinical Course, and Predictors of Prolonged Recovery Time Following Sport-Related Concussion in High School and College Athletes

Cited by 388 publications

References 33 publications

Clinical predictors of vestibulo-ocular dysfunction in pediatric sports-related concussion

Clinical predictors of vestibulo-ocular dysfunction in pediatric sports-related concussion

Social norms theory and concussion education

Duration and Course of Post-Concussive Symptoms

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