Association of time to initial clinic visit with prolonged recovery in pediatric patients with concussion

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  • Department of Orthopaedic Surgery, University of Pittsburgh; and UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania
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OBJECTIVE

No studies to date have investigated the role of early clinical care in time to recovery from concussion in a pediatric population. The purpose of this study was to investigate the role of clinic presentation timing (≤ 7 days [early] compared to 8–20 days [late] from injury) in concussion assessment performance and risk for prolonged recovery (> 30 days) in pediatric concussion.

METHODS

This study is a retrospective cross-sectional study from a concussion clinic between April 2016 and January 2019, including 218 children and adolescents with diagnosed concussion, separated based on clinic presentation timing following injury: early (≤ 7 days) and late (8–20 days). Outcomes were recovery time, Postconcussion Symptom Scale (PCSS), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Vestibular/Ocular Motor Screen (VOMS), and demographics, medical history, and injury information. A general linear model and chi-square analyses were used to assess differences between early and late presentation, along with logistic regression, to predict prolonged recovery (> 30 days).

RESULTS

Those with early presentation reported higher symptoms on VOMS subtests (79%–85%) compared to those with late presentation (61%–78%), with the exception of near-point of convergence distance and visual motion sensitivity (VMS). The strongest predictor of prolonged recovery was number of days to first clinic visit (OR 9.8). Positive VMS (OR 5.18), history of headache/migraine (OR 4.02), and PCSS score (OR 1.04) were also predictive of prolonged recovery.

CONCLUSIONS

Despite patients in the early presentation group presenting with more positive VOMS scores, the early presentation group recovered sooner than patients in the late presentation group. Even after controlling for vestibular dysfunction, history of headache or migraine, and total symptom severity, days to first visit remained the most robust predictor of recovery > 30 days. These findings suggest that early, specialized medical care and intervention for children and adolescents with recent concussion is associated with normal recovery time. Clinicians should educate children and parents on the potential importance of early treatment to improve the odds of positive outcomes following concussion.

ABBREVIATIONS ADHD = attention-deficit hyperactivity disorder; ImPACT = Immediate Post-Concussion Assessment and Cognitive Testing; LD = learning disorder; NPC = near-point of convergence; OR = odds ratio; PCSS = Postconcussion Symptom Scale; VMS = visual motion sensitivity; VOMS = Vestibular/Ocular Motor Screen; VOR = vestibular-ocular reflex.

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Contributor Notes

Correspondence Shawn R. Eagle: University of Pittsburgh School of Medicine, Pittsburgh, PA. seagle@pitt.edu.

INCLUDE WHEN CITING Published online April 24, 2020; DOI: 10.3171/2020.2.PEDS2025.

Disclosures M.W.C. is a co-founder and shareholder of ImPACT applications. M.W.C. and A.P.K. receive royalties from American Psychological Association Books. A.P.K. has received support of non–study-related clinical or research effort from the National Football League.

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