Effects of prior concussion on symptom severity and recovery time in acute youth concussion

James Mooney MD1, James Pate MD2, Ian Cummins MD2, M. Chandler McLeod PhD, MS3, and Sara Gould MD, MPH4
View More View Less
  • 1 Department of Neurosurgery,
  • | 2 School of Medicine,
  • | 3 Department of Surgery, and
  • | 4 Department of Orthopedic Surgery, University of Alabama at Birmingham, Alabama
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

OBJECTIVE

Many studies have identified factors associated with increased symptom burden and prolonged recovery after pediatric and adolescent concussion. Few have systematically examined the effects of prior concussion on these outcomes in patients with concussion due to any mechanism. An improved understanding of the short- and long-term effects of a multiple concussion history will improve counseling and management of this subgroup of patients.

METHODS

A retrospective review of adolescent and young adult acute concussion patients presenting to the multidisciplinary concussion clinic between 2018 and 2019 was conducted at a single center. Patient demographic data, medical history including prior concussion, initial symptom severity score (SSS), injury mechanisms, and recovery times were collected. Univariate and multivariable analyses were conducted to identify associations of history of prior concussion and patient and injury characteristics with symptom score and recovery time.

RESULTS

A total of 266 patients with an average age of 15.4 years (age range 13–27 years) were included. Prior concussion was reported in 35% of patients. The number of prior concussions per patient was not significantly associated with presenting symptom severity, recovery time, or recovery within 28 days. Male sex and sports-related concussion (SRC) were associated with lower presenting SSS and shorter recovery time on univariate but not multivariable analysis. However, compared to non–sport concussion mechanisms, SRC was associated with 2.3 times higher odds of recovery within 28 days (p = 0.04). A history of psychiatric disorders was associated with higher SSS in univariate analysis and longer recovery time in univariate and multivariable analyses. Multivariable log-linear regression also demonstrated 5 times lower odds of recovery within 28 days for those with a psychiatric history.

CONCLUSIONS

The results of this study demonstrated that an increasing number of prior concussions was associated with a trend toward higher presenting SSS after youth acute concussion but did not show a significant association with recovery time or delayed (> 28 days) recovery. Presence of psychiatric history was found to be significantly associated with longer recovery and lower odds of early (≤ 28 days) recovery. Future prospective, long-term, and systematic study is necessary to determine the optimal counseling and management of adolescent and young adult patients with a history of multiple concussions.

ABBREVIATIONS

est = regression estimate; SRC = sports-related concussion; SSS = symptom severity score.

Supplementary Materials

    • Supplementary Tables 1 and 2 (PDF 510 KB)

Illustration from Cinalli et al. (pp 330–341). Printed with permission from © CC Medical Arts.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $515.00
USD  $612.00
  • 1

    Bakhos LL, Lockhart GR, Myers R, Linakis JG. Emergency department visits for concussion in young child athletes. Pediatrics. 2010;126(3):e550e556.

  • 2

    McCrory P, Meeuwisse W, Dvořák J, et al. Consensus statement on concussion in sport—the 5th International Conference on Concussion in Sport held in Berlin, October 2016.Br J Sports Med. 2017;51(11):838847.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Corbin-Berrigan LA, Gagnon I. Postconcussion symptoms as a marker of delayed recovery in children and youth who recently sustained a concussion: a brief report. Clin J Sport Med. 2017;27(3):325327.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Fehr SD, Nelson LD, Scharer KR, et al. Risk factors for prolonged symptoms of mild traumatic brain injury: a pediatric sports concussion clinic cohort. Clin J Sport Med. 2019;29(1):1117.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Heyer GL, Schaffer CE, Rose SC, Young JA, McNally KA, Fischer AN. Specific factors influence postconcussion symptom duration among youth referred to a sports concussion clinic. J Pediatr. 2016;174:3338.e2.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Howell DR, O’Brien MJ, Beasley MA, Mannix RC, Meehan WP III. Initial somatic symptoms are associated with prolonged symptom duration following concussion in adolescents. Acta Paediatr. 2016;105(9):e426e432.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Howell DR, Potter MN, Kirkwood MW, Wilson PE, Provance AJ, Wilson JC. Clinical predictors of symptom resolution for children and adolescents with sport-related concussion. J Neurosurg Pediatr. 2019;24(1):5461.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Iverson GL, Gardner AJ, Terry DP, et al. Predictors of clinical recovery from concussion: a systematic review. Br J Sports Med. 2017;51(12):941948.

  • 9

    Kowalczyk CL, Eagle SR, Holland CL, Collins MW, Kontos AP. Average symptom severity and related predictors of prolonged recovery in pediatric patients with concussion. Appl Neuropsychol Child. 2022;11(2):145149.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Ledoux AA, Tang K, Gagnon I, et al. Association between preinjury symptoms and postconcussion symptoms at 4 weeks in youth. J Head Trauma Rehabil. 2022;37(2):E90E101.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Miller JH, Gill C, Kuhn EN, et al. Predictors of delayed recovery following pediatric sports-related concussion: a case-control study. J Neurosurg Pediatr. 2016;17(4):491496.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    van der Naalt J, Timmerman ME, de Koning ME, et al. Early predictors of outcome after mild traumatic brain injury (UPFRONT): an observational cohort study. Lancet Neurol. 2017;16(7):532540.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Zemek R, Barrowman N, Freedman SB, et al. Clinical risk score for persistent postconcussion symptoms among children with acute concussion in the ED. JAMA. 2016;315(10):10141025.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Manzanero S, Elkington LJ, Praet SF, Lovell G, Waddington G, Hughes DC. Post-concussion recovery in children and adolescents: a narrative review. J Concussion. 2017;1:205970021772687.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Scopaz KA, Hatzenbuehler JR. Risk modifiers for concussion and prolonged recovery. Sports Health. 2013;5(6):537541.

  • 16

    Foley C, Gregory A, Solomon G. Young age as a modifying factor in sports concussion management: what is the evidence?. Curr Sports Med Rep. 2014;13(6):390394.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Berz K, Divine J, Foss KB, Heyl R, Ford KR, Myer GD. Sex-specific differences in the severity of symptoms and recovery rate following sports-related concussion in young athletes. Phys Sportsmed. 2013;41(2):5863.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Desai N, Wiebe DJ, Corwin DJ, Lockyer JE, Grady MF, Master CL. Factors affecting recovery trajectories in pediatric female concussion. Clin J Sport Med. 2019;29(5):361367.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Brook EM, Luo X, Curry EJ, Matzkin EG. A heads up on concussions: are there sex-related differences?. Phys Sportsmed. 2016;44(1):2028.

  • 20

    Meehan WP III, Mannix R, Monuteaux MC, Stein CJ, Bachur RG. Early symptom burden predicts recovery after sport-related concussion. Neurology. 2014;83(24):22042210.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Meehan WP III, Mannix RC, Stracciolini A, Elbin RJ, Collins MW. Symptom severity predicts prolonged recovery after sport-related concussion, but age and amnesia do not. J Pediatr. 2013;163(3):721725.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Meehan WP III, O’Brien MJ, Geminiani E, Mannix R. Initial symptom burden predicts duration of symptoms after concussion. J Sci Med Sport. 2016;19(9):722725.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Schilling S, Mansour A, Sullivan L, Ding K, Pommering T, Yang J. Symptom burden and profiles in concussed children with and without prolonged recovery. Int J Environ Res Public Health. 2020;17(1):E351.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Makdissi M, Davis G, Jordan B, Patricios J, Purcell L, Putukian M. Revisiting the modifiers: how should the evaluation and management of acute concussions differ in specific groups?. Br J Sports Med. 2013;47(5):314320.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Ellis M, Krisko C, Selci E, Russell K. Effect of concussion history on symptom burden and recovery following pediatric sports-related concussion. J Neurosurg Pediatr. 2018;21(4):401408.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Reid DBC, Shah KN, Baum EJ, Daniels AH. Concussion: mechanisms of injury and trends from 1997 to 2019. R I Med J (2013).2020;103(7):7175.

    • Search Google Scholar
    • Export Citation
  • 27

    Eisenberg MA, Andrea J, Meehan W, Mannix R. Time interval between concussions and symptom duration. Pediatrics. 2013;132(1):817.

  • 28

    Ernst N, Eagle S, Trbovich A, Kissinger-Knox A, Bitzer H, Kontos AP. Lower post-injury psychological resilience is associated with increased recovery time and symptom burden following sport-related concussion. Appl Neuropsychol Child. Published online August 19, 2021.doi: 10.1080/21622965.2021.1964966

    • Search Google Scholar
    • Export Citation
  • 29

    Wilmoth K, Curcio N, Tarkenton T, et al. Utility of brief psychological measures for prediction of prolonged symptom clearance in concussed student athletes. Arch Clin Neuropsychol. 2021;36(3):430436.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Nelson LD, Tarima S, LaRoche AA, et al. Preinjury somatization symptoms contribute to clinical recovery after sport-related concussion. Neurology. 2016;86(20):18561863.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Tarkenton T, Caze Ii T, Silver CH, et al. Differences in adolescent symptom reporting following motor vehicle accident versus sport-related concussion. Arch Clin Neuropsychol. 2021;36(4):554560.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Bloom DA, Whitney DC, Gonzalez-Lomas G, Carter CW. The incidence of concussion and symptom non-reporting among professional women’s ice hockey players. Bull Hosp Jt Dis (2013).2021;79(3):158162.

    • Search Google Scholar
    • Export Citation
  • 33

    Pate J, Cummins I, Mooney J, Cooper K, McLeod C, Gould S. Socioeconomic and demographic considerations of pediatric concussion recovery. J Clin Neurosci. 2022;100:9499.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Marmor WA, McElheny KD, Lingor RJ, et al. Disparities in concussion diagnoses compared to ankle injuries. PM R. 2022.

  • 35

    Wallace J, Affagato R, Brooke M, McAllister-Deitrick J, Moran RN, Covassin T. Racial disparities in parent knowledge of concussion and recognition of signs and symptoms. J Safety Res. 2020;75:166172.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Yue JK, Upadhyayula PS, Avalos LN, Phelps RRL, Suen CG, Cage TA. Concussion and mild-traumatic brain injury in rural settings: epidemiology and specific health care considerations. J Neurosci Rural Pract. 2020;11(1):2333.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Yumul JN, McKinlay A. Do multiple concussions lead to cumulative cognitive deficits? A literature review PM R. 2016;8(11):10971103.

  • 38

    Guskiewicz KM, McCrea M, Marshall SW, et al. Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study. JAMA. 2003;290(19):25492555.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Swaine BR, Tremblay C, Platt RW, Grimard G, Zhang X, Pless IB. Previous head injury is a risk factor for subsequent head injury in children: a longitudinal cohort study. Pediatrics. 2007;119(4):749758.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    van Ierssel J, Ledoux AA, Tang K, et al. Symptom burden, school function, and physical activity one year following pediatric concussion. J Pediatr. 2021;228:190198.e3.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41

    Register-Mihalik JK, Mihalik JP, Guskiewicz KM. Association between previous concussion history and symptom endorsement during preseason baseline testing in high school and collegiate athletes. Sports Health. 2009;1(1):6165.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42

    Schneider KJ, Emery CA, Kang J, Schneider GM, Meeuwisse WH. Examining Sport Concussion Assessment Tool ratings for male and female youth hockey players with and without a history of concussion. Br J Sports Med. 2010;44(15):11121117.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 719 719 123
Full Text Views 69 69 36
PDF Downloads 101 101 60
EPUB Downloads 0 0 0