518 - Pediatric Concussion Recovery Time: Influence of Mechanism of Injury, Gender, Age, Socioeconomic Status, and Symptoms

Publication Number: 4508.518

Becket Wren, Children's Hospital Los Angeles, Palos Verdes Estates, CA, United States; Jonathan Santana, Children's Hospital Los Angeles, Los Angeles, CA, United States; Tishya A. L.. Wren, Children's Hospital Los Angeles, Los Angeles, CA, United States; Anita Herrera Hamilton, Children's Hospital, Los Angeles, Seal Beach, CA, United States

Background: Each year, 10% of children and teenagers will experience a concussion, with one in every five people experiencing a concussion by the age of 16 years. With their brains at both an essential developmental stage, children are at a heightened risk of cumulative injury and lasting neurocognitive problems. However, there is little research on the broad range of factors that may affect recovery duration.

Objective: To evaluate the effect of mechanism of injury (sports vs. non-sports), gender, age, socioeconomic status, and other factors on the recovery duration of pediatric concussion patients.

Design/Methods: This study involved patients presenting to sports medicine clinics in a large tertiary children's hospital system for a concussion evaluation. Patients that did not complete recommended follow-up were excluded. Univariate and multivariate negative binomial regressions were used to examine time from injury to clearance against potential explanatory variables including demographic factors, symptom count and severity, presentation delay, and mechanism of injury.

Results: The study included 169 patients with a median age of 14.4 years at injury who sustained 195 concussions with a median of 45 days to clearance (Table 1). In univariate analysis, higher COI scores and sport-related mechanism of injury were associated with shorter days to clearance, especially for males. Delays in presentation were associated with longer recovery times, on average, while higher symptom severity scores and number of symptoms contributed to extended recovery periods (Table 2).

In multivariate analysis, time to clearance was 36% shorter for males (IRR=0.642, p=0.001) and 7% shorter for each 10 unit increase in COI (IRR=0.993, p=0.004), while patients with sport-related injuries were 25% quicker to be cleared (IRR=0.748, p=0.052) (Table 3). Patients who took longer to present for evaluation experienced a 1.5% longer recovery for each day of delay (IRR=1.015, p< 0.001) while patients with more symptoms at the time of evaluation had 6.5% longer recoveries for each additional symptom (IRR=1.065, p=0.065). Symptom severity score had no significant effect (p=0.945).

Conclusion(s): Our results indicate that gender, socioeconomic background, mechanism of injury, delays in presentation, and symptom count are significant predictors of time to recovery. Although initial clinical management should continue to follow common practices, the variety of prognostic factors highlights the need for targeted treatment strategies for patients with increasingly unique backgrounds and concussions.

Table 1: Characteristics of the study sample
Immediate refers to the 48-hour period after injury

Table 2: Univariate analysis of days to clearance using negative binomial regression
Immediate refers to the 48-hour period after injury

Table 3: Multivariable analysis of days to clearance using negative binomial regression (N=119)