485 - Mood and Gender Differences in Pediatric Concussion Outcomes

Publication Number: 4476.485

Anita Herrera Hamilton, Children's Hospital, Los Angeles, Seal Beach, CA, United States; Jazmin Lopez, University of La Verne, West Covina, CA, United States; Becket Wren, Children's Hospital Los Angeles, Palos Verdes Estates, CA, United States; Madison Blackwell, Children's Hospital Los Angeles, Indianapolis, IN, United States; Ryan Kelln, Children's Hospital Los Angeles, Los Angeles, CA, United States

Background: Annually, three million children are diagnosed with mild traumatic brain injury largely due to sports, motor accidents and falls. Compared to adults, youth can take longer to recover, endorse more mood (e.g., sadness) and behavioral changes, and exhibit greater gender differences in clinical presentation. Females are at greater risk for longer recovery. Males endorse fewer affective symptoms compared to females and are less likely to seek care despite increased behavioral difficulties. Overall, among youth post-concussion, psychiatric and concussion-related pre-injury factors influence outcomes in both genders with an elevated risk of developing a psychiatric disorder six to thirty-six months post-injury.

Objective: To determine how gender and mood symptoms affect time to presentation and clearance among post-concussion youth.

Design/Methods: Using convenience sampling, medical records from the Sports Medicine Clinics at a large tertiary children's hospital located in a large metropolitan area were analyzed to assess the effects of gender and mood symptom frequency and severity on time from injury to initial presentation and clearance. Five mood symptoms (low energy/fatigue, more emotional, easily annoyed or moody, sadness, nervousness/anxiety) were reported on a 0-3 scale (0=none, 3=severe) by patients, with parental help if needed, at the time of presentation and recalling symptoms in the 48 hours immediately after injury.

Results: The study sample included 112 female patients and 161 male patients at a median age of 14.6 (range: 4.4-20.9) years. All mood symptoms were endorsed more often in females than males immediately following injury and at the time of presentation (Table 1). The time from injury to clearance was significantly longer in females (median 69 vs. 45, p=0.009). In multivariable analysis, while time to clearance was found to be 67% shorter in males overall (IRR=0.33, 95% CI [0.16-0.66], p=0.002), each one-unit increase in total mood severity score among males extended time to clearance by 13% (IRR 1.13, 95% CI [1.03-1.23], p=0.01) while mood scores did not affect time to clearance in females (Figure 1).

Conclusion(s): Post-concussion symptoms significantly differ between genders, with longer time to clearance in females. While females report more numerous and severe post-concussion mood symptoms, mood severity among males affects time to clearance. Findings highlight the need for gender-specific advocacy, education and support involving youth experiencing post-concussion mood symptoms. Future research regarding post-concussion mood symptoms among young males is needed.

Table 1: Comparison of participant characteristics and symptoms between females and males
Continuous variables are presented as median (IQR) and compared using Mann Whitney rank sum tests. Categorical variables are presented as n (%) and compared using Fisher's exact test.

Figure 1: Effect of mood severity immediately after injury on predicted days to clearance by gender based on Poisson regression with robust standard errors