513 - Pediatric Post-Concussion Symptoms & Predictors of Access and Delays In First Evaluation

Publication Number: 4503.513

Anita Herrera Hamilton, Children's Hospital, Los Angeles, Seal Beach, CA, United States; Yeng Vue, University of California, Merced, Fresno, CA, United States; Leeann Hwang, Children's Hospital Los Angeles, La Canada, CA, United States; Lee Truong, Children's Hospital Los Angeles, Anaheim, CA, United States; Becket Wren, Children's Hospital Los Angeles, Palos Verdes Estates, CA, United States; Bianca Edison, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, United States; Tishya A. L.. Wren, Children's Hospital Los Angeles, Los Angeles, CA, United States

Background: Concussion affects an estimated 1.1 to 1.9 million adolescents annually. Despite this prevalence, nearly half do not immediately report their injuries, resulting in approximately 1.2 million undiagnosed concussions annually.1,2 Pediatric patients are particularly vulnerable, facing higher risks for concussion, prolonged and more complicated recoveries, and unique treatment needs. Timely and accurate diagnosis in young populations is hindered by non-specific symptoms-such as headaches, dizziness, and cognitive fog-and delayed symptom onset. Lack of knowledge regarding pediatric concussion symptom presentation and developmental factors further complicate symptom recognition and reporting, contributing to underdiagnosis.

Objective: This study aims to evaluate whether the number and severity of symptoms reported by pediatric patients diagnosed with concussion or other patient characteristics predict time to first evaluation.

Design/Methods: This study examined a convenience sample of patients presenting with concussion at a large tertiary children's hospital system. Symptom scores were collected using a modified Child SCAT-5 Checklist at first clinic visit recalling symptoms in the 48 hours after injury, with parental assistance for younger children. Socioeconomic status was estimated using the Child Opportunity Index (COI) based on patient zip codes. Simple and multivariable linear regression analyses were performed, with log-transformed days to first visit as the dependent variable.

Results: Among 422 concussions in 359 patients, median symptom severity and number of symptoms were 20 out of 63 and 12 out of 21, respectively. The median time to presentation was 14.5 (IQR 38) days. In univariate analysis, greater symptom severity and number of symptoms were associated with longer times to presentation, while older age, sideline evaluation, private insurance, and higher COI were linked to faster presentation (Table 1). Multivariable regression revealed that sideline evaluation (p=0.041), private insurance (p < 0.001), and higher COI (p=0.001) remained significant predictors of reduced delays, whereas symptom severity, number of symptoms, and age were no longer significant (Table 2).

Conclusion(s): These findings indicate that socioeconomic factors significantly impact a young patient's access to post-concussion treatment. Findings highlight the need for timely access to post-concussion care among disenfranchised youth, and developmentally sensitive education about concussion symptom variability.

Table 1: Univariate Analysis with Log of Days to First Visit as Dependent Variable
Exponentiated coefficients are reported since the dependent variable is log transformed

Table 2: Multivariable Analysis of Significant Variables on Log of Days to First Visit
Exponentiated coefficients are reported since the dependent variable is log transformed (N=160)