Introduction: Sport-related concussion (SRC) is a major public health problem. Approximately 90% of SRC are transient; however, a small percentage of patients remain symptomatic several months post-injury, a condition known as Post-Concussion Syndrome (PCS). Our objective was to identify risk factors for developing PCS in an exclusively pediatric, sports-related concussion group.
Methods: We conducted a retrospective, case-control study within the Vanderbilt Sports Concussion Clinic (VSCC) database. Forty patients with PCS (cases) were identified and matched by age and sex to SRC control patients (1:2 matching) with documented evidence of concussion resolution within 3 weeks. Presenting symptoms were divided by timeframe into a 24-hour phase and 3-week phase. Chi-square Fisher’s exact test was used for categorical variables and Mann-Whitney U-test was used for continuous variables. Forward stepwise regression models (Pin=0.05, Pout=0.10) were used to identify symptoms clusters associated with PCS.
Results: Demographic and presenting information (Table 1) and healthcare utilization (Table 2) are summarized. PCS was predicted by: number of previous concussions (OR 1.8, 95% CI 1.1-2.9, p=0.017), pre-injury depression or anxiety (OR 17.3, 95% CI 2.6-116.4, p=0.003), family history of depression or anxiety (OR 2.9, 95% CI 1.0-8.0, p=0.045), family history of migraine (OR 3.9, 95% CI 1.53 – 9.80, p=0.004), and neuropsychiatric symptoms within 24 hours (Exp (ß)=0.04, 95% CI 0.00-6.33, p=0.023). BMI percentile did not predict PCS. Results from logistic regression are summarized in Table 3.
Conclusions: According to this case-control study of risk factors for PCS in pediatric SRC, individual or family history of pre-injury depression, anxiety, or migraines portended a higher risk of developing PCS. Furthermore, increased number of previous concussions and neuropsychiatric symptoms within 24 hours predicted PCS. These results may afford practitioners greater specificity in the identification of amplified risk for PCS in young athletes.
Patient Care: The goal of our research is to help practitioners identify who is at increased risk for longterm sequelae of SRC, a disease that is usually transient. With the knowledge of who is at increased risk, practitioners can counsel and treat appropriately in hopes of avoiding long term consequences.
Learning Objectives: To understand which athletes are at risk for prolonged symptoms after SRC.
To answer this question in an exclusive sports concussion population, rather than a general mild traumatic brain injury group.