Abstract
Background:
An estimated 3.8 million sport and recreation-related concussions occur annually across the US, with recent research linking mild traumatic brain injuries to long-term attention deficits, verbal IQ reductions, and executive functioning impairments in children. A previous study found that 53.3% of pediatric concussions occurred while participating in organized sports, indicating sports participation as a major risk factor. However, to our knowledge, there are no existing studies comparing the impact of sport versus non-sport-induced concussions on recovery duration across a wide range of pediatric patients.
Hypothesis:
To compare the effect of mechanism of injury (sports vs. non-sports) and other factors on the recovery duration of pediatric concussion patients.
Methods:
This study involved patients presenting to sports medicine clinics in a large tertiary children’s hospital and satellite specialty clinics for a concussion evaluation. Medical records review was conducted to determine age, gender, insurance type, activity causing the injury, time from injury to presentation, and time from injury to medical clearance. Patients that were lost to follow-up or exceeding one year from injury to clearance were not considered. All remaining observations were included in a multiple linear regression, with log of time from injury to clearance as the explained variable. Our explanatory variables included age at time of injury, log of days from injury to first visit, an interaction between log of days to first visit and insurance type (public vs. private), and three categorical variables: gender, sports related concussion, and insurance type.
Results:
Of 195 concussions in 169 patients, 147 (75.8%) were sport-related. Patients presenting with sport-related concussions were older (14.4 vs. 12.1 years, p<0.001) and more likely to be female (51% vs. 49%, p=.040). Patients with sport-related concussions experienced shorter recovery durations than patients with non-sport-related concussions (median 41 vs. 83.5 days, p=.016). Female patients experienced longer recovery durations than males (49.5 vs. 44 days, p=.003), and patients with greater time to presentation experienced longer recovery durations (p=.007). There was no significant effect of age (p=.619), insurance type (p=.580), or the interaction term (p=.307).
Conclusion:
Our results indicate that sport-related concussions yield shorter recovery times, especially in more proactive and male patients, compared to concussions sustained in other activity contexts (falls, motor vehicle accidents, etc.). Although initial clinical management should be similar regardless of mechanism, this study highlights the need to further understand variables predicting longer recovery such as delay in presentation, socioeconomic and psychosocial issues.