In a recent effort to identify factors that may prolong the time to recovery from concussion, researchers conducted a prospective cohort study of 280 children and young adults, ages 11 to 22 years, who presented at the ED within 72 hours of experiencing a concussion.

Concussion was defined broadly as either mental status alteration or any of the following symptoms beginning within four hours of injury: headache, nausea, vomiting, dizziness, fatigue, drowsiness, blurred vision, memory problems, or difficulty concentrating. The Rivermead Post Concussion Symptoms Questionnaire (RPQ) was used to assess symptoms one, two, four, six, eight, and 12 weeks after the concussion occurred.

Most children (64%) were injured playing a sport, the most common of which were hockey, soccer, football, and basketball. Patients' most common symptoms were headache, fatigue, and dizziness; 11% had an abnormal physical finding, most often altered gait or mental status.

Patients who had experienced a concussion within the previous year took nearly three times longer to recover than those with no previous concussion or those who'd had a single concussion more than a year earlier. In addition, patients with two or more concussions in the past took more than twice as long to recover as patients with one or no previous concussions.

Multivariate analysis showed that patients who were 13 years of age or older, with previous concussions, no loss of consciousness, and an initial RPQ score higher than 18 took significantly longer to recover. The authors note that the apparent link between not losing consciousness and longer recovery may be a result of referral bias or because patients who lose consciousness are more likely to recognize the severity of their injury and to adhere to medical recommendations.

The authors recommend that their results be taken into account in managing the care of children and young adults with concussion.

Reference