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January 04, 2022; 98 (1 Supplement 1) Abstracts

Variations in Time to Recovery from Pediatric Concussion Based on Differing Outcomes of Interest

Christina Master, Kristi Metzger, Mr. Daniel Corwin, Catherine McDonald, Melissa Pfeiffer, Kristy Arbogast
First published December 27, 2021, DOI: https://doi.org/10.1212/01.wnl.0000801828.94648.3d
Christina Master
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Kristi Metzger
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Mr. Daniel Corwin
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Catherine McDonald
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Melissa Pfeiffer
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Kristy Arbogast
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Variations in Time to Recovery from Pediatric Concussion Based on Differing Outcomes of Interest
Christina Master, Kristi Metzger, Mr. Daniel Corwin, Catherine McDonald, Melissa Pfeiffer, Kristy Arbogast
Neurology Jan 2022, 98 (1 Supplement 1) S10-S11; DOI: 10.1212/01.wnl.0000801828.94648.3d

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Abstract

Objective To quantify variability in pediatric concussion recovery across multiple outcomes of interest.

Background Pediatric concussion studies are hindered by a common significant limitation: lack of agreement on a standard definition of “recovery.” A variety of clinical outcomes of interest utilized across studies, including symptom self-report, neurocognitive testing results, self-reported return to activity, and physician clearance for activity, leads to challenges for both research, as well as clinical concussion management.

Design/Methods We enrolled concussed youth, ages 11–18 years, from a specialty sports medicine clinic = 28 days of injury. Patients were followed as part of clinical care for concussion for up to 13 weeks. At each visit, participants completed questionnaires and a battery of clinical measures. From these data, we constructed 10 potential definitions of recovery: 3 based on self-reported symptoms (change from pre-injury, no symptoms, below pre-determined thresholds), 2 based on visio-vestibular examination (VVE) deficits (none, = 1), 2 based on physician clearance (for return to school/sport), and 3 based on self-assessment (“back to normal”, return to school/exercise).

Results One hundred seventy-four concussed youth were enrolled (median age: 15 years, 54.6% female) with a median time from injury to initial visit of 12 days (IQR: 7, 20). Median number of visits was 2 (range: 1, 5). We observed a wide variation in the proportion of participants recovered across the 10 definitions. Depending on definition, between 4% and 45% were considered recovered within 4 weeks, and between 10% and 80% were considered recovered at the end of follow-up. The VVE-based definition (=1 deficit) consistently had the highest proportion recovered at all time points, while self-reported return to exercise had the lowest proportion.

Conclusions Recovery from concussion is not a single unitary point in time. These results will provide valuable guidance to clinicians in managing concussion and researchers in designing future observational and interventional trials of pediatric concussion.

Footnotes

  • Disclosure: The institution of Dr. Master has received research support from NIH. The institution of Dr. Master has received research support from DoD. The institution of Dr. Master has received research support from AMSSM. The institution of Dr. Master has received research support from PA Department of Health. Dr. Metzger has nothing to disclose. Mr. Corwin has nothing to disclose. The institution of Dr. McDonald has received research support from National Institutes of Health. The institution of Dr. McDonald has received research support from Centers for Disease Control. The institution of Dr. McDonald has received research support from National Highway Transportation Safety Administration. The institution of Dr. McDonald has received research support from Department of Transportation. The institution of Dr. McDonald has received research support from Pennsylvania Department of Health. Ms. Pfeiffer has nothing to disclose. The institution of Kristy Arbogast has received research support from NIH. The institution of Kristy Arbogast has received research support from Pennsylvania Department of Health. The institution of Kristy Arbogast has received research support from Football Research Inc

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