title: Characteristics of prolonged concussion recovery in a pediatric subspecialty referral population.
abstract: OBJECTIVE
  To identify pre-existing characteristics associated with prolonged recovery from concussion in a sample of patients referred to a pediatric sports medicine clinic.
  
  
  METHODS
  This was a retrospective, exploratory cohort study of 247 patients age 5-18 years with concussion referred to a tertiary pediatric hospital-affiliated sports medicine clinic from July 1, 2010, through December 31, 2011. A random sample of all eligible patient visits (3740) was chosen for further review and abstraction. Statistical comparisons between subsets of patients were conducted using exact χ(2) tests, logistic regression, quantile regression, and Kaplan-Meier survival curves.
  
  
  RESULTS
  The median time until returning to school part-time was 12 days (IQR 6-21); until returning to school full-time without accommodations was 35 days (IQR 11-105); until becoming symptom-free was 64 days (IQR 18-119); and until being fully cleared to return to sports was 75 days (IQR 30-153). Furthermore, 73% of all patients were symptomatic for >4 weeks, 73% were prescribed some form of school accommodation, and 61% reported a decline in grades. Characteristics associated with a prolonged recovery included a history of depression or anxiety; an initial complaint of dizziness; abnormal convergence or symptom provocation following oculomotor examination on physical examination; and history of prior concussion.
  
  
  CONCLUSIONS
  Pediatric and adolescent patients with concussion may experience cognitive and emotional morbidity that can last for several months following injury. Clinicians should consider specific pre-existing characteristics and presenting symptoms that may be associated with a more complicated recovery for concussion patients.
authors.affiliation: Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: corwind@email.chop.edu.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Corwin
authors.affiliation: Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA; Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Zonfrillo
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Sports Medicine and Performance Center, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Christina L
authors.initials: CL
authors.lastname: Master
authors.affiliation: Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA; Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Kristy B
authors.initials: KB
authors.lastname: Arbogast
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Sports Medicine and Performance Center, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Grady
authors.affiliation: Sports Medicine and Performance Center, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Roni L
authors.initials: RL
authors.lastname: Robinson
authors.affiliation: Sports Medicine and Performance Center, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Goodman
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Wiebe
mesh_terms: D000293:Adolescent; D000342:Affective Symptoms / Q000209:etiology; D001924:Brain Concussion / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D002648:Child; D003072:Cognition Disorders / Q000209:etiology; D003289:Convalescence; D005260:Female; D006801:Humans; D008297:Male; D020127:Recovery of Function / Q000502:physiology; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors