Early symptom burden predicts recovery after sport-related concussion.
OBJECTIVE
To identify independent predictors of and use recursive partitioning to develop a multivariate regression tree predicting symptom duration greater than 28 days after a sport-related concussion.


METHODS
We conducted a prospective cohort study of patients in a sports concussion clinic. Participants completed questionnaires that included the Post-Concussion Symptom Scale (PCSS). Participants were asked to record the date on which they last experienced symptoms. Potential predictor variables included age, sex, score on symptom inventories, history of prior concussions, performance on computerized neurocognitive assessments, loss of consciousness and amnesia at the time of injury, history of prior medical treatment for headaches, history of migraines, and family history of concussion. We used recursive partitioning analysis to develop a multivariate prediction model for identifying athletes at risk for a prolonged recovery from concussion.


RESULTS
A total of 531 patients ranged in age from 7 to 26 years (mean 14.6 ± 2.9 years). The mean PCSS score at the initial visit was 26 ± 26; mean time to presentation was 12 ± 5 days. Only total score on symptom inventory was independently associated with symptoms lasting longer than 28 days (adjusted odds ratio 1.044; 95% confidence interval [CI] 1.034, 1.054 for PCSS). No other potential predictor variables were independently associated with symptom duration or useful in developing the optimal regression decision tree. Most participants (86%; 95% CI 80%, 90%) with an initial PCSS score of <13 had resolution of their symptoms within 28 days of injury.


CONCLUSIONS
The only independent predictor of prolonged symptoms after sport-related concussion is overall symptom burden.
From The Micheli Center for Sports Injury Prevention (W.P.M.), Waltham; and the Sports Concussion Clinic, Division of Sports Medicine (W.P.M., C.J.S.), Division of Emergency Medicine (W.P.M., R.M., M.C.M., R.G.B.), and Brain Injury Center (W.P.M., R.M.), Boston Children's Hospital, MA. William.meehan@childrens.harvard.edu.
William P
WP
Meehan
From The Micheli Center for Sports Injury Prevention (W.P.M.), Waltham; and the Sports Concussion Clinic, Division of Sports Medicine (W.P.M., C.J.S.), Division of Emergency Medicine (W.P.M., R.M., M.C.M., R.G.B.), and Brain Injury Center (W.P.M., R.M.), Boston Children's Hospital, MA.
Rebekah
R
Mannix
From The Micheli Center for Sports Injury Prevention (W.P.M.), Waltham; and the Sports Concussion Clinic, Division of Sports Medicine (W.P.M., C.J.S.), Division of Emergency Medicine (W.P.M., R.M., M.C.M., R.G.B.), and Brain Injury Center (W.P.M., R.M.), Boston Children's Hospital, MA.
Michael C
MC
Monuteaux
From The Micheli Center for Sports Injury Prevention (W.P.M.), Waltham; and the Sports Concussion Clinic, Division of Sports Medicine (W.P.M., C.J.S.), Division of Emergency Medicine (W.P.M., R.M., M.C.M., R.G.B.), and Brain Injury Center (W.P.M., R.M.), Boston Children's Hospital, MA.
Cynthia J
CJ
Stein
From The Micheli Center for Sports Injury Prevention (W.P.M.), Waltham; and the Sports Concussion Clinic, Division of Sports Medicine (W.P.M., C.J.S.), Division of Emergency Medicine (W.P.M., R.M., M.C.M., R.G.B.), and Brain Injury Center (W.P.M., R.M.), Boston Children's Hospital, MA.
Richard G
RG
Bachur
D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D001924:Brain Concussion / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D038223:Post-Concussion Syndrome / Q000175:diagnosis / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D013177:Sports; D011795:Surveys and Questionnaires; D055815:Young Adult