title: Factors associated with delayed recovery in athletes with concussion treated at a pediatric neurology concussion clinic.
abstract: OBJECTIVE
  With the increase in knowledge and management of sport-related concussion over the last 15 years, there has been a shift from a grading scale approach to an individualized management approach. As a result, there is an increased need to better understand the factors involved in delayed recovery of concussion. The purpose of this retrospective study was to examine factors that may be associated with recovery from sport-related concussion in student athletes aged 11 to 18 years old.
  
  
  METHODS
  Of the 366 patients who met the inclusion criteria, 361 were included in our analysis. The primary dependent variable included days until athlete was able to return to play (RTP). Independent variables of interest included age, gender, academic performance, comorbid factors, sports, on-field markers, days until initial neurological evaluation, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT®) scores, acute headache rescue medications, chronic headache medication, sleep medication, and referral to concussion rehabilitation program.
  
  
  RESULTS
  Variables associated with longer median RTP were being female (35 days), having a referral to concussion rehabilitation program (53 days), being prescribed acute headache rescue therapy (34 days), and having chronic headache treatment (53 days) (all p < 0.05). Variables associated with shorter RTP were on-field marker of headache (23 days) and evaluation within 1 week of concussion by a concussion specialist (16 days) (Both p < 0.05).
  
  
  CONCLUSIONS
  This study supports the need for a concussed athlete to have access to a provider trained in concussion management in a timely fashion in order to prevent delayed recovery and return to play.
authors.affiliation: WellSpan Health, Emig Research Center, York Hospital, 1001 S. George Street, York, PA, 17405, USA. markbock@comcast.net.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Bock
authors.affiliation: WellSpan Health, Emig Research Center, York Hospital, 1001 S. George Street, York, PA, 17405, USA.
authors.forename: Rod
authors.initials: R
authors.lastname: Grim
authors.affiliation: WellSpan Neurosciences, 228 St Charles Way, York, PA, 17402, USA.|Pennsylvania College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.
authors.forename: Todd F
authors.initials: TF
authors.lastname: Barron
authors.affiliation: Pinnacle Health, Spine and Sports Medicine, 2005 Technology Parkway, Suite 100, Mechanicsburg, PA, 17050, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wagenheim
authors.affiliation: VCU-Fairfax Family Practice Sports Medicine Fellowship, Richmond, VA, USA.|Team Physician, George Mason University, Fairfax, VA, USA.|Team Physician, Herndon High School, 555 Herndon Parkway Suite 100, Herndon, VA, 20170, USA.
authors.forename: Yaowen Eliot
authors.initials: YE
authors.lastname: Hu
authors.affiliation: WellSpan Neurosciences, 228 St Charles Way, York, PA, 17402, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hendell
authors.affiliation: Sports Medicine WellSpan Health, 25 Monument Rd, Ste. 290, York, PA, 17403, USA.
authors.forename: John
authors.initials: J
authors.lastname: Deitch
authors.affiliation: WellSpan Neurosciences, 228 St Charles Way, York, PA, 17402, USA.|Department of Neurology, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Deibert
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000150:complications*; D001924:Brain Concussion / Q000209:etiology* / Q000628:therapy*; D002648:Child; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D009483:Neuropsychological Tests; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors
keywords: Concussion; Factors; Pediatric; Recovery