title: Physical Maturity and Concussion Symptom Duration among Adolescent Ice Hockey Players.
abstract: OBJECTIVE
  To investigate the association between physical maturity and risk of prolonged concussion symptoms in adolescent ice hockey players.
  
  
  METHODS
  Prospective cohort study of 145 patients ages 13-18 years with concussion referred to 3 hospital-affiliated sports medicine clinics between September 1, 2012 and March 31, 2015. Concussion evaluations included Post Concussive Symptom Score, neurologic examination, and postinjury computerized neurocognitive testing. Pubertal development at initial visit was assessed by the Pubertal Developmental Scale. Duration of concussion symptoms (days) was the main outcome. Statistical comparisons were conducted using Student t test, Wilcoxon rank sum, and logistic regression.
  
  
  RESULTS
  Mean symptom duration was 44.5 ± 48.7 days. Nearly one-half (48.3%) of all players enrolled had prolonged concussion symptoms (≥ 28 days); most (86.9%) had symptom resolution by 90 days. Among males, less physically mature adolescents took longer to recover than more physically mature players (54.5 days vs 33.4 days; P = .004). "Early" Pubertal Category Score was the strongest predictor of prolonged symptoms (OR = 4.29, 95% CI 1.24-14.85; P = .021) among males. Among females, heavier weight increased the odds of experiencing prolonged symptoms (OR 1.07, 95% CI 1.00-1.14; P = .039).
  
  
  CONCLUSIONS
  Among adolescent ice hockey players, early-pubertal stage is independently associated with longer recovery from concussion in males, and heavier weight is associated with longer concussion recovery in females. Until further studies determine valid physical maturity indicators, peripubertal collision sport athletes should compete in leagues grouped by relative age and be discouraged from "playing up" on varsity teams.
authors.affiliation: Division of Sports Medicine, Departments of Orthopedics and Pediatrics, Warren Alpert Medical School, Brown University, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI. Electronic address: Peter_Kriz@brown.edu.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Kriz
authors.affiliation: Sports Concussion Clinic, Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Stein
authors.affiliation: Youth Sports Concussion Clinic, South Shore Hospital, Weymouth, MA.
authors.forename: Janet
authors.initials: J
authors.lastname: Kent
authors.affiliation: Division of Sports Medicine, Departments of Orthopedics and Pediatrics, Warren Alpert Medical School, Brown University, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI.
authors.forename: Danielle
authors.initials: D
authors.lastname: Ruggieri
authors.affiliation: Division of Sports Medicine, Departments of Orthopedics and Pediatrics, Warren Alpert Medical School, Brown University, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI.
authors.forename: Emilie
authors.initials: E
authors.lastname: Dolan
authors.affiliation: Sports Concussion Clinic, Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA; Micheli Center for Sports Injury Prevention, Waltham, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: O'Brien
authors.affiliation: Sports Concussion Clinic, Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA; Micheli Center for Sports Injury Prevention, Waltham, MA.
authors.forename: William P
authors.initials: WP
authors.lastname: Meehan
mesh_terms: D000293:Adolescent; D001924:Brain Concussion / Q000175:diagnosis* / Q000534:rehabilitation; D005260:Female; D006688:Hockey / Q000293:injuries*; D006801:Humans; D008297:Male; D009462:Neurology / Q000379:methods; D038223:Post-Concussion Syndrome / Q000175:diagnosis*; D011446:Prospective Studies; D011627:Puberty; D012044:Regression Analysis; D012737:Sex Factors; D013178:Sports Medicine / Q000379:methods; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome