title: Specific Factors Influence Postconcussion Symptom Duration among Youth Referred to a Sports Concussion Clinic.
abstract: To identify the clinical factors that influence the duration of postconcussion symptoms among youth referred to a sports concussion clinic.
  
  
  
  A retrospective cohort study was conducted to evaluate several potential predictors of symptom duration via a Cox proportional hazards analyses. The individual postconcussion symptom scores were highly correlated, so these symptoms were analyzed in the statistical model as coefficients derived from principal component analyses.
  
  
  
  Among 1953 youth with concussion, 1755 (89.9%) had dates of reported symptom resolution. The remainder (10.1%) were lost to follow-up and censored. The median time to recovery was 18 days (range 1-353 days). By 30 days, 72.6% had recovered; by 60 days, 91.4% had recovered; and by 90 days, 96.8% had recovered. Several variables in a multivariate Cox model predicted postconcussion symptom duration: female sex (P < .001, hazard ratio [HR] = 1.28), continued activity participation (P = .02, HR = 1.13), loss of consciousness (P = .03, HR = 1.18), anterograde amnesia (P = .04, HR = 1.15), premorbid headaches (P = .03, HR = 1.15), symptom components from the day of concussion (emotion, P = .03, HR = 1.08), and the day of clinic evaluation (cognitive-fatigue, P < .001, HR = 1.22; cephalalgic, P < .001, HR = 1.27; emotional, P = .05, HR = 1.08; arousal-stimulation, P = .003, HR = 1.1). In univariate analyses, greater symptom scores generally predicted longer symptom durations. Worsening of symptoms from the day of concussion to the day of clinic evaluation also predicted longer recovery (P < .001, HR = 1.59).
  
  
  
  Several factors help to predict protracted postconcussion symptom durations among youth referred to a sports concussion clinic.
authors.affiliation: Division of Pediatric Neurology, Nationwide Children's Hospital, Columbus, OH; Department of Neurology, The Ohio State University, Columbus, OH. Electronic address: geoffrey.heyer@nationwidechildrens.org.
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Heyer
authors.affiliation: Department of Health Sciences, Clemson University, Clemson, SC.
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Schaffer
authors.affiliation: Division of Pediatric Neurology, Nationwide Children's Hospital, Columbus, OH; Department of Neurology, The Ohio State University, Columbus, OH.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Rose
authors.affiliation: Division of Sports Medicine, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Young
authors.affiliation: Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University, Columbus, OH.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: McNally
authors.affiliation: Division of Sports Medicine, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Anastasia N
authors.initials: AN
authors.lastname: Fischer
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000554:Ambulatory Care Facilities; D001265:Athletic Injuries / Q000150:complications* / Q000523:psychology*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D038223:Post-Concussion Syndrome / Q000150:complications* / Q000523:psychology*; D025341:Principal Component Analysis; D016016:Proportional Hazards Models; D020127:Recovery of Function; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: TBI; adolescent; mTBI; pediatric; traumatic brain injury