Predictors of Persisting Symptoms After Concussion in Children and Adolescents

Context: Although most children and adolescents recover from concussion within several weeks, a substantial subset experience persisting symptoms that can interfere with daily functioning. Early identification of those at risk for persisting symptoms after concussion (PSaCs) is critical for guiding intervention. Objective: To determine predictors of PSaCs in children and adolescents aged 8 to 18 years presenting to a community practice setting. Setting: Community practice clinics. Design: Prospective cohort study. Patients or Other Participants: A total of 236 children and adolescents (97 females, 138 males, 1 who did not report sex; age = 14.3 ± 2.1 years) who sustained sport- or recreation-related concussions. Intervention(s): Individuals reported to community practice clinics within 72 hours of sport- or recreation-related concussion. At this initial visit, parents or guardians provided information including demographics, their children's behavior after injury, injury characteristics, and reported symptoms. Approximately 1 month later (median = 36 days [interquartile range, 31–41 days] after injury), parents or guardians were contacted to provide information about PSaCs, indexed using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). Main Outcome Measure(s): Factors provided at the initial visit (demographics, parent- or guardian-reported behavior, injury characteristics, and reported symptoms) were examined as predictors of the presence of PSaCs (endorsement of ≥3 RPQ symptoms as being worse than preinjury) at 1 month using univariate logistic regressions. Factors that were significant predictors in the univariate models (P < .05) were entered into a multivariable model. Secondary analyses examined which factors were predictors of endorsing more (≥3) versus fewer (1–2) persisting symptoms on the RPQ. Results: Female sex, parent or guardian reports of acting abnormally, parent reports of lethargy, and the initial total symptom score were predictors of PSaCs (P ≤ .03). Acting abnormally was the only significant predictor of endorsing more versus fewer persisting symptoms (P = .03). Conclusions: Children and adolescents who are female, whose parents or guardians report them acting abnormally or being lethargic, and those with a higher initial total symptom score within 72 hours of injury may be at increased risk of experiencing PSaCs. Acting abnormally postinjury also may be a risk factor for endorsing more PSaCs. These findings provide information about potential indicators of children and adolescents who may benefit from early, targeted clinical intervention to reduce persisting symptom burden after sport- or recreation-related concussion.