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Advances in concussion management
Epidemiology and age comparisons of patients presenting to a dedicated community concussion clinic
  1. Johna K Register-Mihalik1,*,
  2. Valerie J De Maio1,2,
  3. Holly Tibbo-Valeriote1,
  4. Brian Lanier1,
  5. Thomas Jackson1,
  6. John D Wooten3
  1. 1Emergency Services Institute, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
  2. 2Wake Emergency Physicians, Pennsylvania, Raleigh, North Carolina, USA
  3. 3Raleigh Neurology and Associates, Raleigh, North Carolina, USA


    Objective To describe the epidemiology of student-athletes presenting to a community concussion clinic and to compare post-concussive outcomes between younger and older patients.

    Design Retrospective cohort.

    Setting Community concussion clinic.

    Patients Student-athletes (10–18 years) presenting to a concussion clinic August 2009–July 2011 (n=280).

    Interventions The independent variable was age (10–14 vs 15–18 years).

    Main Outcome Measurements Outcome measures included Immediate Post Concussion Assessment and Cognitive Test (ImPACT) composite (COMP) and percentile-rank (PR) scores, symptom scores, and Balance Error Scoring System (BESS) score. Univariate statistics were used for age comparisons.

    Results Characteristics of patients were: male (76%), mean age (14.6±2.3 years), previous head trauma (61%), migraine family history (25%), initially evaluated in the emergency department (ED) (55%), loss of consciousness (24%), anterograde amnesia (21%). Common sport and injury mechanisms were American football (42%) and person-to-person contact (41%). Common symptoms included: headache (67%), fatigue (45%), difficulty concentrating (44%), and drowsiness (44%). At initial visit, younger (n=135) compared to older (n=145) patients had lower processing speed PR (30.5±27.8 vs 38.1±29.7*) and COMP (29.9±6.5 vs 35.2±8.1*), slower reaction time COMP (0.67±0.14 vs 0.61±0.09*), and lower cognitive symptom severity (2.8±3.9 vs 4.6±6.0*). Older patients were more likely to report time-of-injury dizziness (OR=2.0; 95% CI 1.1 to 3.8*) and fogginess (OR=2.0; 95% CI 1.2 to 3.4*) and being dazed (OR=2.3; 95% CI 1.2 to 4.2*) and foggy (OR=2.3; 95% CI 1.3 to 4.3*) at initial visit. (*p<0.05) No BESS differences were observed.

    Conclusions Patients presenting to concussion clinics are often ED referrals and may represent a unique group with complicated post-injury patterns. Clinicians should be mindful of age and cognitive differences in post-concussion evaluations.

    Competing interests None.

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