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Association between initial post-concussion presentation and persistent symptoms at 1–month post-concussion
  1. Johna Register-Mihalik1,2,
  2. Mackenzie Herzog1,3,
  3. O Josh Bloom1,2,4,
  4. Janna Fonseca1,3,4,
  5. Kristen Phillips1,4,
  6. Valerie De Maio1,5
  1. 1Matthew Gfeller Sport-Related Traumatic Brain Injury Research Centre, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
  2. 2Injury Prevention Research Centre, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
  3. 3Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
  4. 4Carolina Family Practice & Sports Medicine, Cary, NC, USA
  5. 5Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA


Objective To examine associations between acute post-concussion measures and 1-month persistent symptom presence among paediatric concussion patients.

Design Prospective cohort.

Setting Three family medicine clinics, from the same practice, in an urban/suburban area of the USA.

Subjects Paediatric concussion patients (n=179); ages 8-18 years (median age=15; IQR: 13-16) presenting within three days of injury.

Intervention Participants completed a systematic evaluation during their initial visit and a 4-6 week follow-up survey (80% follow-up; n=144). The initial visit variables included age, gender, previous head injury, total symptom severity, Immediate Postconcussion Assessment and Cognitive Test (ImPACTTM) composite scores, and near point convergence (NPC).

Outcome measures The primary outcome was 1-month follow-up persistent symptom presence, determined using the Rivermead Postconcussion Symptoms Questionnaire. We assessed univariate relationships for each variable with persistent symptoms. Variables significant in univariable analyses (p<0.10) were included in a multivariable logistic regression model.

Results Persistent symptoms were reported for 27.1% (n=39) of participants. Females were more likely to have persistent symptoms (OR=1.9; 95% CI: 0.9, 4.0; p=0.086). Initial visit total symptom severity (Z=4.2; p<0.001) was higher in those with persistent symptoms. Initial visit verbal memory (Z=−1.7; p=0.083), processing speed (Z=−1.7; p=0.093), and reaction time (Z=2.8; p=0.001) were worse in those with persistent symptoms. Total symptom severity was the only factor significant in the multivariable model (OR=1.04; 95% CI=1.02–1.07).

Conclusions Gender, acute symptom burden and post-concussion neurocognitive deficits have significant relationships with persistent symptom presence. Clinicians should be mindful of these factors when considering treatment.

Competing interests The current study was funded in part by the National Operating Committee on Standards for Athletic Equipment.

Dr. Bloom is employed at the study setting.

Ms. Fonseca is employed at the study setting.

Ms. Phillips is employed at the study setting.

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