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Abstract
Objective The Buffalo Concussion Physical Examination (BCPE) is a brief, but pertinent physical examination designed for the subacute, outpatient assessment of concussion. The purpose of this study was to perform the BCPE on a larger sample and derive a scoring system to identify children at risk for Persistent Post-Concussive Symptoms (PPCS, recovery ≥30 days).
Methods This prospective, observational cohort study from September 2016 to March 2019 was performed at three university-affiliated concussion clinics. Male and female children (n=270, 14.92±1.86 years, range 8–18, 38% female) were diagnosed with a concussion within 14 days of injury and followed-up until recovery. Logistic regression was used with history and physical examination variables to predict PPCS and a weighted scoring metric was derived.
Results Out of 15 predictor variables, the main effects of 1 preinjury variable (≥3 previous concussions), 2 injury characteristic variables (days-since-injury and type-of-injury), 3 physical examination variables (orthostatic intolerance (OI), vestibulo-ocular reflex (VOR) and tandem gait) and 2 interaction terms (OI/VOR and tandem gait/type-of-injury) produced a score that was 85% accurate for identifying children with low-risk, medium-risk and high-risk for PPCS on cross-validation.
Conclusion The Risk for Delayed Recovery (RDR)-Score allows physicians in an outpatient setting to more accurately predict which children are at greater risk for PPCS early after their injury, and who would benefit most from targeted therapies. The RDR-Score is intended to be used as part of a comprehensive assessment that should include validated symptom checklists, mental health history and adjunct testing (eg, cognitive or physical exertion) where clinically indicated.
- brain concussion
Data availability statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. De-identified clinical examination data for the Buffalo Concussion Physical Exam at the initial visit can be made available on request from Dr MN Haider (haider@buffalo.edu).
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Data availability statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. De-identified clinical examination data for the Buffalo Concussion Physical Exam at the initial visit can be made available on request from Dr MN Haider (haider@buffalo.edu).
Footnotes
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Contributors MNH, BW and JJL designed the study; MNH, JJL, SD, HNS, MSF and RKJ contributed to study design, acquisition of data and revising the clinical management protocols; MNH and AC performed all the statistical analysis; MNH, AC, JJL and BW contributed significantly in preparing the manuscript; all authors contributed to manuscript writing and gave final approval before submission.
Funding Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award number 1R01NS094444 and by the National Centre for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001412 to the University at Buffalo. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Disclaimer The authors are well known in the field because of the Buffalo Concussion Treadmill Test (BCTT) and Buffalo Concussion Protocol, and the Buffalo Concussion Physical Exam (BCPE) shares the same moniker. There are no monetary gains associated with this naming pattern.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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