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411 Acute concussion versus post-concussion syndrome (PCS): how can we prevent progression?
  1. Sheharzad Mahmood1,2,
  2. Ann-Marie Przyslupski1,3,
  3. Teresa DeFreitas1,2,3,
  4. Martin Mrazik1,4,
  5. Constance Lebrun1,2,3
  1. 1Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Canada
  2. 2Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
  3. 3Department of Family Medicine, University of Alberta, Edmonton, Canada
  4. 4Department of Educational Psychology, University of Alberta, Edmonton, Canada


Background Concussions can be classified as acute (<90 days to resolution) or post-concussion syndrome (PCS, ≥90 days to resolution). PCS poses a great burden to the individual and to public health.

Objective To contrast the presentation and recovery of acute concussion and PCS to identify potential factors for PCS prevention.

Design Retrospective chart review of concussion patients seen by Sports and Exercise Medicine physicians from 2015–2019.

Setting Glen Sather Sports Medicine Clinic, Edmonton, Alberta, Canada.

Patients 496 patients (289 male/207 female, 19.7±9.4 years) presented with 561 concussions in 1471 visits.

Assessment of Risk Factors Concussions were subdivided into acute and PCS by time from injury to first appointment.

Main Outcome Measurements Demographics, injury mechanisms, Standardized Concussion Assessment Tool (SCAT) scores, management, and recovery timelines.

Results Acute concussions accounted for 88% of injuries and 12% were PCS. Females (RR=1.4) and adults ≥ 25 years (RR=3.6) were more likely to be diagnosed with PCS. In both, injuries occurred most commonly in hockey, football, and soccer. Family physicians were the most frequent referral provider (58% acute, 76% PCS). Median injury-appointment time was 11.0 days (acute) compared to 182.0 days (PCS). Initial total SCAT symptom score was significantly greater (p<0.001) in PCS (56.0±33.0) compared to acute concussion (39.8±31.9). Therapies (i.e. referral, medication, intervention) were prescribed in 44% of acute injury visits compared to 73% of PCS visits (χ2=88.6, p<0.00001). Recovery timelines for return to work, school, and sport were significantly longer in PCS patients than in those with acute concussions (p<0.05).

Conclusions Athletes who are female and/or ≥25 years of age may be at greater risk for PCS progression, requiring closer monitoring and further injury prevention efforts. Considering the number of referrals from family physicians, further concussion education may better optimize initial management and shorten delays in seeking necessary sports medicine consultation.

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