Objective To describe the population undergoing head CT (HCT) within 7 days of SRC, and to compare outcomes between those with negative HCT versus no HCT.

Design Retrospective Case Control.

Setting Regional Concussion Center.

Participants Athletes ages 12–23 presenting for SRC between 11/2017–10/2020 were included. Those with positive head imaging (n=8) were excluded.

Assessment of Risk Factors Independent variables were demographics, initial presentation setting, initial Post-Concussion Symptom Scale (PCSS) score, and prior concussion history.

Outcome Measures Performance of an acute HCT, time to symptom resolution, and final follow-up PCSS.

Main Results A total of 639 patients (age 16.1±1.98, 64% male) were included, of which 106 (17%) received a HCT. Of 132 patients presenting to the emergency department (ED), 76 (58%) received HCT. ED patients had significantly higher odds of receiving HCT (OR 27.7, 95%CI 14.36–53.47, p<0.001), even after adjusting for demographics, time to presentation, and initial PCSS. Loss of consciousness (LOC) (OR 2.5, 95%CI 1.49–4.23, p<0.001) and amnesia (OR 1.8, CI 1.12–2.90, p=0.015) significantly increased odds of ED presentation, whereas older age (OR 0.87, 95%CI 0.77–0.97, p=0.012) decreased odds. In multivariable regression, patients receiving HCT did not experience delayed recovery (β=0.062, p=0.393) or higher final PCSS (β=0.011, p=0.830) after adjusting for these factors.

Conclusions Patients presenting to the ED after SRC were most likely to receive HCT. LOC, amnesia, and younger age were associated with ED presentation. However, HCT was not a proxy for severe injury and had no relationship with recovery.