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Clinical predictors of symptom resolution for children and adolescents with sport-related concussion
David R Howell1,2, Morgan N Potter1,2, Michael W Kirkwood3,4
11Sports Medicine Center and.
Insights
For pediatric concussion patients, an abnormal Romberg test during an initial evaluation is linked to longer symptom duration. This finding suggests postural stability tests can help predict recovery time in young individuals.
Area of Science:
- Pediatric neurology
- Sports medicine
- Clinical research
Background:
- Concussion is a common injury in children and adolescents.
- Predicting recovery time is crucial for appropriate management and return-to-activity decisions.
Purpose of the Study:
- To identify clinical evaluation variables independently associated with symptom resolution time in pediatric concussion patients.
- To determine if initial assessment findings can predict the duration of concussion symptoms.
Main Methods:
- Prospective clinical registry data from 351 pediatric concussion patients were analyzed.
- Cox proportional hazards models were used to assess the association between initial clinical variables and time to symptom resolution.
- Predictor variables included preinjury factors, symptom inventories, and neurological tests (balance, vestibular, oculomotor).
Main Results:
- Univariate analysis showed multiple factors associated with longer symptom duration, including headache severity, confusion, and dizziness.
- An abnormal Romberg test (a measure of postural stability) was independently associated with a significantly longer duration of concussion symptoms (HR 0.65, 95% CI 0.44-0.98).
Conclusions:
- Abnormal Romberg test performance in the initial evaluation is an independent predictor of prolonged symptom duration in pediatric concussion.
- Postural stability assessments, like the Romberg test, may offer valuable prognostic information for clinicians managing pediatric concussion.
Objective:
The goal of this study was to determine which variables assessed during an initial clinical evaluation for concussion are independently associated with time until symptom resolution among pediatric patients.
Methods:
Data collected from a prospective clinical registry of pediatric patients with concussion were analyzed. The primary outcome variable was time from injury until symptom resolution. Predictor variables assessed within 10 days after injury included preinjury factors, Health and Behavior Inventory scores, headache severity, and balance, vestibular, and oculomotor test performances. The researchers used univariate Cox proportional models to identify potential predictors of symptom resolution time and constructed a multivariate Cox proportional hazards model in which total duration of concussion symptoms remained the outcome variable.
Results:
The sample consisted of 351 patients (33% female, mean age 14.6 ± 2.2 years, evaluated 5.6 ± 2.6 days after concussion). Univariate Cox proportional hazards models indicated that several variables were associated with a longer duration of symptoms, including headache severity (hazard ratio [HR] 0.90 [95% CI 0.85-0.96]), headache frequency (HR 0.83 [95% CI 0.71-0.96]), confusion (HR 0.79 [95% CI 0.69-0.92]), forgetfulness (HR 0.79 [95% CI 0.68-0.92]), attention difficulties (HR 0.83 [95% CI 0.72-0.96]), trouble remembering (HR 0.84 [95% CI 0.72-0.98]), getting tired often (HR 0.86 [95% CI 0.76-0.97]), getting tired easily (HR 0.86 [95% CI 0.76-0.98]), dizziness (HR 0.86 [95% CI 0.75-0.99]), and abnormal performance on the Romberg test (HR 0.59 [95% CI 0.40-0.85]). A multivariate Cox proportional hazards model indicated that an abnormal performance on the Romberg test was independently associated with a longer duration of symptoms (HR 0.65 [95% CI 0.44-0.98]; p = 0.038).
Conclusions:
For children and adolescents evaluated within 10 days after receiving a concussion, abnormal performance on the Romberg test was independently associated with a longer duration of symptoms during recovery. In line with findings of other recent studies investigating predictors of symptom resolution, postural stability tests may provide useful prognostic information for sports medicine clinicians.
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