Association of time to initial clinic visit with prolonged recovery in pediatric patients with concussion
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Updated: Dec 23, 2025
Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion
Published on: January 20, 2019
Insights
Early clinical care for pediatric concussion significantly improves recovery time. Seeking prompt medical attention within 7 days of injury is crucial for better outcomes and reduced risk of prolonged recovery.
Area of Science:
- Pediatric neurology
- Sports medicine
- Clinical outcomes research
Background:
- Concussion recovery in children is complex.
- Early clinical care's impact on pediatric concussion recovery is understudied.
- Understanding factors influencing recovery time is vital for effective management.
Purpose of the Study:
- To investigate the role of clinic presentation timing in pediatric concussion recovery.
- To assess the association between early (≤7 days) vs. late (8-20 days) presentation and recovery time.
- To identify predictors of prolonged recovery (>30 days) in pediatric concussion.
Main Methods:
- Retrospective cross-sectional study of 218 pediatric concussion patients.
- Comparison of early vs. late clinic presentation groups.
- Analysis of recovery time, symptom scales (PCSS, VOMS), and cognitive testing (ImPACT).
Main Results:
- Early presentation (≤7 days) was associated with faster recovery than late presentation (8-20 days).
- Days to first clinic visit was the strongest predictor of prolonged recovery (OR 9.8).
- Positive VOMS scores, headache history, and PCSS scores also predicted prolonged recovery.
Conclusions:
- Early specialized medical care for pediatric concussion is linked to normal recovery times.
- Prompt clinic visits are critical for predicting and improving concussion recovery.
- Clinicians should emphasize the importance of early treatment for better pediatric concussion outcomes.
Objective:
No studies to date have investigated the role of early clinical care in time to recovery from concussion in a pediatric population. The purpose of this study was to investigate the role of clinic presentation timing (≤ 7 days [early] compared to 8-20 days [late] from injury) in concussion assessment performance and risk for prolonged recovery (> 30 days) in pediatric concussion.
Methods:
This study is a retrospective cross-sectional study from a concussion clinic between April 2016 and January 2019, including 218 children and adolescents with diagnosed concussion, separated based on clinic presentation timing following injury: early (≤ 7 days) and late (8-20 days). Outcomes were recovery time, Postconcussion Symptom Scale (PCSS), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Vestibular/Ocular Motor Screen (VOMS), and demographics, medical history, and injury information. A general linear model and chi-square analyses were used to assess differences between early and late presentation, along with logistic regression, to predict prolonged recovery (> 30 days).
Results:
Those with early presentation reported higher symptoms on VOMS subtests (79%-85%) compared to those with late presentation (61%-78%), with the exception of near-point of convergence distance and visual motion sensitivity (VMS). The strongest predictor of prolonged recovery was number of days to first clinic visit (OR 9.8). Positive VMS (OR 5.18), history of headache/migraine (OR 4.02), and PCSS score (OR 1.04) were also predictive of prolonged recovery.
Conclusions:
Despite patients in the early presentation group presenting with more positive VOMS scores, the early presentation group recovered sooner than patients in the late presentation group. Even after controlling for vestibular dysfunction, history of headache or migraine, and total symptom severity, days to first visit remained the most robust predictor of recovery > 30 days. These findings suggest that early, specialized medical care and intervention for children and adolescents with recent concussion is associated with normal recovery time. Clinicians should educate children and parents on the potential importance of early treatment to improve the odds of positive outcomes following concussion.
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