Related Experiment Video
Updated: Oct 13, 2026
A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
Published on: September 25, 2014
Derivation of the Buffalo Concussion Physical Examination risk of delayed recovery (RDR) score to identify children
Mohammad Nadir Haider1, Adam Cunningham2, Scott Darling3,4
1Orthopaedics and Sports Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA haider@buffalo.edu.
Insights
A new Risk for Delayed Recovery (RDR)-Score accurately identifies children at high risk for persistent post-concussive symptoms (PPCS) after concussion. This tool aids early intervention for better recovery outcomes in pediatric concussion management.
Area of Science:
- Pediatric neurology
- Sports medicine
- Rehabilitation science
Background:
- Concussion assessment in children requires effective tools for predicting recovery.
- Persistent Post-Concussive Symptoms (PPCS) impact a significant number of pediatric concussion patients.
- The Buffalo Concussion Physical Examination (BCPE) was developed for subacute concussion assessment.
Purpose of the Study:
- To validate the BCPE on a larger pediatric sample.
- To develop a scoring system for identifying children at risk for PPCS (recovery ≥30 days).
- To improve early prediction of prolonged recovery after concussion.
Main Methods:
- A prospective, observational cohort study of 270 children (8-18 years) diagnosed with concussion.
- Follow-up until recovery, with logistic regression used to predict PPCS.
- Derivation of a weighted scoring metric using history and physical examination variables.
Main Results:
- A scoring system combining preinjury, injury, and physical exam variables achieved 85% accuracy in predicting PPCS risk.
- Key predictors included previous concussions, days since injury, type of injury, orthostatic intolerance, vestibulo-ocular reflex, and tandem gait.
- Interaction terms (OI/VOR, gait/injury type) improved predictive accuracy.
Conclusions:
- The Risk for Delayed Recovery (RDR)-Score enables outpatient physicians to predict PPCS risk in children early post-injury.
- The RDR-Score facilitates targeted therapies for children at higher risk of delayed recovery.
- It is recommended as part of a comprehensive assessment including symptom checklists and adjunct testing.
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.
