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Updated: Jul 25, 2026
A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
Published on: September 25, 2014
Multidomain Predictors of Protracted Recovery following Concussion Among 5- to 9-Year-Old Patients: A Preliminary
Alicia M Trbovich1, Anne Mucha2, Aaron J Zynda1
1University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA.
Insights
Delayed clinic visits and positive Vestibular/Ocular Motor Screen-Child (VOMS-C) findings predict prolonged concussion recovery in young children. Early intervention based on these factors may improve outcomes for pediatric concussion patients.
Area of Science:
- Pediatric neurology
- Sports medicine
- Clinical assessment
Background:
- Concussion recovery varies significantly in pediatric patients.
- Identifying early predictors of protracted recovery is crucial for timely intervention.
- Multidomain assessments offer a comprehensive approach to evaluating concussion sequelae.
Purpose of the Study:
- To identify key components of a multidomain assessment that predict prolonged recovery in pediatric concussion.
- To develop a predictive model for protracted recovery in children aged 5-9 years.
- To enhance clinical decision-making for concussion management in young patients.
Main Methods:
- Prospective cohort study of 68 pediatric patients (5-9 years) presenting within 21 days of concussion.
- Utilized demographic data, symptom reports, balance assessments, Vestibular/Ocular Motor Screen-Child (VOMS-C), and cognitive testing.
- Logistic regression and receiver operating characteristic analysis were employed to identify significant predictors.
Main Results:
- The predictive model accounted for 39% of the variance in recovery time.
- Delayed first clinic visit (OR, 1.2) and positive VOMS-C findings (OR, 8.32) were significant predictors of protracted recovery (>30 days).
- The 2-factor model demonstrated strong discrimination between normal and protracted recovery (AUC, 0.82).
Conclusions:
- Days to first clinic visit and positive VOMS-C findings are robust predictors of protracted recovery in young pediatric concussion patients.
- These factors can aid clinicians in identifying children at risk for prolonged recovery.
- Targeted interventions based on these predictors may improve concussion outcomes.
Objective:
To determine which components from a multidomain assessment best predict protracted recovery in pediatric patients with a concussion.
Study Design:
A prospective cohort of patients aged 5-9 years who presented within 21 days of concussion to a specialty clinic were categorized into normal (≤30 days) and protracted (>30 days) recovery. Participants provided demographic and medical history information, and completed the Child Sport Concussion Assessment Tool-5 symptom report and balance assessment, the Vestibular/Ocular Motor Screen-Child (VOMS-C), and the Pediatric Immediate Post-concussion Assessment and Cognitive Testing. Univariate logistic regressions (LR) were used to inform a follow-up forward stepwise LR to identify the best predictors of protracted recovery. Receiver operating characteristic analysis of the area under the curve (AUC) was used to identify which predictors retained from the LR model best discriminated recovery.
Results:
The final sample included 68 patients (7.52 ± 2.3 years; 56% male), 36 (52.9%) with normal and 32 (47.1%) with protracted recovery. Results of the LR to identify protracted recovery were significant (P < .001) and accounted for 39% of the variance. The model accurately classified 78% of patients, with days to first clinic visit (OR, 1.2; 95% CI, 1.1-1.4; P = .003) and positive VOMS-C findings (OR, 8.32; 95% CI, 2.4-28.8; P < .001) as significant predictors. A receiver operating characteristic analysis of the AUC of this 2-factor model discriminated protracted from normal recovery (AUC, 0.82; 95% CI, 0.71-0.92; P < .001).
Conclusions:
Days to first clinic visit and positive findings on the VOMS-C were the most robust predictors of protracted recovery after concussion in young pediatric patients.
