Patterns of Concussion Recovery and Persisting Symptoms in Adolescent Females

Many studies of concussion in adolescents include both sexes, but males are often overrepresented. Female adolescents may be more susceptible to concussion and greater symptom severity than males, potentially masking associations that may exist in concussed adolescent females between pre-existing/injury-related factors and persisting symptoms. To address these issues, our research objectives were to (1) determine what factors at initial clinical evaluation are predictive of persisting concussion symptoms, specifically in adolescent females using modern statistical approaches, and (2) identify the persisting symptoms potentially linked to these factors to inform best practices for the targeted treatment of adolescent females.

Specialty concussion clinics.

732 adolescent females aged 12 to 18 years with a diagnosis of concussion ≤30 days from injury.

Data from a prospective cohort study were obtained at 2 clinical time points, within 1 month following injury and 3 months later. Data were analyzed using machine learning techniques in logistic regression and random forest classification models.

Demographic variables, pre-existing factors, and injury-related factors; Sport Concussion Assessment Tool 5 © (SCAT5) Symptom Evaluation, General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8), and Pittsburgh Sleep Quality Index (PSQI).

In the machine learning analysis, the area under the curve (AUC) for the random forest model was 0.73 (SE = 0.014), and the AUC of the logistic regression model was 0.70 (SE = 0.0014). SCAT5 Symptom Severity Score, SCAT5 Emotional Cluster Symptom Severity, Number of SCAT5 Symptoms, GAD-7 Score, PHQ-8 Score, PSQI Score, and pre-existing/injury-related factors were predictive of persisting concussion symptoms. Specific persisting symptoms were also identified.

Adolescent females with greater initial post-concussion symptoms, especially emotional symptoms, were more likely to report persisting symptoms. Use of readily available screening tools can be utilized by providers to identify adolescent females who may be at risk for persisting symptoms and direct focused treatment for these symptoms.