Retrospective, Observational Study of Recovery in Pediatric Recurrent Concussions

Recurrent concussion (RC) studies, especially in young children, are limited and provide conflicting results. We studied 505 children sustaining concussions presenting to an outpatient concussion clinic over a 2-year period, ages 5-18, of which 207 were RCs. Recovery time was defined by days to return to play (RTP), return to learn (RTL), and headache recovery (HR). Recovery was not affected by age at first concussion. Neither loss of consciousness nor posttraumatic amnesia were more frequent in RC. The number of concussions was associated with prolonged HR, P = .03. Prolonged RTP (P = .002) and HR (P = .006) were associated with a longer duration of prior concussion recovery time. Prolonged RTL was associated with a shorter interval between concussions, P = .01. RC was associated with a higher number of total symptoms on initial presentation, endorsed affective symptomology, fatigue and headache, and a history of premorbid self-reported headaches and anxiety. HR was associated with a prior history of self-reported anxiety and depression in RC, whereas, in first concussions (FC) only anxiety was associated. Sleep disturbance on initial presentation was associated with HR in both groups. Although recovery from FC and those with RC exhibit broad variation, RC demonstrates differences in recovery, indicating a need for greater awareness of clinical recovery in this group. Definitions of full recovery from concussion are evolving. Further study of concussion recovery is needed, especially in children with RC.