Concussion Symptom Resolution Expectations and Subsequent Development of Persisting Symptoms After Adolescent...

Patient recovery expectations may influence actual recovery, although how this applies to adolescents with concussion is not well understood.

To evaluate associations between anticipated symptom resolution time with persisting symptoms after concussion (PSaC). We hypothesized that longer anticipated symptom resolution time would be associated with higher odds of developing PSaC.

We conducted a prospective cohort study of adolescents with concussion. Participants were enrolled within 21 days of concussion and identified their anticipated recovery time (in weeks since injury). We monitored them through self-reported symptom resolution: PSaC was defined as symptoms lasting >28 days postinjury.

Adolescents with concussion seen for care at 2 tertiary care centers.

Eighty-seven adolescents (average age = 15.8 years, 49% female) with a recent concussion were followed for >1 month after initial evaluation, which took place <21 days postinjury.

Thirty-nine participants (45%) developed PSaC. Participants reported an average anticipated symptom resolution time of 3.1 weeks from the date of their injury, reported at the time of first evaluation (SD = 1.5; range, 1-10 weeks). Those who developed PSaC anticipated longer recovery times than those who did not (3.6 ± 1.8 versus 2.7 ± 1.1 weeks; P = .009). After adjusting for covariates (symptom severity, concussion history, anxiety/depressive symptoms, sex, age, and time since injury), longer expected recovery time was associated with higher odds of developing PSaC (odds ratio = 2.22; 95% CI = 1.18, 4.16; P = .01). Among the entire sample, the average total time required for symptom resolution was 4.8 ± 3.5 weeks, with an average difference between anticipated symptom resolution time and actual symptom resolution time of 1.8 ± 3.5 weeks, favoring sooner estimated recovery time than what occurred.

Concussion recovery expectations were associated with PSaC development. Initial postconcussion expectations may be considered with anticipatory guidance for concussion recovery. Clinicians should include patient education to guide expectations surrounding recovery, especially in the setting of increased patient access to potentially inaccurate information.