Increased affective and sleep symptoms reported after late presentation for concussion

1. In this retrospective study, individuals who sought care at a concussion specialty clinic 15-30 days after a sports-related injury were significantly more likely to report affective and sleep symptoms than those who sought care within 0-7 days after injury.

2. Self-reported concussion symptoms were high at all time points from 0-30 days after injury.

Evidence Rating Level: 2 (Good)

Study Rundown: Previous research has indicated certain symptoms are more commonly reported within the first week following a concussion. However, a large portion of individuals do not seek care within the first week after injury. This study aimed to evaluate how the timing of presentation to a concussion clinic influences reported symptoms. Post-injury groups were separated into early (days 0-7), middle (days 8-14), and late (days 15-30) presentations to a concussion subspecialty clinic. The Post-Concussion Symptom Scale (PCSS) was used to evaluate symptoms across 4 domains: cognitive-fatigue-migraine, sleep, affective, and somatic. Results supported the use of the PCSS as a valid measure for assessing 4 clusters of symptoms at all three time points. Overall, each group reported a high number of symptoms, with no significant differences in total symptoms across groups. Affective and sleep symptoms were more commonly reported in the late group when compared to the early group. Although this study did not include moderate or severe head injuries, it suggests that individuals who seek care later after a mild head injury may have higher sleep and affective impairments, which should be targeted for specific interventions. Further studies should evaluate symptom progression over time within individuals, with a longer follow-up period.

Click to read the study in Journal of Pediatrics  

Relevant Reading: Evaluation of an active rehabilitation program for concussion management in children and adolescents

In-Depth [retrospective cohort]: This retrospective cohort study included 782 individuals ages 12-25 who sought care at two concussion specialty clinics in the United States within 0-30 days after a sports-related injury. Individuals were included if there was a clear mechanism of injury, with at least 1 concussion symptom and/or sign (e.g., post-traumatic amnesia, disorientation or confusion) attributed to a head injury. Moderate and severe injuries (prolonged loss of consciousness, Glasgow Coma Scale < 13, or abnormal head imaging findings) were excluded. Time of presentation to the clinic was separated into 3 groups post-injury: early (0-7 days), middle (8-14 days) and late (15-30 days). Baseline demographics (i.e., age, sex, loss of consciousness, post-traumatic amnesia, disorientation/confusion) and risk factors that could influence symptoms (i.e., history of ADHD, motion sickness, ocular disorders, headache/migraine, psychiatric, concussions) were assessed. The PCSS was administered at the first clinic visit. Overall, there were few differences in baseline characteristics and risk factors, and no significant differences in PCSS score at first visit. All three groups reported a high number of symptoms (PCSS score ~30). In the late group, affective (p= 0.01) and sleep symptoms (p<0.001) were significantly higher when compared to the early group, with no difference compared to the middle group.

Image: PD

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