Sport-related concussion (SRC) in the primary care setting is understudied.
PURPOSE: This study describes the epidemiology and gender differences of young SRC patients presenting to the primary care setting.
METHODS: This was a prospective cohort presenting to 3 clinics of a large urban/suburban practice group from December 19, 2015-October 10, 2015. Included were patients 8-18 years, presenting within 3 days of a SRC, who consented to participate. Certified athletic trainers completed data collection at the initial visit. Participants completed a standardized initial concussion visit, including a clinical exam, a symptom checklist, the Immediate Post-Concussion and Cognitive Test (ImPACT), and a visual-vestibular screening. T-tests and Chi-Square analyses were used to examine gender differences.
RESULTS:A total of 131 patients were included: 75 (57.3%) were male, 101 (77.1%) Caucasian, 17 (13.1%) were injured in football, 16 (12.2%) had ADHD, 7 (5.4%) had a history of a psychological disorder, and 46 (35.1%) had a prior history of head trauma. Emergency department visits preceded the clinic visit for 19 (14.5%) patients and 10 (7.6%) patients had imaging for their SRC. There were 10 (7.6%) with loss of consciousness and 16 (12.2%) with amnesia post-injury. Mean age was 14.3±2.0 years. Mean symptom severity was 27.3±21.2. Mean ImPACT composites scores for patients clinically able and within the appropriate age range (n=123) were: Verbal Memory=81.8±12.4, Visual Memory=71.8±13.9, Reaction Time=1.0±3.6; and Processing Speed=33.7±8.1. Thirty-seven (28.2%) patients had abnormal near point convergence (>5cm). Females (Symptom Total=34.1, 95% CI: 27.4-40.8) reported a significantly greater symptom burden than males (Symptom Total=22.9, 95% CI: 19.2-26.7). Females also scored slightly lower on Verbal Memory (Female=78.7, 95% CI:75.3-82.0; Male=83.2, 95% CI: 80.0-86.3) and Visual Memory (Female=68.8, 95% CI: 65.2-72.4; Male=73.8, 95% CI: 70.4-77.3). No other gender differences were observed (p>0.05).
CONCLUSIONS: Clinicians face multiple presentations when evaluating SRC, and gender may drive some of this variability. Future studies should evaluate how initial presentation impacts treatment and outcomes.
Funded by the National Operating Committee on Standards for Athletic Equipment.