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Characteristics of Pediatric and Adolescent Concussion Clinic Patients With Postconcussion Amnesia

Register-Mihalik, Johna K. PhD*,†; De Maio, Valerie J. MD, MSc; Tibbo-Valeriote, Holly L. RN§; Wooten, John D. MD¶,‖

Clinical Journal of Sport Medicine: November 2015 - Volume 25 - Issue 6 - p 502–508
doi: 10.1097/JSM.0000000000000161
Original Research

Objective: The current study examines the demographics, injury characteristics, and outcomes associated with the presence of postconcussion amnesia in young concussion clinic patients.

Design: Cross-sectional, retrospective clinical cohort.

Setting: Concussion services clinic.

Patients: Pediatric and adolescent concussion services program patients, presenting within 10 days postinjury, aged 10-18 years, with the goal of returning to sport (n = 245).

Assessment of Risk Factors: Age, gender, race, head trauma history, injury mechanism, loss of consciousness (LOC), injury-related visit to an emergency department, cognitive and balance scores, symptoms, and management recommendations.

Main Outcome Measures: Univariate and multivariate analyses determined adjusted odds ratios for reported presence of any postconcussion amnesia (anterograde or retrograde).

Results: Factors associated with amnesia (univariate, P < 0.10) and included in the multivariate model were race, head trauma history, mechanism of injury, LOC, injury-related visit to an emergency department, management recommendations and time of injury and initial visit symptom severity. Age and gender were also included in the model due to biological significance. Of the 245 patients, 181 had data for all model variables. Of the 181 patients, 58 reported amnesia. History of head trauma [odds ratio (OR), 2.7; 95% confidence interval (CI), 1.3-5.7]; time of injury (TOI) symptom severity >75th percentile (OR, 2.6; 95% CI, 1.2-5.3) and LOC (OR, 2.2; 95% CI, 1.1-4.6) were found to have significant and independent relationships with amnesia in the multivariate model.

Conclusions: This study illustrates that patients presenting with postconcussion amnesia are more likely to have a history of head trauma, LOC, and greater symptom severity. Future research is needed to better understand amnesia following concussion.

Clinical Relevance: Amnesia presence, previous head trauma, LOC, and increased symptom severity may aid in identifying patients with a greater initial injury burden who warrant closer observation and more conservative management.

*Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC;

The Injury Prevention Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC;

Emergency Medicine Physicians (EMP), Canton, OH;

§Emergency Services Institute, WakeMed Health & Hospitals, Raleigh, NC;

Raleigh Neurology Associates, P.A., Raleigh, NC; and

WakeMed Concussion Services, WakeMed Health & Hospitals, Raleigh, NC.

Corresponding Author: Johna K. Register-Mihalik, PhD, LAT, ATC, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, 125 Fetzer Hall CB#8700, Chapel Hill, NC 27599 (johnakay@email.unc.edu).

The authors report no conflicts of interest.

Received March 05, 2014

Accepted August 09, 2014

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.