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Length of Recovery From Sports-Related Concussions in Pediatric Patients Treated at Concussion Clinics

Thomas, Donald, J., BS*,†; Coxe, Kathryn, MSW*; Li, Hongmei, PhD*,‡; Pommering, Thomas, L., DO†,§; Young, Julie, A., ATC§; Smith, Gary, A., MD, PhD*,†; Yang, Jingzhen, PhD, MPH*,†

Clinical Journal of Sport Medicine: January 2018 - Volume 28 - Issue 1 - p 56–63
doi: 10.1097/JSM.0000000000000413
Original Research

Objectives: We quantified the length of recovery time by week in a cohort of pediatric sports–related concussion patients treated at concussion clinics, and examined patient and injury characteristics associated with prolonged recovery.

Design: A retrospective, cohort design.

Setting: Seven concussion clinics at a Midwest children's hospital.

Patients: Patients aged 10 to 17 years with a diagnosed sports-related concussion presenting to the clinic within 30 days of injury.

Main Outcome Measures: Length of recovery by week.

Methods: Unadjusted and adjusted multinomial logistic regression analyses were used to model the effect of patient and injury characteristics on length of recovery by week.

Results: Median length of recovery was 17 days. Only 16.3% (299/1840) of patients recovered within one week, whereas 26.4% took longer than four weeks to recover. By 2 months postinjury, 6.7% of patients were still experiencing symptoms. Higher symptom scores at injury and initial visit were significantly associated with prolonged symptoms by week. Patients who presented to the clinic more than 2 weeks postinjury or who had 2 or more previous concussions showed increased risk for prolonged recovery. Females were at greater risk for prolonged recovery than males (odds ratio = 2.08, 95% confidence interval = 1.49-2.89). Age was not significantly associated with recovery length.

Conclusions: High symptom scores at injury and initial visit, time to initial clinical presentation, presence of 2 or more previous concussions, and female sex are associated with prolonged concussion recovery. Further research should aim to establish objective measures of recovery, accounting for treatment received during the recovery.

Clinical Relevance: The median length of recovery is 17 days among pediatric sports–related concussion patients treated at concussion clinics. Only 16.3% of patients recovered within one week, whereas 26.4% took longer than 4 weeks to recover.

*Center for Injury Research and Policy, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio;

The Ohio State University College of Medicine, Columbus, Ohio;

Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China; and

§Concussion Clinic, Westerville Sports Medicine/Orthopedic Center, Nationwide Children's Hospital, Columbus, Ohio.

Corresponding Author: Jingzhen Yang, PhD, MPH, Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43215 (

Supported by The Ohio State University College of Medicine Barnes Research Scholarship (D. Thomas). The interpretations and conclusions do not necessarily reflect those of the funding organization.

The authors report no conflicts of interest.

Received March 14, 2016

Accepted October 31, 2016

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