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Risk Factors for Prolonged Symptoms of Mild Traumatic Brain Injury

A Pediatric Sports Concussion Clinic Cohort

Fehr, Shayne D. MD*,†; Nelson, Lindsay D. PhD; Scharer, Kyle R. MS, ATC; Traudt, Elizabeth A. MD*; Veenstra, Joshua M. MD*; Tarima, Sergey S. PhD§; Liu, Xue-Cheng MD, PhD*,†; Walter, Kevin D. MD*,†

Clinical Journal of Sport Medicine: January 2019 - Volume 29 - Issue 1 - p 11–17
doi: 10.1097/JSM.0000000000000494
Original Research

Objective: To examine predictors of prolonged symptom duration from mild traumatic brain injury (mTBI) in a pediatric sports medicine specialty clinic cohort as these predictors may be distinct in this population.

Design: Retrospective chart review.

Setting: Outpatient specialty clinic.

Patients: Charts of 549 patients (age range: 10-18 years) with concussions were reviewed in an outpatient clinic that predominantly managed sports-related injuries (77.3%). Patients (n = 431) included in the final analysis met the criteria for mTBI and were symptomatic at their first visit.

Assessment of Risk Factors: Patient history, injury, and recovery variables were evaluated.

Main Outcome Measures: Predictors of prolonged time to reach self-reported symptom recovery were evaluated using Cox proportional hazards.

Results: Median time to symptom recovery of the 431 patients who presented to clinic with symptoms was 40 days (full clinic sample median = 34 days). Analyses identified 3 unique predictors of symptom recovery: loss of consciousness (LOC) [hazard ratio (HR) = 0.56, P < 0.0001], female sex (HR = 0.57, P < 0.0001), and concussion symptom score at first clinic visit (HR = 0.76, P < 0.0001).

Conclusions: Prolonged duration of mTBI symptoms in patients who present to a pediatric sports-based concussion clinic is related to initial symptom severity, female sex, and LOC.

*Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin;

Children's Hospital of Wisconsin, Milwaukee, Wisconsin;

Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin; and

§Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.

Corresponding Author: Shayne D. Fehr, MD, Pediatric Orthopaedics, Medical College of Wisconsin, 9000 W Wisconsin Ave, PO Box 1997, Suite C360, Milwaukee, WI 53201 (

The authors report no conflicts of interest.

Received November 15, 2016

Accepted March 07, 2017

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