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Factors Affecting Recovery Trajectories in Pediatric Female Concussion

Desai, Natasha MD, CAQSM*; Wiebe, Douglas J. PhD; Corwin, Daniel J. MD; Lockyer, Julia E. MS§; Grady, Matthew F. MD, CAQSM§,¶; Master, Christina L. MD, CAQSM§,¶

Clinical Journal of Sport Medicine: September 2019 - Volume 29 - Issue 5 - p 361–367
doi: 10.1097/JSM.0000000000000646
Original Research
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Objective: Up to one-third of children with concussion have persistent postconcussion symptoms lasting beyond 4 weeks. Females have been shown to have prolonged concussion recovery compared with males. This study examined characteristics in pediatric athletes with concussion to investigate the underlying factors that may contribute to this difference and their relation to recovery trajectories in females compared with males.

Design: A retrospective cohort study of pediatric patients with sports-related concussion (SRC).

Setting: A subspecialty pediatric concussion program.

Subjects: One hundred ninety-two records were reviewed, 75 females and 117 males, ages 7 to 18 years old.

Assessment of Risk Factors: Sex of patient, time to presentation to specialty care after injury, presence of vision, and vestibular deficits on initial clinical examination.

Main Outcome Measures: The main outcome of interest was time to clinical recovery, defined by resolution of symptoms, recovery of physical examination deficits, including vision and vestibular examination, recovery of neurocognitive function, and return to school, exercise, and sport.

Results: Pediatric females, on average, presented later to specialty care for evaluation after SRC than males. Females also took longer to recover on 5 markers of recovery: time to return to school without accommodations, time to return to noncontact exercise, time to return to full sport, time to recovery of neurocognitive function on computerized testing, and time to clinical recovery of vision and vestibular deficits on examination including smooth pursuits, saccades, gaze stability, near point of convergence, and balance. These sex-based differences in recovery disappeared when controlling for time to presentation to specialty care.

Conclusions: In this cohort of pediatric patients, ages 7 to 18 years old with SRC, females took longer to recover than males. Our results indicate, however, that a modifiable extrinsic factor, time to presentation to specialty care, may contribute to this difference in recovery between the sexes.

*Division of Sports Medicine, Department of Orthopedics, Columbia University Medical Center, New York;

Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

§Division of Orthopedic Surgery and Sports Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Corresponding Author: Natasha Desai, MD, CAQSM, Sports Medicine, Columbia University School of Medicine, 622 W. 168th St, PH-11, New York, NY 10032 (Nd2498@cumc.columbia.edu).

The authors report no conflicts of interest.

Received February 28, 2018

Accepted June 25, 2018

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