Repeated Concussions May Mean Slower Recovery in Adolescents

Repeat concussions place a child at risk for prolonged recovery, according to results from a study published online June 10 in Pediatrics.

Although every year millions of children sustain concussions, little is known about the risk factors for prolonged symptoms after subsequent concussions. Such information is important to protect children more likely to have head injuries, such as student athletes.

Over the course of a year, Matthew A. Eisenberg, MD, from the Division of Emergency Medicine, Boston Children’s Hospital, Massachusetts, and colleagues conducted a prospective cohort investigation of 280 patients aged 11 to 22 years who presented in the emergency department with acute concussion. Concussion was defined as a blunt injury to the head resulting in altered mental status or symptoms (headache, nausea, vomiting, balance problems, dizziness, fatigue, drowsiness, blurred vision, memory loss, inability to concentrate) within 4 hours. To be eligible for the study, patients had to present in the emergency department within 72 hours of injury.

The researchers used the 16-item Rivermead Post-Concussion Symptoms Questionnaire to assess time to symptom resolution and recorded information on the circumstances of the injury, symptoms, diagnostic test and exam results, and medical history. They readministered the questionnaire 3 months postinjury or later for patients with persisting symptoms.

Patients with previous concussions had longer-lasting symptoms than patients who had not had earlier events (24 vs 12 days; P = .02). Symptoms lasted a median of 28 days for patients who had had more than 1 previous concussion (P = .03) and 35 days for those who had had a concussion within the previous year (P = .007).

The researchers conclude that age 13 years or older, previous concussion, no loss of consciousness, and initial Rivermead Post-Concussion Symptoms Questionnaire score exceeding 18 are "significant predictors" of prolonged symptoms after subsequent concussions. Patients who had only a single past concussion more than a year earlier experienced the same symptom duration as children who had not had a past concussion.

Most (63.8%) of the patients sustained concussions during athletics: hockey (14%), soccer (9.4%), football (8.5%), and basketball (8.1%).

The researchers conclude, "Our study demonstrates that previous concussion is predictive of a longer time to symptom resolution after pediatric concussion." They advise allowing sufficient time to recover from a concussion before resuming potentially dangerous activities.

Limitations of the study include self-reporting of symptoms, which may have encouraged some athletes to deny symptoms to return to play sooner, and perhaps others to exaggerate symptoms to avoid schoolwork. Some students might not have understood the questionnaire, the researchers add.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online June 10, 2013.

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