Epidemiology and age comparisons of patients presenting to a dedicated community concussion clinic

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Abstract

Objective

To describe the epidemiology of student-athletes presenting to a community concussion clinic and to compare post-concussive outcomes between younger and older patients.

Design

Retrospective cohort.

Setting

Community concussion clinic.

Patients

Student-athletes (10–18 years) presenting to a concussion clinic August 2009–July 2011 (n=280).

Interventions

The independent variable was age (10–14 vs 15–18 years).

Main Outcome Measurements

Outcome measures included Immediate Post Concussion Assessment and Cognitive Test (ImPACT) composite (COMP) and percentile-rank (PR) scores, symptom scores, and Balance Error Scoring System (BESS) score. Univariate statistics were used for age comparisons.

Results

Characteristics of patients were: male (76%), mean age (14.6±2.3 years), previous head trauma (61%), migraine family history (25%), initially evaluated in the emergency department (ED) (55%), loss of consciousness (24%), anterograde amnesia (21%). Common sport and injury mechanisms were American football (42%) and person-to-person contact (41%). Common symptoms included: headache (67%), fatigue (45%), difficulty concentrating (44%), and drowsiness (44%). At initial visit, younger (n=135) compared to older (n=145) patients had lower processing speed PR (30.5±27.8 vs 38.1±29.7*) and COMP (29.9±6.5 vs 35.2±8.1*), slower reaction time COMP (0.67±0.14 vs 0.61±0.09*), and lower cognitive symptom severity (2.8±3.9 vs 4.6±6.0*). Older patients were more likely to report time-of-injury dizziness (OR=2.0; 95% CI 1.1 to 3.8*) and fogginess (OR=2.0; 95% CI 1.2 to 3.4*) and being dazed (OR=2.3; 95% CI 1.2 to 4.2*) and foggy (OR=2.3; 95% CI 1.3 to 4.3*) at initial visit. (*p<0.05) No BESS differences were observed.

Conclusions

Patients presenting to concussion clinics are often ED referrals and may represent a unique group with complicated post-injury patterns. Clinicians should be mindful of age and cognitive differences in post-concussion evaluations.

Competing interests

None.

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