In 2013, Ohio enacted a law to mitigate consequences of pediatric sports-related concussions. This study aimed to describe changes in clinic visits and symptom duration for pediatric sports-related ...concussions before and after this law. 3,133 new visits by 2,861 unique patients (10-18 years) presenting between April 2012 and April 2015 for sports-related concussions within 30 days of injury were included. There were 937 (29.9%), 1,132 (36.1%) and 1,064 (34.0%) concussion visits for pre-law, immediate-post law, and post-law periods, respectively. A greater proportion of concussion visits was observed among females from pre-law to post-law (P < 0.0001). No differences were observed across the three periods in symptom scores at injury (P = 0.5028) or at first clinic visit (P = 0.5686). However, patients presented to concussion clinics significantly earlier (17.6 vs. 22.8 days, P < 0.0001) and had quicker recovery (26.5 vs. 40.6 days, P < 0.0001) post-law than pre-law.
Background:
The identification and comparison of risk factors between concussed children with symptom resolution >28 days and those with symptom resolution >90 days may aid in clinical care.
Purpose:
...The objective of this study was to identify demographic, comorbidity, and injury factors associated with prolonged (>28 days) and extended (>90 days) concussion recovery among children aged 10 to 18 years with concussions.
Methods:
Demographics, injury characteristics and comorbidities were recorded in patients aged 10-18. We assessed the associations of patients’ demographics, comorbidities, and injury characteristics with the outcome variable of concussion symptom resolution >28 days post-injury using two-level, Generalized Linear Mixed model (GLMM). We repeated the analysis for concussion symptom resolution >90 days post-injury. Odds ratios(OR) and 95% confidence intervals(CI) were reported.
Results:
A total of 4,937 concussions were analyzed. Of these, 32.6% had resolution >28 days and an additional 20.1% had resolution >90 days after injury. Risk factors for symptom resolution >28 days included female sex, (OR=1.22, 95% CI=1.03, 1.44), ADD/ADHD diagnosis (OR=1.31, 95% CI=1.00, 1.72), those with one (OR=1.41, 95% CI=1.17, 1.71), two (OR=1.41, 95% CI=1.02, 1.95), or three or more previous concussions (OR=2.08, 95% CI=1.42, 3.05), higher initial symptom score (OR=1.04, 95% CI=1.04, 1.05), and greater days from injury to first visit (OR=2.80, 95% CI=2.53, 3.09). Risk factors for >90 days to recovery included older age group (OR=1.66, 95% CI=1.18, 2.32) in 15-18 year olds compared to 10-14 year olds, two (OR=1.84, 95% CI=1.10, 3.07), or three or more (OR=2.30, 95% CI=1.27, 4.19) previous concussions, history of headaches (OR=0.65, 95% CI=0.46, 0.93), anxiety disorder diagnosis (OR=1.66, 95% CI=1.04, 2.64), higher symptom scores at first visit, (OR=1.01, 95% CI=1.00-1.01), and a greater number of days from injury to first visit (OR=1.29, 95% CI=1.20-1.39).
Discussion:
Female sex and ADD/ADHD diagnosis were unique risk factors for >28 day recovery and history of headaches, anxiety diagnosis, and age were unique risk factors for >90 day recovery. For both groups, higher initial symptom scores and longer time to initial evaluation resulted in longer recovery. Future studies are needed to screen and detect children at risk for prolonged recovery during the acute phase post-injury so that appropriate clinical care can be provided to expedite concussion recovery.
The purpose of this study was to determine the effect of a didactic presentation on secondary school educators’ academic concussion management knowledge. Three hundred fifty-four educators completed ...a questionnaire before and after a 30-minute presentation that took place in their school’s auditorium or library. Paired samples The purpose of this study was to determine the effect of a didactic presentation on secondary school educators’ academic concussion management knowledge. Three hundred fifty-four educators completed a questionnaire before and after a 30-minute presentation that took place in their school’s auditorium or library. Paired samples
t
tests were used to compare pretest and posttest scores and to compare pretest score differences between subgroups. Scores significantly increased after the presentation (
P
< .001; 95% confidence interval −4.09 to −3.11). There were no differences in pretest scores between coaches and non-coaches, those with a personal history of concussion and those without, those with prior concussion education/training and those without, or those with experience managing students with concussion in the classroom and those without. A didactic presentation on academic concussion management can improve educators’ immediate knowledge. Job title and prior exposure to concussion did not affect baseline concussion knowledge. Future research should investigate how well educators retain such knowledge and whether didactic presentations lead to change in behaviors.
Athletic Training and Sports Health Care.
2015;7(4):144–149.
ObjectivesFor young patients sustaining concussion, assessing recovery is vital in determining safe return to play. Identifying risk factors may aid clinicians in recognising patients at risk for ...prolonged recovery. The study objective is to identify risk factors for prolonged (>28 days) and extended (>90 days) recovery (defined as symptom duration) and analyse how these risk factors differ between the two groups.MethodsWe retrospectively analysed electronic health record data (n=4937) among patients aged 10–18 years collected at Nationwide Children’s Hospital Sports Medicine concussion clinics between 1 July 2012 and 30 June 2019. Data collected included patient demographics, comorbidities (eg, prior psychiatric diagnoses, prior concussions) and injury characteristics (eg, loss of consciousness, injury setting). We examined patient risk factors for prolonged (>28 days) and/or extended (>90 days) recovery using modified Poisson regression models.ResultsFactors associated with increased risk of prolonged recovery from concussion included prior concussions (adjusted risk ratio (ARR) 1.19, 95% CI 1.02 to 1.38) for two concussions (ARR 1.36, 95% CI 1.14 to 1.61), for >3, and higher initial symptom score (ARR 2.57, 95% CI 2.34 to 2.83) for postconcussion symptom (PCS) scores 21–60 (ARR 2.89, 95% CI 2.54 to 3.29), for PCS>60. Risk factors for extended recovery included history of concussion (ARR 1.50, 95% CI 1.09 to 2.06) for two concussions (ARR 1.75, 95% CI 1.17 to 2.62), for >3 and older age (15–18 years, ARR 1.11, 95% CI 1.05 to 1.18). Additionally, comorbid attention deficit hyperactivity disorder increased risk of prolonged recovery (ARR 1.14, 95% CI 1.01 to 1.29) while anxiety increased risk for extended recovery (ARR 1.47, 95% CI 1.10 to 1.95).ConclusionOverall, risk factors for prolonged recovery differ somewhat from risk factors for extended recovery. For patients who present to clinic with concussion, mental health is an important consideration which may impact the timeline for symptom recovery.
Interest and participation in organized sports for children, preadolescents, and adolescents continue to grow. Because of increased participation, and younger entry age, in organized sports, ...appropriate practice, game schedules, and content become more important, taking into account athlete developmental stage and skills. Parental support for organized sports in general, with focus on development and fun instead of winning, has emerged as a key factor in the athlete's enjoyment of sports. Schools and community sports organizations who support multiple levels of sport (eg, recreational, competitive, elite) can include more youth who want to play sports and combat sport dropout. This report reviews the benefits and risks of organized sports as well as the roles of schools, community organizations, parents, and coaches in organized sports. It is designed to complement the American Academy of Pediatrics clinical reports "Physical Activity Assessment and Counseling in Pediatric Clinical Settings" and "Sports Specialization and Intensive Training in Young Athletes" by reviewing relevant literature on healthy organized sports for youth and providing guidance on organized sport readiness and entry. The report also provides guidance for pediatricians on counseling parents and advocating for healthy organized sports participation.
This study aimed to analyze changes in physical activity (PA) recommendations after pediatric concussions and examine the associations of patient and injury characteristics with physicians' PA ...recommendations.
Retrospective observational study.
Concussion clinics associated with a pediatric hospital.
Patients aged 10 to 18 years with a concussion diagnosis, presenting to the concussion clinic within 14 days of the injury were included. A total of 4727 pediatric concussions and corresponding 4727 discharge instructions were analyzed.
The independent variables for our study were time, injury characteristics (eg, mechanism and symptom scores), and patient characteristics (eg, demographics and comorbidities).
Physician PA recommendations.
From 2012 to 2019, the proportion of physicians recommending light activity at an initial visit increased from 11.1% to 52.6% ( P < 0.05) within 1-week postinjury and from 16.9% to 64.0% during the second week postinjury ( P < 0.05). A significantly increased odds of recommending "light activity" (odds ratio OR = 1.82, 95% confidence interval CI, 1.39-2.40) and "noncontact PA" (OR = 2.21, 95% CI, 1.28-2.05), compared with "no activity" within 1-week postinjury, was observed in each consecutive year. In addition, higher symptom scores at the initial visit were associated with lower likelihood of recommending "light activity" or "noncontact PA."
Physician recommendation of early, symptom-limited PA after a pediatric concussion has increased since 2012, which mirrors a shift in acute concussion management. Further research assessing how these PA recommendations may facilitate pediatric concussion recovery is warranted.
Abstract Herpes zoster (HZ), shingles, is caused by the varicella-zoster virus (VZV). HZ develops as a reactivation of latent VZV and is characterized by a painful, vesicular rash typically ...manifesting in a dermatomal distribution on the arms, trunk or face. HZ occurs in individuals who had primary VZV disease (chickenpox) as a child or in those who have received live, attenuated VZV vaccine. HZ is common in the elderly and the immunocompromised, with age being the single greatest risk factor. The incidence of HZ in children is 74/100,000 person years for the unvaccinated and 38/100,000 person years for the vaccinated. We discuss the case of a 12-year-old soccer player with HZ who presented with right arm pain after a putative traumatic event. Diagnosis was made after two emergency department visits where the condition was not identified. HZ should be considered in the clinician's differential even in immunocompetent, vaccinated children.
Sports participation can have tremendous physical and mental health benefits for children. Properly implemented progressive training programs can yield a broad range of beneficial physiologic ...adaptations, but imbalances of training load and recovery can have important negative consequences. Overuse injuries, for example, can result from repetitive stress without sufficient recovery that leads to accumulated musculoskeletal damage. In addition, extended periods of increased training loads that exceed the intervening recovery can have systemic consequences such as overtraining syndrome, which results in decreased performance, increased injury and illness risk, and derangement of endocrine, neurologic, cardiovascular, and psychological systems. Burnout represents one of the primary reasons for attrition in youth sports. Broadly defined as physical or mental exhaustion and a reduced sense of accomplishment that leads to devaluation of sport, burnout represents a direct threat to the goal of lifelong physical activity and the wide-ranging health benefits that it provides. This clinical report is intended to provide pediatricians with information regarding the risk factors, diagnosis, management, and prevention of these conditions to assist in the identification of at-risk children, the treatment of young athletes, and the guidance of families in the promotion of safe and healthy sport participation.
ObjectiveAs opposed to postconcussion physical activity, the potential influence of cognitive activity on concussion recovery is not well characterised. This study evaluated the intensity and ...duration of daily cognitive activity reported by adolescents following concussion and examined the associations between these daily cognitive activities and postconcussion symptom duration.MethodsThis study prospectively enrolled adolescents aged 11–17 years with a physician-confirmed concussion diagnosis within 72 hours of injury from the emergency department and affiliated concussion clinics. Participants were followed daily until symptom resolution or a maximum of 45 days postinjury to record their daily cognitive activity (intensity and duration) and postconcussion symptom scores.ResultsParticipants (n=83) sustained their concussion mostly during sports (84%), had a mean age of 14.2 years, and were primarily male (65%) and white (72%). Participants reported an average of 191 (SD=148), 166 (SD=151) and 38 (SD=61) minutes of low-intensity, moderate-intensity and high-intensity daily cognitive activity postconcussion while still being symptomatic. Every 10 standardised minutes per hour increase in moderate-intensity or high-intensity cognitive activities postconcussion was associated with a 22% greater rate of symptom resolution (adjusted hazard ratio (aHR) 1.22, 95% CI 1.01 to 1.47). Additionally, each extra day’s delay in returning to school postconcussion was associated with an 8% lower rate of symptom resolution (aHR 0.92, 95% CI 0.85 to 0.99).ConclusionIn adolescents with concussion, more moderate-high intensity cognitive activity is associated with faster symptom resolution, and a delayed return to school is associated with slower symptom resolution. However, these relationships may be bidirectional and do not necessarily imply causality. Randomised controlled trials are needed to determine if exposure to early cognitive activity can promote concussion recovery in adolescents.
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