Post-injury Outcomes Following Non-sport Related Concussions In Pediatric Patients

OBJECTIVE: To investigate group differences in clinical outcomes and symptoms following non-sport related concussion (non-SRC) relative to sport-related concussion (SRC) in pediatric athletes. Design/METHODS: This observational study included patients aged 5-12 years presenting to a specialty care concussion clinic within 28 days of injury. Primary outcomes included post-injury loss of consciousness (LOC), retrograde (RGA) and posttraumatic amnesia (PTA), changes to daily habits, sleep changes, and school days missed (≤5 days vs. >5 days). Self-reported symptoms were measured by the Post-Concussion Symptoms Inventory (PCSI). Injury proportion ratios (IPR) were used to compare the proportion of injuries by mechanism for LOC, RGA, PTA, changes to daily habits, sleep changes, and school days missed. The IPRs not including 1.00 in the 95% confidence interval were considered statistically significant. Mann-Whitney U tests were used to assess group differences in symptom count and severity. RESULTS: One thousand, one hundred and thirty-eight patients were included in final analysis (488 female (42.9%); 616 non-SRC (54.1%); age = 10.1 ± 1.9). A higher proportion of non-SRC reported PTA (IPR = 1.40 95%CI = 1.03-1.95), changes to daily habits (IPR = 1.35 95%CI = 1.14-1.60), sleep changes (IPR = 1.18 95%CI = 1.01-1.38), and missed >5 school days (IPR = 1.35 95%CI = 1.03-1.78). Non-SRC reported with greater symptom count (p < 0.001) and severity (p < 0.001) relative to SRC (Table). Conclusions: A higher proportion of pediatric patients with non-SRC reported with worse clinical outcomes (PTA, changes to daily habits, sleep), more school days missed, and greater symptom burden relative to SRC patients. Non-SRC remain a largely understudied group of head injuries. It is critical to continue examining these injuries to better inform clinical management and prevention strategies for concussion occurring outside of sport. - IPR (95% CI) Non-Sport Related Concussion Sport-Related Concussion N = 616 N = 522 Clinical Outcomes Loss of consciousness, n(%) 62 (10.3%) 38 (7.3%) 1.40 (0.94-2.10) Retrograde amnesia, n(%) 33 (5.5%) 28 (5.5%) 1.01 (0.61-1.68) Posttraumatic amnesia, n(%) 92 (15.2%) 56 (10.9%) 1.40 (1.03-1.95) Changes to daily habits, n(%) 346 (60.9%) 222 (45.1%) 1.35 (1.14-1.60) Sleep changes, n(%) 365 (62.5%) 263 (52.9%) 1.18 (1.01-1.38) School days missed, n(%) ≤5 days 398 (75.%) 371 (81.9%) 0.92 (0.80-1.06) >5 days 129 (24.5%) 82 (18.1%) 1.35 (1.03-1.78) Post-Concussion Symptom Inventory Mann-Whitney U Test Symptom count, median(IQR) 11 (6-15) 9 (4-13) <0.001 Symptom severity, median(IQR) 14 (7-21) 10 (4-17) <0.001