Prolonged symptoms associated with multiple concussions

Children and adolescents who sustained a concussion and had a history of concussion, particularly recent or multiple concussions, experienced symptoms that lasted at least twice as long as those without previous concussion in a recent study.

Researchers in Boston conducted a 12-month prospective study of 235 patients aged 11 to 22 years (mean age, 14.3 years; 57.4% male) presenting at an ED with acute concussion. Rivermead Post-Concussion Symptoms Questionnaire (RPSQ), a 16-item checklist, was used to assess the time to symptom resolution, the main outcome measure. A questionnaire describing cause of injury, associated symptoms, medical history, examination findings, diagnostic studies and the RPSQ was completed by patients and providers. The RPSQ was administered online to patients up to six times across 3 months after concussion or until symptoms resolved.

Longer symptom duration was experienced by patients with a previous concussion (median, 24 days) compared with those without previous concussions (median, 12 days; P=.02). When compared with patients without risk factors, patients with multiple concussions had a longer median symptom duration of 28 days (P=.03), as did patients who experienced concussion in the previous year (35 days; P=.007). Significant predictors of prolonged recovery included previous concussion (P=.03), not losing consciousness (P=.02), patients who were aged 13 years or older (P=.04) and an initial RPSQ score of greater than 18 (P=.002), according to multivariate analysis.

“Children with a history of previous concussion, particularly those with recent or multiple concussions, are at increased risk for prolonged symptoms after concussion,” the researchers concluded. “These findings have direct implications on the management of concussion patients, particularly those at high risk for future concussive injuries, such as athletes.”

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Source: Eisenberg MA. Pediatrics. 2013;132:8-17.