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Association of Time Since Injury to the First Clinic Visit With Recovery Following Concussion

Educational Objective
To investigate the association of time since injury with initiation of clinical care on recovery time following concussion.
1 Credit CME
Key Points

Question  Do patients who receive clinical care sooner after concussion recover faster?

Findings  In this cross-sectional study of 162 adolescent and young adult athletes with concussion, those who initiated clinical care earlier (within 7 days) recovered faster and were less likely to have prolonged (≥30-day) recovery times than those who initiated care later (at 8-20 days).

Meaning  Per this study, early initiation of care after a concussion may be warranted to expedite recovery time.


Importance  Recovery after concussion varies, with adolescents taking longer (approximately 30 days) than adults. Many factors have been reported to influence recovery, including preinjury factors, perceptions about recovery, comorbid conditions, and sex. However, 1 factor that may play a role in recovery but has received little attention from researchers is the timeliness of clinical evaluation and care.

Objective  To investigate the association of time since injury with initiation of clinical care on recovery time following concussion.

Design, Setting, and Participants  This retrospective, cross-sectional study was conducted in a sports medicine clinic between August 2016 and March 2018. Eligible participants were aged 12 to 22 years and had a diagnosed, symptomatic concussion; patients were excluded if recovery data were incomplete. Participants were divided into 2 groups: those seen within 7 days of the injury (early) vs between 8 and 20 days of the injury (late). Data were analyzed between June 2019 and August 2019.

Exposures  Time from injury (concussion) to initiation of clinical care.

Main Outcomes and Measures  Recovery time; testing with the Post-Concussion Symptom Scale, Immediate Post-Concussion Assessment and Cognitive Testing, and Vestibular/Ocular Motor Screening instruments; demographic factors, medical history, and injury information.

Results  A total of 416 individuals were eligible, and 254 (61.1%) were excluded, leaving 162 (38.9%) in analyses. The early group (98 patients) and late group (64 patients) did not differ in age (mean [SD] age, early, 15.3 [1.6] years; late, 15.4 [1.6] years), number of female patients (early, 51 of 98 [52.0%]; late, 40 of 64 [62.5%]), or other demographic, medical history, or injury information. The groups also were similar on symptom severity, cognitive, ocular, and vestibular outcomes at the first clinic visit. Results from a logistical regression supported being in the late group (adjusted odds ratio, 5.8 [95% CI, 1.9-17.6]; P = .001) and visual motion sensitivity symptoms greater than 2 (adjusted odds ratio, 4.5 [95% CI, 1.1-18.0]; P = .04) as factors significantly associated with recovery time.

Conclusions and Relevance  Findings suggest that earlier initiation of clinical care is associated with faster recovery after concussion. Other factors may also influence recovery time. Further research is needed to determine the role of active rehabilitation and treatment strategies, as well as demographic factors, medical history, and injury characteristics on the current findings.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: November 1, 2019.

Corresponding Author: Anthony P. Kontos, PhD, UPMC Sports Concussion Program, UPMC Freddie Fu Sports Medicine Center, 3200 S Water St, Pittsburgh, PA 15203 (akontos@pitt.edu).

Published Online: January 6, 2020. doi:10.1001/jamaneurol.2019.4552

Author Contributions: Dr Kontos had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Kontos, Jorgensen-Wagers, Trbovich, French.

Acquisition, analysis, or interpretation of data: Kontos, Ernst, Emami, Gillie, French, Holland, Elbin.

Drafting of the manuscript: Kontos, Jorgensen-Wagers, Trbovich, Emami, Holland, Elbin.

Critical revision of the manuscript for important intellectual content: Jorgensen-Wagers, Trbovich, Ernst, Gillie, French, Elbin.

Statistical analysis: Kontos, Ernst, Elbin.

Administrative, technical, or material support: Emami, Gillie, French, Holland.

Supervision: Kontos, Trbovich, French, Holland.

Conflict of Interest Disclosures: Dr Kontos reported grants from National Football League, personal fees from APA Books, and other from University of Pittsburgh outside the submitted work. No other disclosures were reported.

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