This is for our pain clinic providers.
The best predictor of a speedy recovery after a sports-related concussion is simply the initial symptom burden as measured by the Post-Concussion Symptom Scale (PCSS), a new study suggests.
Other measures, including computerized neurocognitive testing, are not predictive, according to the study results.
“The bottom line is that the lower your symptoms score when you have your first clinic appointment, the more likely you are to recover quickly, and the higher your score, the more likely you will have a longer recovery,” said lead study author William Meehan III, MD, director, Micheli Center for Sports Injury Prevention, Waltham, Massachusetts.
The study was in Neurology.
The analysis included 531 patients who were referred to the Sports Concussion Clinic at Boston Children’s Hospital within 3 weeks of their injury between October 1, 2009, and July 31, 2011. Their mean age was 14.6 years (range, 7 to 26 years), and almost two thirds (62.4%) were male.
Concussion is defined as experiencing a rapid rotational acceleration of the head resulting in the onset of signs and symptoms. The PCSS is a list of 22 common symptoms resulting from a concussion. On a scale from 1 (none) to 6 (severe) athletes rate the level they are experiencing each symptom, so scores can range from 0 to 132.
The mean PCSS score of the study cohort at the initial visit was 26.
At the time of the injury, 21.1% of patients reported loss of consciousness and 33.1% reported experiencing amnesia. More than a third (34.7%) had sustained at least one previous sport-related concussion.
Most patients (86%) with a PCSS score of less than 13 had their symptoms resolve within 28 days, whereas 65% of those with PCSS score of 13 or over had prolonged symptoms.
The study showed that only total symptom burden recorded on the PCSS at the time of the initial visit was independently associated with symptom duration of greater than 28 days (adjusted odds ratio [OR], 1.044; 95% confidence interval [CI], 1.034 – 1.054).
Although computerized neurocognitive testing scores for the 129 patients (24% of the total) who underwent these tests were lower in the group with prolonged symptoms, these scores did not predict recovery time. Again, only symptom burden was independently associated with symptoms lasting longer than 28 days (OR, 1.082; 95% CI, 1.037 – 1.127).
“It was previously thought that gender and age, whether or not you lost consciousness, whether or not you had amnesia, and all these things, also predicted recovery, but they don’t seem to in our study,” said Dr Meehan.