Additional Visits for Sports-Related Concussions Associated with Several Factors

Younger age, higher symptom scores at initial presentation, previous history of concussion, and family history of psychiatric disorders are factors associated with the need for additional clinic visits among student athletes with concussion, according to study findings published in the Clinical Journal of Sport Medicine.

Researchers conducted a retrospective cohort study at a multidisciplinary sports concussion center from January 11, 2017 to January 10, 2020. They assessed 524 patients (236 were discharged after their initial clinic visit; 288 patients required additional clinic visits), aged 12 to 23 years old, evaluated for sports-related concussions at the center.

The researchers assessed various factors in patients who were immediately discharged to care under an athletic trainer compared with patients who required additional clinic visits prior to discharge to an athletic trainer. The factors assessed included patient’s age, sex, initial visit symptom score, family and personal history of psychiatric disorder and migraine, and history of prior concussion.

Young athletes requiring additional clinic visits scored higher on the initial visit symptoms score (P =.002), required more frequent imaging of the head (P <.02), and reported previously sustained concussions (P =.02). These patients also were younger (P =.014) and stated that they had a family history of migraines and/or psychiatric disorders (P <.001 each).

In particular, family history of psychiatric disorders (odds ratio [OR], 3.12; 95% CI, 1.53-6.34; P =.002), previous history of concussions (OR, 1.39; 95% CI, 1.02-1.89; P =.037), higher initial symptom scores (OR, 1.05; 95% CI, 1.03-1.05; P <.001), and younger age (OR, 0.87; 95% CI, 0.77-0.97; P =.021) all strongly correlated with additional clinic visits.

“Optimal concussion care is ideally efficient if it reduces the chances of suffering long-term adverse consequences or of entering premature return-to-play protocols,” the authors said. “Knowledge of significant variables associated with additional clinic visits may contribute to better expectations understood by patients and their families during the recovery process.”

The study has several limitations that warrant mention. Only patients who eventually were discharged to care under an athletic trainer were included; the inability to infer factors on causation of concussion-related outcomes; and the lack of follow-up regarding successful return-to-play for these athletes.