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J Pediatr. 2019 Jul;210:13-19.e2. doi: 10.1016/j.jpeds.2019.04.001. Epub 2019 May 14.

Risk of Repeat Concussion Among Patients Diagnosed at a Pediatric Care Network.

Author information

1
Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: currya@email.chop.edu.
2
Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
3
Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA.
4
National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA.
5
Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA; Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, PA.

Abstract

OBJECTIVE:

To quantify the risk of repeat concussions for children and identify demographic and clinical aspects of the index concussion associated with repeat injury.

STUDY DESIGN:

For this retrospective cohort study, we queried the Children's Hospital of Philadelphia healthcare network's unified electronic health record to identify all 5- to 15-year-old patients who had their first clinical visit for an index concussion at a Children's Hospital of Philadelphia location from July 2012 through June 2013. A 25% random sample (n = 536) were selected. Clinical data were abstracted for their index concussion and all concussion-related visits for 2 years following the index concussion.

RESULTS:

Overall, 16.2% (n = 87) of patients experienced at least 1 repeat concussion within 2 years of their index concussion. The risk of repeat concussion increased with patient age (9.5% for ages 5-8 years; 10.7% for ages 9-11 years; and 19.8% for ages 12-15 years). After we adjusted for other factors, risk was particularly heightened among patients whose index concussion had a longer clinical course (>30 vs 0-7 days, adjusted risk ratio 1.65 [1.01-2.69]) and greater symptom burden (>11 vs 0-2 symptoms, adjusted risk ratio 2.12 [1.12-3.72]).

CONCLUSIONS:

We estimate that 1 in 6 youth diagnosed with a concussion are diagnosed with a subsequent concussion within 2 years and that several clinical characteristics of the index concussion increase this risk. Identifying factors associated with a repeat injury is essential to inform the clinical management of concussion and direct injury prevention efforts.

KEYWORDS:

multiple concussions; postconcussive symptom; recurrence; repetitive; traumatic brain injury

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