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J Neurosurg Pediatr. 2019 Jan 15:1-10. doi: 10.3171/2018.8.PEDS18356. [Epub ahead of print]

Health-related quality of life following adolescent sports-related concussion or fracture: a prospective cohort study.

Russell K1,2,3, Selci E1,2, Black B4,5,6, Ellis MJ1,4,7,2,3,6.

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1Department of Pediatrics and Child Health, and.
5Children's Hospital Research Institute of Manitoba.
6Canada North Concussion Network; and.
2Department of Surgery.
4Orthopaedic Surgery, University of Manitoba.
7Pan Am Concussion Program, Winnipeg, Manitoba, Canada.
Sections of3Neurosurgery and.


OBJECTIVEThe longitudinal effects of sports-related concussion (SRC) in adolescents on health-related quality of life (HRQOL) remain poorly understood. Hence, the authors established two objectives of this study: 1) compare HRQOL outcomes among adolescents with an acute SRC or a sports-related extremity fracture (SREF) who were followed up until physician-documented clinical recovery; and 2) identify the clinical variables associated with worse HRQOL among adolescent SRC patients.METHODSThe authors conducted a prospective cohort study of adolescents with acute SRC and those with acute SREF who underwent clinical assessment and follow-up at tertiary subspecialty clinics. Longitudinal patient-reported HRQOL was measured at the time of initial assessment and at each follow-up appointment by using the adolescent version (age 13-18 years) of the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scale and Cognitive Functioning Scale.RESULTSA total of 135 patients with SRC (60.0% male; mean age 14.7 years; time from injury to initial assessment 6 days) and 96 patients with SREF (59.4% male; mean age 14.1 years; time from injury to initial assessment 8 days) participated in the study. At the initial assessment, the SRC patients demonstrated significantly worse cognitive HRQOL and clinically meaningful impairments in school and overall HRQOL compared to the SREF patients. Clinical variables associated with a worse HRQOL among SRC patients differed by domain but were significantly affected by the patients' initial symptom burden and the development of delayed physician-documented clinical recovery (> 28 days postinjury). No persistent impairments in HRQOL were observed among SRC patients who were followed up until physician-documented clinical recovery.CONCLUSIONSAdolescent SRC is associated with temporary impairments in HRQOL that have been shown to resolve in patients who are followed up until physician-documented clinical recovery. Future studies are needed to identify the clinicopathological features that are associated with impaired HRQOL and to assess whether the initiation of multidisciplinary, targeted rehabilitation strategies would lead to an improvement in HRQOL.


ADHD = attention-deficit/hyperactivity disorder; HRQOL = health-related quality of life; IQR = interquartile range; MCID = minimal clinically important difference; PCSS = Post-Concussion Symptom Scale; PPCS = persistent postconcussion symptoms; PedsQL = Pediatric Quality of Life Inventory; SRC = sports-related concussion; SREF = sports-related extremity fracture; TBI = traumatic brain injury; adolescent; fracture; health-related quality of life; mTBI = mild TBI; patient outcomes; sports-related concussion; trauma


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