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After Multiple Concussions, Youths Found to Face Longer Recovery

Children with a history of concussions, especially those who have had multiple concussions or have sustained a concussion within the past year, tend to have a longer-lasting symptoms than those with their first concussion, according to a study published online today in the journal Pediatrics.

The findings "have direct implications on the management of concussion patients, particularly those at high risk for future concussive injuries, such as athletes," the authors write.

Researchers from Boston Children's Hospital and Harvard University's medical school examined a total of 280 patients between the ages of 11 and 22 who went to the emergency department of a children's hospital within 72 hours of a concussion. These youths went through the 16-item Rivermead Post-Concussion Symptoms Questionnaire to determine when they were considered symptom-free. Of the youths initially enrolled in the study, 45 were lost to follow-up, meaning that 235 patients were included in the final findings.

The majority of patients (66 percent) were enrolled in the study on the same day they sustained their concussion, 24.7 percent enrolled the following day, 7.2 percent enrolled two days later, and the remaining 1.7 percent enrolled three days later. A majority (150 of the 235) sustained their concussion while playing a sport. Hockey (14 percent), soccer (9.4 percent) and football (8.5 percent) were the most common. Of the 235 patients included in the study, 68 had previously sustained a concussion.

For all patients, the median amount of time it took to become asymptomatic was 13 days. Those with a previous history of concussions had a significantly longer recovery period (a median of 22 days) compared with those without a history of concussions (a median of 12 days). Those who had sustained a concussion within the previous year had a median symptom duration of 35 days, while those with multiple previous concussions had a median symptom duration of 28 days. For the group with multiple previous concussions, it's unclear whether they sustained at least one of those concussions within the previous year.

"This suggests that repeat concussion, particularly within a vulnerable time window, may lead to longer duration of symptoms," the authors conclude.

Beyond a history of previous concussions, certain risk factors stood out as being associated with significantly longer symptom duration. Youths 13 and older, those with a score above 18 on the Rivermead Post-Concussion Symptoms Questionnaire, and those with a history of depression also had significantly higher odds of facing a prolonged recovery.

Consider these findings more food for thought as states continue revising their youth-concussion laws and as districts revise their emergency management plans for youth-sports concussions.

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