The Course of Concussion Recovery in Children 6-12 Years of Age: Experience From an Interdisciplinary Rehabilitation Clinic

Background: Current concussion evidence is derived largely from teenagers and adults. Concussion in younger children occurs within the context of neuromaturation, with differing age-based pathophysiological responses to injury. Therefore, our current understanding of concussion in older children and adults is unlikely to directly apply to younger children.

Objective: To describe patient variables, clinical course, and factors associated with time to discharge from concussion care in children 6-12 years of age with concussion treated in an interdisciplinary rehabilitation-based concussion clinic.

Design: Retrospective chart review.

Setting: Interdisciplinary concussion clinic at an academically affiliated rehabilitation center.

Patients: Children aged 6-12 years (n = 105; mean 10.8 years of age, 70% male) seen within 60 days of concussive injury.

Main outcome measurements: Descriptive statistics explored demographic, injury, and clinical features. The primary outcome measure, time to discharge from concussion care, was estimated with survival-analysis methods based on the date of discharge from the clinic. Multivariate models were used to examine factors associated with longer time to discharge.

Results: Median time to discharge was 34 days postinjury (range 5-192 days); 75% of children were discharged within 60 days of injury. A minority reported persisting symptoms at discharge. Younger age and increased symptom burden at initial evaluation predicted longer time to discharge.

Conclusions: Although children 6-12 years old treated in a specialty concussion clinic show variability in time to discharge from concussion care, most were discharged within 2 months after injury. Risk factors for prolonged recovery, such as younger age and greater symptom burden at initial visit, can be used when counseling families and planning interventions. There may be varying contributions, including psychosocial stressors, to ongoing symptoms in children who experience persisting symptoms after other concussion-related concerns have resolved. Future work focused on the subset of children who report persisting symptoms will be useful for developing an evidence base related to their care.

Level of evidence: II.