The Association Among Primary Clinical Profiles And Prolonged Recovery After Sport Related Concussion

The clinical profiles (CP) model was developed to better conceptualize sport related concussion (SRC). CPs are characterized by symptoms, impairment, and risk factors previously reported to contribute to prolonged recovery. It is unknown, however, if CPs are also associated with prolonged recovery. PURPOSE: To describe the frequency of primary CPs and examine the association between primary CPs and recovery time in patients with SRC. We hypothesized Anxiety/Mood, Migraine, and Vestibular primary CPs would be associated with prolonged recovery. METHODS: This was a retrospective cohort study with data from a specialty concussion clinic. Patients 10-22 years of age who were diagnosed with SRC ≤ 30 days of injury were included. Patients were excluded if they had incomplete demographic or injury information, were non-English speaking, or had no primary CP at their first visit. The Concussion Clinical Profiles Screening tool was used to determine the primary CP (Anxiety/Mood, Cognitive-Fatigue, Migraine, Ocular, Vestibular). Prolonged recovery was defined as ≥28 days from date of injury to date of clearance. Frequencies and percentages were used to describe the prevalence of primary CPs. A logistic regression was used to assess the relationship between primary CPs and prolonged recovery while adjusting for confounding variables (sex, history of concussion, on-field dizziness). Statistical significance was determined by p ≤ .05. RESULTS: A total of 323 patients (mean age 15.39 ± 1.72 years; male = 168 [53%]) with SRC were included. About 25% (n = 80) of patients had prolonged recovery. The most common primary CPs were Migraine (n = 108; 34.1%), Cognitive-Fatigue (n = 78; 24.6%), and Ocular (n = 66; 20.8%). No clinical profile had significantly higher odds of prolonged recovery than any other clinical profile, after adjusting for confounding variables (p = 0.20) CONCLUSIONS: Over one third of patients had primary Migraine CP, more than previously reported. Contrary to our hypothesis, no primary CP was associated with prolonged recovery. Results may be affected by small sample sizes of primary CPs and the possibility that patients received treatment, improving recovery time. Given the prevalence of Migraine, Cognitive-Fatigue, and Ocular primary CPs, future researchers should develop targeted treatment approaches.