Early vs. delayed evaluation and persisting concussion symptoms during recovery in adults

Abstract

Objective: Persisting concussion symptoms may adversely affect return to work and functioning in daily activities. This study compared adults who were initially evaluated < 30 days versus those evaluated ≥ 30 days following a concussion at a specialty concussion clinic to determine if delayed initial evaluation is associated with persisting symptoms during recovery. Method: Participants (N = 205) 18 years of age and older who sustained a concussion and presented to a North Texas Concussion Registry (ConTex) clinic were evaluated at two time points: initial clinical visit and three-month follow-up. Participants provided medical history, injury related information, and completed the Sport Concussion Assessment Tool-5 Symptom Evaluation, Generalized Anxiety Disorder 7-item scale (GAD-7), and Patient Health Questionnaire (PHQ-8). Participants were divided into two groups: early and delayed evaluation (±30 days post injury). Results: Number and severity of concussion symptoms were similar between both groups at their initial clinical visit. However, linear regression models showed that a delayed clinical evaluation was associated with a greater number and severity of concussion symptoms along with greater aggravation of symptoms from physical and cognitive activity at three-month follow-up. Conclusions: Individuals who sought care at specialty concussion clinics regardless of previous care 30 or more days following their injury reported more serious persisting concussion symptoms at three month follow-up than those who sought care sooner. Education to improve adults’ recognition of concussions when they occur and obtaining earlier clinical evaluation may represent important opportunities in promoting better recovery and reducing persisting concussion symptoms.

STATEMENT OF CLINICAL RELEVANCE

This study found that a delayed presentation to a specialty concussion clinic (30 or more days post-injury) regardless of previous evaluation was associated with poorer recovery outcomes in adults compared to those with an earlier presentation. Time from injury to a formal clinical evaluation of a concussion should be considered at initial evaluation by all providers and incorporated into prognosis and treatment planning. Concussion educational programs should be developed specifically for adults to promote recognition of concussions and importance of seeking prompt evaluation by specialized providers for this injury.

Keywords:

• Concussion
• persisting symptoms
• recovery
• SCAT-5

Acknowledgements

The authors wish to thank the participants, as well as the cooperating institutions in the North Texas Concussion Registry (ConTex): UT Southwestern Medical Center, Texas Scottish Rite Hospital for Children, Children’s Medical Center Dallas, and Texas Health Resources. Assistance in the development of this manuscript was provided by Sarah Sprinkle.

Disclosure statement

The authors have no conflict of competing interests or financial disclosures to declare.

Data availability statement

The data that support the findings of this study are available from the corresponding author, Stephen Bunt, Ph.D., upon reasonable request.

Additional information

Funding

This work and the North Texas Concussion Registry (ConTex) were supported by a grant from the Texas Institute for Brain Injury and Repair (TIBIR), a state-funded initiative as part of the Peter J. O’Donnell Jr. Brain Institute at the University of Texas Southwestern Medical Center. Support for the use of REDcap came from the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001105.