Concussion symptom presentation and clinical recovery among pediatric athletes: comparing concussions sustained during school and summer months

ABSTRACT

Objective

We examined post-concussion symptom presentation, exercise, and sleep among pediatric athletes who sustained concussion during the school year vs. summer months.

Methods

We evaluated athletes 6–18 years old within 21-days of concussion. They reported symptoms (Health and Behavior Inventory), with cognitive/somatic domain sub-scores calculated, and indicated if they had exercised or experienced sleep problems since injury. We grouped patients by injury season: summer months (June–August) vs. school year (September–May).

Results

350 patients (14.4 ± 2.4 years old; 37% female; initial visit 8.8 ± 5.3 days post-concussion) were seen for care: 24% sustained a concussion during summer months, 76% during the school year. Lower cognitive (median = 7 [IQR = 1, 15] vs. 9.5 [4, 17]; p = 0.01), but not somatic (7 [2.5, 11] vs. 8 [4, 13]; p = 0.06), HBI scores were observed for patients injured during the summer. Groups were similar in proportion exercising (16% vs 17%) and endorsing sleep problems (29% vs 31%). After adjustments, sustaining a concussion during the summer predicted total (β=-3.43; 95%CI = −6.50, −0.36; p = 0.029) and cognitive (β = -2.29; 95%CI = −4.22, −0.36; p = 0.02), but not somatic (β=-1.46; 95%CI = −2.84, −0.08; p = 0.04), symptom severity.

Conclusion

Pediatric patients with concussion may present with greater cognitive symptoms during the school year, compared to summer months.

KEYWORDS:

• Mild traumatic brain injury
• academics
• recovery
• sleep
• physical activity

Acknowledgments

Morgan N. Potter, Corrine N. Seehusen, Casey C. Little

Disclosure statement

This study did not receive any financial support.

Data availability statement

The data set associated with this work, in addition to the supporting results and analyses, can be made available upon reasonable request.

Additional information

Funding

Unrelated to this study, Dr. Howell has received research support from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (R03HD094560, R01HD108133), the National Institute of Neurological Disorders And Stroke (R01NS100952, R43NS108823), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (1R13AR080451), 59^th Medical Wing Department of the Air Force, MINDSOURCE Brain Injury Network, the Tai Foundation, and the Colorado Clinical and Translational Sciences Institute (UL1 TR002535‐05) and he serves on the Scientific/Medical Advisory Board of Synaptek, LLC. The remaining authors declare no conflicts of interest.