Disclosures: Barrett Weiss, MD: No financial relationships or conflicts of interest

Objective: This study seeks to determine the optimal timeframe for management of concussions in adolescents by evaluating its association with clearance date of return to sport. Our goal was to determine if there is an optimal time in which the first clinical visit should take place.

Design: A retrospective cohort study.

Setting: Outpatient sports medicine clinic.

Participants: 574 adolescent (average age 15.1 with standard deviation of 1.6) patients with primarily sports-related concussion (87.2% sports related) with known date of injury, first clinic visit and clearance date.

Interventions: Not applicable.

Main Outcome Measures: Primary outcome measure was time from injury to clearance for return to play as defined as return to baseline symptoms, normalization of computerized neurocognitive testing to baseline, and completion of supervised return to play protocol without symptoms. A series of binary variables were created to divide patients into categories from day 2 through day 7. Analysis was performed with both unadjusted and adjusted demographic and clinical characteristics which include concussion history, learning disability, attention-deficit/hyperactivity disorder, migraine headaches, depression, anxiety, mechanism of injury, and initial King-Devick score in first clinic visit.

Results: Unadjusted analysis revealed that being seen at day 5-6 since concussion occurred is significantly associated with faster clearance time (p=0.011 and p=0.015 respectively). The overall association between days to first visit and clearance date also shows statistical significance (p=0.002). However, there is no longer a statistical significance difference once adjusted for demographic and clinical characteristics. Notably, when stratified to gender (sex), males were similar to overall results.

Conclusions: This data demonstrates that there is an optimal benefit in clearance for sport when the patient is evaluated in a sports medicine clinic on day 5-6 after time of injury. One other study has suggested similar conclusion for earlier evaluation in first 7 days for optimal concussion management. Further investigations are needed modify treatment for better outcomes.

Level of Evidence: Level II

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/optimal-evaluation-timeframe-in-adolescent-concussions-from-date-of-injury-to-clearance-date/