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. 2023 Aug 17;11(8):23259671231186430.
doi: 10.1177/23259671231186430. eCollection 2023 Aug.

Predicting Time to Evaluation After Pediatric Concussion: Factors Affecting Specialty Concussion Care

Mathew J Wingerson  1   2 , Samantha N Magliato  1   2 , Katherine L Smulligan  1   2 , Julie C Wilson  1   2   3 , Casey C Little  2   4 , David R Howell  1   2
Affiliations

Predicting Time to Evaluation After Pediatric Concussion: Factors Affecting Specialty Concussion Care

Mathew J Wingerson et al. Orthop J Sports Med. .

Abstract

Background: The timing of clinical evaluation after pediatric concussion represents an important and potentially modifiable clinical milestone for diagnosis, selection of appropriate treatment pathways, and recovery prognosis. Patient demographics, socioeconomic status, or medical history may affect the time to the initial evaluation and subsequently influence recovery outcomes.

Purpose/hypothesis: The purpose of this investigation was to evaluate the association of patient characteristics with the time to specialty evaluation after a concussion. It was hypothesized that patients with a history of concussion, a preexisting relationship with our specialty concussion program, or a higher ZIP code-based income estimate would present for care more quickly after a concussion than patients without these characteristics.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: Included were patients with a concussion between 6 and 18 years old who were seen for care at a single sports medicine center between January 1 and December 31, 2019. Patient demographic, socioeconomic, injury, and clinical characteristics were collected through a retrospective review of the medical records. The primary outcome was the number of days between the date of the concussion and the patient's initial specialty evaluation.

Results: Overall, 220 patients (mean age, 14.4 ± 2.5 years; 46% female) were seen for care at a mean of 9.7 ± 5.6 days (range, 1-21 days) after concussion. A shorter time to specialty evaluation was associated with a history of concussion (β = -1.72 [95% CI, -3.24 to -0.20]; P = .03) and a prior clinical relationship with the treating clinical department (β = -1.85 [95% CI, -3.52 to -0.19]; P = .03). Referral by a primary care provider was associated with a longer time to evaluation (β = 3.86 [95% CI, 2.39-5.33]; P < .0001).

Conclusion: A history of concussion and having a preexisting clinical relationship with the deparment were associated with a shorter time to evaluation after concussion. Referral from a primary care physician was associated with a longer time to evaluation. Issues may exist in the propensity to access care after an injury, resulting in delays for initiating early treatment.

Keywords: adolescent; brain injury; clinical presentation; mTBI; pediatric; rehabilitation; timing of evaluation.

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Conflict of interest statement

The authors have declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. 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), 59th Medical Wing Department of the Air Force, MINDSOURCE Brain Injury Network, the Tai Foundation, the Colorado Clinical and Translational Sciences Institute (UL1 TR002535‐05), and the Denver Broncos Foundation. The remaining authors declare no conflicts of interest. This study did not receive any financial support.

Figures

Figure 1.
Figure 1.
The relationship between 3 variables predictive of the time to the specialty evaluation, separated into the mean time from the injury to scheduling (dark bars) and the mean time from scheduling to the initial specialty evaluation (light bars). Error bars indicate 95% CIs. P values represent individual comparisons for time from the injury to appointment scheduling and time from scheduling to the initial specialty evaluation.
See this image and copyright information in PMC

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