Risk Score Helpful Identifying Post-concussion Complications

Persistent post-concussion symptoms are a major concern in pediatric sports medicine clinic, but physicians can get help identifying the risk for this type of complication with a clinical risk score.

In a study, “Identifying Persistent Post-concussion Symptom Risk in a Pediatric Sports Medicine Clinic,” published online in the American Journal of Sports Medicineon September 28, 2018, David R. Howell, Ph.D., ATC, lead researcher at the Children’s Hospital Colorado Sports Medicine Center and an assistant professor at the University of Colorado School of Medicine, Department of Orthopedics, and colleagues found that a higher clinical risk score was significantly associated with greater odds for developing persistent post-concussion symptoms.

To evaluate the efficacy of the Predicting Persistent Post-concussive Problems in Pediatrics (5P) clinical risk score, an emergency department-derived and validated tool, the researchers calculated the score for 230 children (mean age, 14.8 ± 2.5 years; 50% female) who were evaluated at a pediatric sports medicine concussion clinic between May 1, 2013 and October 1, 2017.

The main outcome was persistent post-concussion symptoms (PPCS), defined as symptoms lasting more than 28 days. Those patients who developed PPCS reported feeling slowed down (72% vs. 44%, respectively; respectively; p< .001), headache (94% vs. 72%, respectively; p< .001), sensitivity to noise (71% vs 43%, respectively; p< .001), fatigue (82% vs 51%, respectively; p< .001) and committed four or more errors in tandem stance more than those who did not develop PPCS.

Of those patients who scored high on the clinical risk score, 82% went on to experience PPCS.

Howell told OTW, “Using clinical risk scores may provide prognostic value soon after a concussion in the sports medicine setting. The measures we used were all obtained within the context of a standard clinical evaluation. Thus, clinicians may be able to identify patients at risk for developing persistent symptoms using this approach and initiate treatments at an earlier time.”

He added that “Although not all individual components of the risk score were associated with odds of developing PPCS, the combined risk score was, suggesting that multifaceted approaches are worthwhile to implement.

“Identifying whether or not a patient is likely to experience persistent symptoms is valuable for sports medicine physicians in particular, as they routinely evaluate patients in the acute or sub-acute injury time.”