Differences in Adolescent Symptom Reporting Following Motor Vehicle Accident Versus Sport-Related Concussion.

OBJECTIVE: To characterize potential differences in youth concussion sustained in motor vehicle accident (MVA) versus sport-related concussion (SRC), hypothesizing that youth who sustain concussion in a MVA would endorse higher initial and persistent symptom scores compared to those with SRC, despite similar injury severity levels. METHODS: Participants age 12-18 who sustained a concussion (i.e., Glasgow Coma Scale = 13-15) in a MVA (n = 35) were matched with SRC participants (n = 35) by sex, age, and days since injury. ANCOVA comparing initial postconcussion total symptom scores between the MVA and SRC groups were performed. Chi-square analysis with injury group by recovery time was used to determine whether youth who sustained concussion from MVA were more likely to endorse symptoms persisting >30 days at 3 months postinjury, and ANCOVA compared 3-month total symptom scores. RESULTS: On average, the MVA group reported significantly higher initial postconcussion and more frequent persistent symptom scores compared to the SRC group. CONCLUSIONS: This is the first known study to examine context of injury in youth concussion while matching for injury severity, age, sex, and days since injury. Findings suggest the context of injury is an important clinical variable related to initial reporting of symptoms and endorsement of symptoms lasting more than 30 days. Tailored interventions that consider the context of injury may facilitate symptom resolution.

Management and Treatment of Concussions via Tele-Concussion in a Pediatric Setting: Methodological Approach and Descriptive Analysis.

BACKGROUND: Approximately 2 million children in the United States sustain a concussion annually, resulting in an economic impact as high as US $20 billion. Patients who receive treatment at concussion specialty clinics, versus primary care, experience faster recovery, thereby reducing patient burden and subsequent medical-related costs. Accessibility to specialty clinics is typically limited by the availability of in-office visits. This is particularly relevant in light of the severe acute respiratory syndrome coronavirus 2 pandemic and subsequent guidance to eliminate all non-medically necessary in-clinic visits. Telehealth has been used to effectively deliver in-clinic care across several disciplines including psychiatry, psychology, and neuropsychology. However, a model of telehealth delivered concussion assessment, treatment, and management has not been established. OBJECTIVE: The purposes of this paper are to describe a pediatric concussion specialty clinic's experiences in delivering telehealth concussion services and to provide preliminary descriptive data on a sample of pediatric telehealth patients with concussions. METHODS: The specialty pediatric concussion clinic described here began providing telehealth services in 2019 and is part of the largest and fastest-growing telehealth hospital network in the United States. The clinical care process will be described, including accessing the telehealth platform, assessment during the initial appointment, injury management including communication with relevant patient stakeholders (eg, parent or guardians, athletic trainers), dissemination of rehabilitation exercises, and nature of follow-up visits. Descriptive data will include patient demographics, the radius of care, the time between the date of injury and initial visit, the average number of follow-up visits, and days until medically cleared for return-to-learn and return-to-play. RESULTS: The analytic sample included 18 patients with concussions who were seen for all of their visits via telehealth between August 2019 and April 2020. The mean age of the sample was 14.5 (SD 2.5) years. The radius of care was a median of 17 (IQR 11.0-31.0) miles from the clinic with a median time between injury and the first visit of 21 (IQR 6.0-41.5) days. The mean number of visits was 2.2 (SD 0.8) with a median days between visits of 5.4 (IQR 3.0-9.3) to manage and treat the concussion. Of the 18 patients, 55.6% (n=10) were medically cleared for return-to-learn or -play in a median of 15.5 (IQR 11.0-29.0) days. CONCLUSIONS: Limited access to health care is a well-understood barrier for receiving quality care. Subsequently, there are increasing demands for flexibility in delivering concussion services remotely and in-clinic. This is the first paper to provide a clinically relevant framework for the assessment, management, and treatment of acute concussion via telehealth in a pediatric population.