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

Mathew J Wingerson; Samantha N Magliato; Katherine L Smulligan; Julie C Wilson; Casey C Little; David R Howell

doi:10.1177/23259671231186430

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

Orthop J Sports Med. 2023 Aug 17;11(8):23259671231186430. doi: 10.1177/23259671231186430. eCollection 2023 Aug.

Authors

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

¹ Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA.
² Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA.
³ Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.
⁴ University of Virginia School of Medicine, Charlottesville, Virginia, USA.

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.

Abstract

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