Sport versus Nonsport Injury Setting as a Moderator of Postconcussive Symptoms Following Pediatric Concussion: An Advancing Concussion Assessment in Pediatrics Study.

Abstract

To examine whether the setting in which children incur concussion occurs is associated with the trajectory of postconcussive symptoms (PCS). This substudy used data from the Advancing Concussion Assessment in Pediatrics study, which involved a prospective cohort design. Participants aged 8-16 years with concussion (n = 529) or orthopedic injury (OI) (n = 265) were recruited during emergency department visits to 5 Pediatric Emergency Research Canada sites. The inclusion of an OI comparison group helps to differentiate concussion-specific effects from the general effects of injury on symptom reporting. Children rated their PCS at 1 week, 3 months, and 6 months postinjury using the Health and Behavior Inventory, a 20-item rating scale that yields cognitive and somatic symptom subscales. Linear multivariable multilevel modeling was used to examine the association of injury group (concussion vs OI) and injury setting (sport-related vs nonsport-related), and their interaction, with PCS over time. Children with concussion reported more severe cognitive and somatic PCS than those with OI at the postacute assessment regardless of injury setting. However, over time, injury setting moderated group differences in cognitive PCS, such that children who sustained concussions in nonsport-related settings reported significantly worse cognitive PCS than those with nonsport-related OI, but children with concussion and OI did not differ if injured in sport-related settings. At 6 months postinjury, group differences in cognitive symptoms remained significant and clinically meaningful for nonsport-related concussion (d = 1.26), but not for sport-related concussion (d = 0.09). In contrast, injury setting did not moderate group differences for somatic PCS. Cognitive but not somatic PCS are more pronounced and of longer duration when concussions are sustained in nonsport-related settings compared with sport-related settings. Further research is needed to determine why injury setting moderates concussion outcomes.