McPherson JI, Kaur G, Darling SR, Surace A, Willer BS, Leddy JJ, Haider MN. Early Identification and Management of Cervical Impairments in Pediatric Patients With Concussion May Reduce Risk of Delayed Recovery.
Clin J Sport Med 2024;
34:25-29. [PMID:
37462603 DOI:
10.1097/jsm.0000000000001179]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/22/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE
Previous research, including high-quality systematic reviews, has found that cervical injury, which often accompanies concussive head injury, can delay recovery from concussion. One pilot randomized controlled trial found that focused cervical assessment and appropriate intervention in children and young adults with persisting postconcussive symptoms (PPCS) improved recovery outcomes. Our sports medicine clinics adopted this approach early (within 2 weeks) in children (aged 10-18 years) after concussion. This study describes our clinical management protocol and compares the recovery trajectories in children after concussion with and without a concomitant cervical injury.
DESIGN
Prospective cohort study.
SETTING
Three university-affiliated outpatient sports medicine clinics from September 2016 to December 2019.
PATIENTS
One-hundred thirty-four concussed children with cervical impairment (mean age 14.9 years, 65% male, and 6.2 days since concussion) were compared with 130 concussed children without cervical impairment (mean age 14.9 years, 57% male, and 6.0 days since concussion).
INDEPENDENT VARIABLES
Examination findings related to the cervical spine (range of motion, cervical spasm, and cervical tenderness).
MAIN OUTCOME MEASURES
Recovery time (measured in days), concussion symptom burden (Postconcussion Symptom Scale), and incidence of PPCS.
RESULTS
Children with cervical impairment reported a higher initial symptom burden; however, there were no differences in recovery time (33.65 [28.20-39.09] days vs 35.98 [27.50-44.45] days, P = 0.651) or incidence of PPCS (40.0% vs 34.3%, P = 0.340).
CONCLUSIONS
We conclude that within this pediatric population, early identification and management of cervical injuries concomitant with concussion may reduce the risk of delayed recovery.
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