Examining initial post-concussion dizziness and postural stability as predictors of time to symptom resolution. Issue 6 (June 2022)

• Record Type: Journal Article
• Authors: Smulligan, Katherine L.; Wingerson, Mathew J.; Seehusen, Corrine N.; Wilson, Julie C.; Howell, David R.
• Is Part Of: Journal of science and medicine in sport. Volume 25:Issue 6(2022)
• Page Start: 455
• Page End: 459
• Publication Date: 2022-06
• Subjects: Adolescent -- Sports -- Athletic injury -- Symptom resolution -- Balance -- Rehabilitation; Sports sciences -- Periodicals; Sports medicine -- Periodicals; Exercise -- Physiological aspects -- Periodicals; Sports -- physiology -- Periodicals; Sports Medicine -- Periodicals; Sportgeneeskunde; 617.102705
• DOI: 10.1016/j.jsams.2022.01.010
• Languages: English
• ISSNs: 1440-2440

Abstract

Abstract: Objectives: To examine the utility of a multimodal assessment battery of self-reported dizziness, clinician obtained postural stability, and symptom severity ratings within 14 days of concussion to predict symptom resolution time among children and adolescents. Design: Prospective cohort. Methods: Patients ages 6–18 years completed evaluation ≤14 days post-concussion, including self-reported symptom severity using the Post-Concussion Symptom Inventory (PCSI) and postural stability assessments. We grouped patients as dizzy or not dizzy based on the difference in current and pre-injury PSCI dizziness ratings: difference between current and pre-injury dizziness ≥3 = dizzy; difference <3 = not dizzy. We evaluated postural stability using modified Balance Error Scoring System (mBESS) and tandem gait (TG). Our primary outcome was time from concussion to symptom resolution. Using a univariable Cox proportional hazard model, we examined the association between dizziness and symptom resolution time. We then used a multivariable Cox proportional hazard model to adjust for potential confounding variables. Results: We examined 89 patients and grouped each as dizzy ( n = 34; age = 14.7 ± 2.7 years; 7.1 ± 3.4 days post-injury; symptom resolution time = 40.8 ± 5.7 days) or not dizzy ( n = 55; age = 14.4 ± 2.3 years; 7.2 ± 3.1 days post-injury; symptom resolution time = 23.3 ± 3.2 days). Upon univariable examination, dizziness was independently associated with increased symptom resolution time (Hazard Ratio [HR] = 0.49; 95%CI: 0.28, 0.83; p = 0.009). After adjusting for potential confounders (total symptom severity, mBESS tandem stance errors, TG time, loss of consciousness), only symptom severity change was associated with symptom resolution time (HR = 0.98; 95%CI: 0.96, 0.997; p = 0.025). Conclusions: Total symptom severity assessed within 14 days of concussion, but not dizziness or postural stability, was significantly associated with symptom resolution time among children and adolescents following concussion.