Predictors for delayed presentation to a specialty concussion clinic following sport-related concussion.

Objective: Limited literature exists on predictors for delayed presentation to a specialty concussion clinic following sport-related concussions (SRCs). The current study aimed to 1) describe demographics, injury characteristics, and recovery timelines for athletes presenting to a concussion clinic at least 30 days after SRC; and 2) identify predictors of delayed presentation ≥ 30 days postinjury.

Methods: The current retrospective cohort study examined 14- to 18-year-old athletes who sustained SRCs from November 2017 to April 2022 and presented to a specialty sports concussion clinic. Presentation time was categorized as < 30 days or ≥ 30 days postinjury. Univariate analyses included chi-square, Mann-Whitney U-, and t-tests. Multivariable logistic regression was performed controlling for age, sex, on-field evaluation, distance from the clinic, psychiatric conditions, migraines, and family history of psychiatric conditions/migraines.

Results: Of 923 athletes (mean age 16.2 ± 1.2, 66.2% male), 872 (94.5%) presented within 30 days of their concussion, and 51 (5.5%) presented ≥ 30 days after injury. Delayed presenters (≥ 30 days) lived farther away (U = 29,941.5, p < 0.001), had higher proportions of psychiatric history (χ2 = 17.23, p < 0.001), family migraine history (χ2 = 17.23, p < 0.001), family psychiatric history (χ2 = 26.52, p < 0.001), prior healthcare visits to nonspecialty sites (χ2 = 6.44, p = 0.012), and had lower rates of on-field evaluations (χ2 = 14.28, p < 0.001). In the multivariable logistic regression predicting delayed presentation, significant predictors included psychiatric history (OR 1.40, p = 0.022), family migraine history (OR 1.39, p = 0.007), and absence of on-field evaluation (OR 0.23, p < 0.001). Not surprisingly, late presenters had longer times to symptom resolution (median 54.0 vs 15.5 days, U = 13,470.5, p < 0.001) and return to play (median 55.5 vs 20.0 days, U = 14,822.0, p < 0.001).

Conclusions: In high school-aged athletes with SRCs, psychiatric history, family history of migraine, and absence of on-field evaluation were predictors of delayed presentation to a specialty concussion clinic presentation. These findings highlight opportunities to improve timely access to a dedicated sports concussion center, which may improve outcomes through early intervention.