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Background: A validated clinical risk tool has been developed to identify pediatric and adolescent patients at risk of developing persisting symptoms after concussion, but has not been prospectively investigated within a sample of athletes seen after concussion by primary care sports medicine physicians and/or athletic trainers. Purpose: To determine whether a validated clinical risk prediction tool for persistent postconcussive symptoms (PPCSs) predicted which patients would develop PPCSs when obtained within 14 days of concussion among a multicenter sample of adolescent athletes. Study Design: Cohort study; Level of evidence, 2. Methods: Pediatric and adolescent patients (8-18 years of age) from 7 pediatric medical centers and 6 secondary school athletic training facilities who were diagnosed with a concussion and presented ≤14 days after concussion were enrolled as part of the Sport Concussion Outcomes in Pediatrics (SCOPE) study during their initial visit and were followed until symptom resolution. Clinical risk scores (Predicting and Preventing Post-concussive Problems in Pediatrics [5P]) and total symptom severity were obtained using the Post-Concussion Symptom Inventory at the initial visit (mean, 4.9 ± 2.9 days after concussion). Participants were then compared based on symptom resolution time: PPCS group (≥28 days to symptom resolution) and no-PPCS group (<28 days). The authors assessed the odds of developing PPCSs based on the 5P risk score using a binary logistic regression model and the utility of the clinical risk prediction tool to identify total time to symptom resolution using a Cox proportional hazards model. Results: A total of 184 participants enrolled, underwent initial evaluation, and were followed until symptom resolution (mean age, 15.2 ± 2.1 years; 35% female). The mean time to symptom resolution across the entire sample was 17.6 ± 3.7 days; 16% (n = 30) of participants developed PPCS. Those in the PPCS group had significantly greater mean initial total 5P risk scores than those in the no-PPCS group (7.9 ± 1.7 vs 5.9 ± 2.3, respectively; P <.001). After adjustment for initial symptom severity, time to assessment, and assessment setting, a higher initial total 5P risk score was associated with a significantly greater odds of developing PPCSs (adjusted odds ratio, 1.49; 95% CI, 1.07-2.08; P =.019). Furthermore, a higher 5P risk score was significantly associated with longer total symptom resolution time (hazard ratio, 0.80; 95% CI, 0.74-0.88; P <.001). Conclusion: In a multicenter sample of youth athletes seen in different outpatient health care settings, the 5P risk score accurately predicted which athletes may be at risk for developing PPCSs. [ABSTRACT FROM AUTHOR]

Background: Concussion produces diverse symptoms, functional impairment, and societal limitations that may result in decreased quality of life (QoL). Various factors, including sex, prior concussion and mental health history have been associated with a reduction of QoL compared to baseline. However, the influence of various factors on post-concussion QoL has not been investigated in a prospective, multi-site investigation. Hypothesis/Purpose: To examine factors that may predict decreased post-concussion QoL and increased symptom severity. Methods: Pediatric patients (6-18 years) were enrolled as part of the Sport Concussion Outcomes in Pediatrics (SCOPE) study at 6 children's medical centers and 9 secondary schools during the initial visit for a diagnosis of sport-related concussion. Patients completed a medical history, the Post-Concussion Symptom Inventory (PCSI), and Patient-Reported Outcomes Measurement Information System Pediatric Profile-25 (PROMIS-PP). The PCSI is an age-specific, validated symptom survey on which patients rate their current concussion symptoms. Higher numbers indicate greater symptom severity. The PROMIS-PP includes six domains: physical functioning and mobility, anxiety, depressive symptoms, fatigue, peer relationships, and pain interference. Lower scores indicate higher QoL for all domains, except peer relationships, where a higher score indicates better QoL. Eight predictor variables (Table 1) were assessed using negative binomial regression models constructed for each dependent variable. Results: The analysis included 141 patients (14.9±2.4 years, 40.4% female). Patients were enrolled 5.2±3.1 days post-concussion (range=1-14 days). The percentage (frequency) of patients with a positive self-reported medical history included prior concussion (38%, n=55), migraines (4% (n=5), ADD/ADHD (11%, n=55), LOC at time of injury (7%, n=10), and amnesia at time of injury (20%, n=29). Table 1 presents the pre-injury characteristics associated with each QoL domain and the total PCSI score. Self-reported amnesia was a significant predictor of lower QoL for the anxiety, depressive symptoms, fatigue, and pain interference domains. Migraines were associated with higher QoL scores in the anxiety domain. Younger age and longer time since injury were associated with higher symptom severity. Conclusion: Self-reported amnesia at the time of concussion was associated with a lower QoL related to anxiety, depressive symptoms, fatigue, and pain interference. Interestingly prior concussion and other pre-injury factors did not significantly impact post-injury QoL at the initial visit. Future studies should assess the influence of these factors on QoL at later post-injury time points using a concussion-specific outcomes instrument. Patients may be able to better reflect on the impact of the concussion on QoL over time during recovery. Table 1. Patient characteristics associated with each quality-of-life domain and total PCSI score. Due to the zero-inflated count variable nature of the PROMIS variables, negative binomial regression models were constructed for each domain. *Significant predictor of QoL domain. [ABSTRACT FROM AUTHOR]

Background: Posterior ankle impingement (PAI) is a known cause of posterior ankle pain in athletes performing repetitive plantarflexion motion. Even though empirically recommended in adult PAI, there is minimal literature related to the role of conservative physical therapy (PT) in pediatric patients. Purpose: To identify patient characteristics and determine if there is a difference in pediatric patients with PAI who were successful with conservative PT and those who were unsuccessful, requiring surgical intervention. Methods: Prospective study at a tertiary children’s hospital included patients <18 years diagnosed with PAI and underwent PT. Patients who received PT at an external facility were excluded. Collected data included demographics, initial presentation at PT evaluation, treatment throughout PT, patient presentation at PT discharge, time to return to sport (RTS) from initial PT evaluation (if successful), time to surgery from initial PT evaluation (if unsuccessful). Visual Analogue Scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were collected. Group comparisons were conducted using independent t-tests or chi-square analyses (alpha level set at .05). Results: 31 (12 males, 19 females) patients diagnosed with PAI were enrolled with a mean age 12.61 years (range: 8-17). Gymnastics, football, and basketball were the most commonly implicated sports (42% patients). All patients underwent initial conservative PT for an average of 16.24 weeks (9.23 visits ±7.73). 20/31(64.5%) patients failed conservative management and underwent arthroscopic debridement. PAI pathology was predominantly bony in 61.3% and soft tissue 38.7%. Between the successful PT group and unsuccessful PT group, there was no difference in the proportion of athletes/non-athletes (p=.643). Average RTS time for successful group was 11.47 weeks and average time to surgery for unsuccessful group was 17.82 weeks. There were no significant differences in sex (p=.332), age (p=.674), number of PT visits (p=.945), initial weight-bearing status (p=.367), use of manual therapy (p=.074) including manipulation (p=.172) and mobilization (p=.507), sport (p=.272), initial evaluation ankle ROM (p>.05). Initial AOFAS scores for pain, function, alignment, or total were not significantly different (p=.551, .998, .555, .964 respectively). Conclusion: The first prospective study in pediatric patients with PAI demonstrates that even though success of PT is not dependent on age, sex, sport or PAI pathology, a notable proportion of patients who undergo PT do not need surgery. Conservative management including PT should be the initial line of management for PAI. PT treatment and surgery (if unsuccessful with PT) allowed patients to return to prior level of activity/sports. [ABSTRACT FROM AUTHOR]

Objective: To examine patient and injury factors that may predict quality of life (QoL) and symptom duration after concussion. Design: Prospective, longitudinal. Settings: Six children’s hospital-based medical centers and 9 secondary school athletic training facilities. Patients: Pediatric patients (8-18 years) were enrolled as part of the Sport Concussion Outcomes in Pediatrics (SCOPE) study during their initial visit for a diagnosis of sport-related concussion. Interventions: Patients completed a medical history, the Postconcussion Symptom Inventory (PCSI), and Patient-Reported Outcomes Measurement Information System Pediatric Profile-25 (PROMIS-PP). Main Outcome Measures: Eight predictor variables [age, sex, assessment time, loss of consciousness, amnesia and history of concussion, migraines, or attention-deficit hyperactivity disorder or (ADHD)] were assessed using regression models constructed for each dependent variable. Results:A total of 244 patients (15.162.1 years, 41% female) were enrolled (mean 5 5 6 3 days after concussion; range 5 1-14 days). Female sex, later initial assessment, and presence of amnesia were associated with lower QoL scores on several domains, whereas loss of consciousness was associated with higher QoL for fatigue. A history of migraines was associated with lower peer relationship QoL. Patients who subsequently developed persisting symptoms had lower mobility scores and higher anxiety, depressive symptom, fatigue, and pain interference scores. Conclusions: Female sex, later clinic presentation, and amnesia were associated with a lower QoL related to mobility, anxiety, depressive symptoms, fatigue, and pain interference. Interestingly, previous concussion and preinjury ADHD diagnosis did not negatively impact postinjury QoL at the initial visit. Future studies should assess the influence of these factors on QoL at later postinjury time points using a concussion-specific outcomes instrument. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Objective: To determine whether an association exists between fear of pain and recovery time from sports-related concussion in a pediatric population. Design: Prospective observational study. Setting: Primary outpatient sports medicine clinic of a large pediatric hospital. Patients: One hundred twenty-eight pediatric patients aged 8 to 18 years who presented to clinic with a primary diagnosis of concussion from September 2018 to March 2020. Inclusion criteria included presentation within 2 weeks of injury and symptomatic on initial visit. Patients who sustained a concussion because of motor vehicle collisions or assault were excluded. Independent Variables: There was no intervention. Study participants who met inclusion criteria were administered the Fear of Pain Questionnaire (FOPQ) at their initial visit. Main Outcome Measures: Time to clinical recovery was the main outcome measure and was determined by the fellowship-trained sports medicine physician based on resolution of concussion symptoms, resumption of normal physical and cognitive daily activities, no use of accommodations or medications, and normalization of physical exam. Results: There was a significant difference in FOPQ scores for those with prolonged recovery (M = 33.12, SD = 18.36) compared with those recovering in fewer than 28 days (M = 26.16, SD = 18.44; t [126] = −2.18, P = 0.036). Conclusions: Consistent with the adult literature, we found that pediatric patients are more likely to have a prolonged recovery from concussion when they have higher fear of pain. [ABSTRACT FROM AUTHOR]