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Assault- and Sports-Related Concussions May Differ in Kids

Concussions resulting from assaults and sports may not be entirely similar in children and youth, researchers report. For example, more than twice as many children who experience assault-related concussions report declines in school grades compared with those with sports-related concussions.

The researchers also saw trends suggesting there are clinically meaningful differences between the groups in terms of longer periods before return to school, symptom resolution, and full physician clearance after injury. Patients with assault-related concussion were also less likely to be referred to specialists and to receive initial visio-vestibular testing.

Dr Margaret Means

The research, conducted over a 2-year period with 124 children and adolescents aged 8 to 18 years, stands out by focusing on lesser-understood outcomes of concussions related to assault, said study author Margaret Means, MD, of Children’s Hospital of Philadelphia, in Pennsylvania.

“From my standpoint as a pediatrician and training to be a pediatric neurologist, I want to make sure I come into each patient encounter with as much understanding as I can and to treat all the associated factors adequately,” Means said.

“It’s so important to recognize that one disease process, as we categorize it, such as concussion, doesn’t mean all your patients are going to have the same needs or outcomes,” Means told Medscape Medical News. “We focus a lot on sports-related concussion, and that’s very important, but unless we recognize [that] a child who presents to the emergency department after assault could have a concussion, they are much less likely to be screened for certain concussion aspects.”

The research was presented at the virtual American Academy of Pediatrics (AAP) National Conference.

Means and her colleagues undertook a retrospective chart review comparing 62 patients with assault-related concussions to the same number with sports- and recreation-related concussion between 2012 and 2014.

Patients with assault-related concussion were more likely to be Black, publicly insured, and to initially present to the emergency department. Markedly fewer patients with assault-related concussions received visio-vestibular testing at their first visit compared with sports concussion patients (25% vs 75%; P < .001).

Although the total number of reported physical, cognitive, emotional, and sleep symptoms didn’t differ between the groups during their recovery period, patients with assault-related concussions reported drops in school grades more than twice as often as those youths with sports concussion (47% vs 20%; P = .012).

“The decline in grades in this group suggests it takes longer for children to become asymptomatic from concussion related to an assault,” Means explained. “We need to investigate that further to hopefully address that difference and help kids to not experience that decline in grades.”

Clinically meaningful but not statistically significant differences were revealed in the rate of specialist referral for those with assault-related vs sports-related concussions (53% vs 40%; P = .086). Patients with assault-related concussions also tended to take longer to return to school than patients with sports-related concussions (11 days vs 8 days; P = .252); to experience symptom resolution (13.5 days vs 11.5 days; P = .389); and to