Concussions in Children Most Frequently Tied to Recreational Play Not Sports

Concussions in children, particularly those aged 5 to 12, most frequently are related to recreational play vs sports, according to study findings published in The Journal of Pediatrics.

Researchers conducted a retrospective observational study between January 2018 and September 2022 to explore characteristics of sport-related, recreationally related, and non-sport/non-recreationally related concussions among children aged 5 to 12 who presented to the specialty care concussion program at the Children’s Hospital of Philadelphia within 28 days of injury.

The researchers queried data from the Minds Matter Concussion Registry using electronic health records. Sport-related concussions included injuries that occurred during organized and competitive sport, while recreationally related concussions included those that occurred during recess, free play, or sport activity in a noncompetitive environment (ie, bicycle-related). Non-sport/non-recreationally related concussions included those occurring due to motor vehicle crashes, falls, or assaults. Symptoms were self-reported and using the Post-Concussion Symptom Inventory for Children (PCSI-C). The Visio-Vestibular Examination (VVE) was used to assess visio-vestibular function. Kruskal-Wallis tests were used in statistical analyses.

A total of 1141 patients (median age, 11; girls, 42.9%) were included in the final analysis. The most common injury mechanisms were recreationally related (37.3%), non-sport/non-recreationally related (31.9%), and sport-related (30.9%) concussions.

Among recreationally related injuries, the most common external causes were fall (46.6%), strike by object (35.3%), and strike by person (14.1%). Of the non-sport/non-recreationally related injuries, the most common external causes were strike by object (34.6%), fall (34.1%), and motor vehicle crash (19.0%).

Patients presenting with sport-related vs recreationally related and non-sport/non-recreationally related concussions were older in age. Compared with patients presenting with sport-related concussions (10.3%), those presenting with non-sport/non-recreationally related concussions (19.5%) were more likely to be non-Hispanic Black. There were fewer patients with sport-related concussions (14.5%) vs recreationally related (23.5%) and non-sport/non-recreationally related (26.7%) concussions who had public insurance.

Patients with sport-related vs recreationally related injuries were first evaluated an average of 1.7 days earlier. Similarly, children with sport-related vs non-sport/non-recreationally related injuries were first evaluated an average of 2.5 days earlier.

Among all patients, the most common clinicians seen before presenting to the specialty care concussion program were primary care (42.1%), ED (34.7%), and urgent care (10.2%) physician. Children with a sport-related (9.4%) vs recreationally related (4.9%) or non-sport/non-recreationally related (2.7%) concussion were more likely to have seen no clinician prior to being evaluated by a specialist.

A smaller proportion of children with sport-related (27.9%) vs those with recreationally related (35.7%) or non-sport/non-recreationally related (39.6%) saw an ED physician prior to a specialist.

Lastly, patients with non-sport/non-recreationally related vs those with recreationally related and sport-related injuries reported significantly higher symptom number and severity. A greater proportion of patients with non-sport/non-recreationally related vs recreationally and sport-related concussions reported abnormal total VVE scores. 

Study limitations included reduced generalizability of results to patients presenting to facilities other than a specialty concussion program, the use of self-reported data, and missing data.

“Equipping ED and primary care providers with up-to-date tools for concussion diagnosis and management as well as connecting with school personnel to create a concussion-aware community can help mitigate the potential for disparities generated by different patterns of care by injury mechanism” the researchers concluded.