Objective To examine pre-existing anxiety disorders as a risk factor for increased concussion symptomology and prolonged recovery in children and adolescents.
Methods In this retrospective cohort study, we abstracted medical record data for 637 children/adolescents (5–17 years) presenting to three tertiary concussion clinics between April 2018 and March 2019. Primary outcomes were mean concussion symptom and vision symptom severity scores measured at clinic visits. Linear mixed-effects regression models were employed to investigate differences in average symptom load, vision symptom score and symptom recovery trajectories across anxiety strata, adjusted for random effects (time), age and sex. Secondary outcomes, time to concussion symptom recovery and time to return to academics and sports, respectively, were examined via log-rank tests and multivariable Cox regression.
Results Among 637 eligible concussion patients, 155 (24%) reported pre-existing anxiety. On average, patients with anxiety reported an additional 2.64 (95% CI 1.84 to 3.44) concussion symptoms and 7.45 (95% CI 5.22 to 9.68) higher vision symptom severity scores throughout recovery versus those without, after adjusting for age and sex. There was no evidence that concussion or vision symptom trajectories varied over time between those with/without anxiety after accounting for baseline dissimilarities in symptom scores (all pinteraction >0.05). Anxiety was significantly associated with delayed symptom recovery (adjusted HR 3.34, 95% CI 2.18 to 5.12), return to school (adjusted HR 2.01, 95% CI 1.59 to 2.53) and return to physical activity (adjusted HR 1.88, 95% CI 1.49 to 2.37).
Conclusions Pre-existing anxiety disorders were associated with more severe symptomology and prolonged recovery after concussion in children and adolescents. These results can be referenced by providers to manage patients’ recovery expectations.
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Contributors AKM conceptualised and designed the study, collected data, carried out the statistical analysis and interpretation of results, drafted the initial manuscript and reviewed and revised the manuscript. AJP participated in designing the statistical analysis and interpretation of results and critically reviewed the manuscript for important intellectual content. HWS and RCD conceptualised the study and reviewed and revised the manuscript. MBK and KBS designed the data collection instruments, collected data and reviewed and revised the manuscript. KMI and VNN designed the data collection instruments, coordinated and supervised data collection, collected data and reviewed and revised the manuscript. AML conceptualised and designed the study, obtained funding, designed the data collection instruments, coordinated and supervised data collection, participated in statistical analysis and interpretation of results, participated in drafting the manuscript and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study protocol was approved by the Children’s Minnesota Institutional Review Board before data collection commenced.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request. Deidentified individual participant data may be made available on publication to researchers who provide a methodologically sound proposal for use in achieving the goals of the approved proposal. Proposals should be submitted to the Children’s Minnesota Neuroscience Research Program (AML, PhD; firstname.lastname@example.org).
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