Date of Award

Spring 5-2016

Degree Name

Doctor of Philosophy in Nursing (PhD)

Advisor(s)

Terri S. Armstrong, PhD, ANP-BC - Chair

Second Advisor

Summer D. Ott, PsyD

Third Advisor

Janet Meininger, PhD, RN, FAAN

Fourth Advisor

Nikhil Padhye, PhD

Abstract

Background: Concussions in adolescents are a public health concern with the growing popularity of high school sports. Recent legislation mandates that athletes who are suspected of a concussion be cleared to return-to-play by a clinician. More research is needed to develop a concussion predictive model to identify populations at risk for more severe and prolonged symptoms and long-term neurologic deficits.

Aims: The aims of this study were to (1) examine the effect of race and gender on neurocognitive and symptom scores and (2) determine which clinical (e.g., number of concussions, migraine history, learning disabilities/ attention deficit disorders) and demographic factors (e.g., age, gender, race/ ethnicity, health insurance, mechanism of injury/ sport, education) predict prolonged recovery times.

Methods: This was an observational cohort study of clinical data reviewed retrospectively in adolescents aged 13 to 19 years who were evaluated for an acute concussion (≤ 10 days from injury) at a university-based concussion clinic between January 1, 2012 to August 1, 2015. Multivariate analysis of variance was used to examine the role of gender and race on Immediate Post-concussion Assessment and Cognitive Testing composite scores. Logistic regression, Kaplan-Meier analysis, and Cox regression proportional hazards model were utilized to examine predictors of concussion recovery times.

Results: The sample (N = 118) was primarily male (71.2%) with a median age of 16 (range 13-19 years old). Ethnic minorities (Blacks and Hispanics) constituted 40% of the sample. Univariate analyses revealed that females had slower reaction times than males (p = .04) and minority females performed significantly worse on verbal memory (p = .04) than other groups. Predictors of protracted recovery included ADHD (p < .001) and prior concussion history (p = .03). Predictors of shorter recovery times included student athletic insurance (p = .02) and public insurance (Medicaid or Chips) (p = .03) as compared with private or no insurance.

Conclusions: The findings showed that there was a gender difference on reaction time and there was an interaction of race and gender on verbal memory after a concussion. This study also identified key risk factors that may be used prognosticate concussion recovery times in adolescents.

Keywords

Adolescents, Brain concussion, Post-concussion syndrome, Sports injuries, Multi-variate analysis

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