Research In Action

Research In Action

prolonged concussion recovery
Characteristics of Prolonged Concussion Recovery for Children
December 9, 2014

I recently co-authored a research article in the Journal of Pediatrics that identified pre-existing characteristics associated with prolonged recovery from concussions for children and youth (ages 5-18 years) who were referred to Children’s Hospital of Philadelphia’s Sports Medicine specialists from 2010-2011. These patients typically have prolonged and/or more severe symptoms than the general pediatric population and, thus, are referred for specialty care.

We hope our Research in Action readers can use these data to further study risk factors for prolonged recovery and to help with decision-making and care planning for concussion patients.

In the study, we described characteristics of children who had prolonged recoveries according to different types of known risk factors, although none reached statistical significance. The most interesting findings involved pre-existing conditions, presenting signs and symptoms, age, and previous concussions.

Our recovery outcomes included time until a patient was symptom-free and time until a patient was cleared to participate in sports by the Sports Medicine Clinic. Because these patients were school-aged, we included school-related outcomes, such as the need for special accommodations prescribed by the clinic, decline in grades as reported by the student, and time taken until a student returned full-time (without accommodations).

We noted that this cohort took much longer to recover than the general pediatric population: The median number of days to return to school full-time was 35 days and to be symptom-free was 64 days. The median time to be cleared for all activities was 76 days! In the general pediatric population, the estimated healing time is 14 to 28 days.

While more detail is available in the full article, I want to share are few highlights about the characteristics of children with prolonged recoveries:

Pre-existing Conditions

  • 20% of patients or parents reported at least one pre-existing condition.
  • As compared to those without anxiety and depression, those with these conditions took more than twice as long to fully recover.

Presenting Signs and Symptoms

  • 66% reported experiencing dizziness immediately following the injury and 9 percent reported loss of consciousness (LOC).
  • Patients reporting dizziness were more likely than those not reporting dizziness to have prolonged symptoms past 4 weeks and to be prescribed school accommodations.
  • Patients whose symptoms could be triggered by an oculomotor (or eye movement) exam were more likely to have symptoms past 4 weeks, need special school accommodations, require more time to return to school full-time, and to report a decline in grades.


  • Children 12 and younger took nearly twice as long to become symptom-free compared to 17- to 18-year-olds.
  • Returning to school full-time varied by age: a median 40 days for 13- to 14-year-olds, 35 days for 15- to 16-year-olds and 22 days for children 12 and younger.

History of Previous Concussions

  • Those with 2+ and 3+ prior concussions took more than twice as long and more than three times as long, respectively, to recover when compared to those with fewer concussions.