Predictors of Pharmacological Intervention in Adolescents With Protracted Symptoms After Sports-Related Concussion

Abstract Background Although recovery after concussion is spontaneous and typically occurs within 2-3 weeks, a subset of adolescents develop persistent symptoms after a sports-related concussion. Medications are frequently prescribed as part of a comprehensive treatment approach to alleviate these symptoms; however, there are no guidelines for prescription of pharmacologic therapy after concussion. Objective To investigate common factors that are associated with the use of medications (antiepileptic, antidepressant, neurostimulant, or sleeping medication) during recovery from a sports-related concussion. Design Retrospective observational study. Setting Single-center specialty concussion center. Participants A total of 100 adolescents, between the ages of 12 and 18 years, who sustained concussion due to sports. Assessment of Risk Factors Independent variables collected included age at the time of concussion, gender, sports played, personal history of prior concussion or mental health disorder, and personal or family history of headache (eg, migraines) or seizure disorder. Main Outcome Measure Prescription of medications for treatment of concussion. Results Twenty-four patients (24%) were prescribed medications in this study, all of whom reported headache at the time of medication prescription. Amantadine was the most commonly prescribed medication, with amitriptyline and melatonin also being prescribed. Among the demographic information collected, only age and gender met criteria for inclusion in the regression model. Logistic regression analysis demonstrated that the odds that female participants were prescribed medications was 3.790 (95% confidence interval=1.262-11.380) higher than male participants. A higher symptom score on the initial Post Concussion Symptom Scale (PCSS) was associated with increased odds of being prescribed medications (odds ratio=1.031, 95% CI=1.009-1.052). Conclusions The current study found that initial symptom severity and female gender were associated with use of medication in recovery from sports-related concussion among variables available for study. Level of Evidence II