Derivation of a Focused, Brief Concussion Physical Examination for Adolescents With Sport-Related Concussion

Objective: To describe the derivation of a brief but pertinent physical examination (PE) for adolescents who have sustained sport-related concussion (SRC). Design: Prospective cohort. Setting: University concussion management clinic. Participants: Acutely concussed (AC, n = 52, 15.5 +/- 1.4 years, 4.4 +/- 2 days since injury, 26.2 +/- 38 days to recovery, 71% males) and healthy control (HC) adolescents (n = 30, 15.8 +/- 1.4 years, 73% males). Intervention: Acutely concussed had a PE on visit 1 and were retested at visit 2 (13.6 +/- 1 day after visit 1). Acutely concussed were further characterized as normal recovery (NR, n = 41, 15.5 +/- 1.5 years, recovery time 13.0 +/- 7 days) and delayed recovery (DR, n = 11, 15.5 +/- 1.2 years, recovery time 75.4 +/- 63 days). Main Outcome Measure: Physical examination findings, including cervical, vestibular, and oculomotor systems. Results: Visit 1 abnormal PE signs were significantly greater in AC versus HC (2.79 +/- 2.13 vs 0.07 +/- 0.37, P < 0.0001) but not in NR versus DR (2.61 +/- 2.2 vs 3.45 +/- 1.8, P = 0.246). Visit 2 abnormal PE signs differentiated NR versus DR (0.17 +/- 0.7 vs 2.45 +/- 2.1, P < 0.0001). Conclusions: A brief focused PE can help to diagnose SRC, establish recovery, and may have prognostic value.