Concussion: Why Nurses Need to Understand This Hidden Injury

Ann Worley


Pediatr Nurs. 2019;45(5):235-243. 

In This Article

Risk Factors for Special Populations and Co-morbidities

Although increased number, severity, and duration of symptoms (particularly during the acute phase of 2 to 3 days post-injury) are the most consistent predictors of prolonged recovery (Harmon et al., 2013; McCrory et al., 2017; Zemek et al., 2016), there are specific characteristics that seem to be associated with lingering recovery problems. The most significant of these is widely known to be history of previous head injury, particularly multiple mTBIs (AAN, 2013; McCrory et al., 2017). Other risk factors for prolonged recovery include history of headaches (migraines in particular), developmental disabilities (including attention-deficit/hyperactivity disorder), learning disabilities, and history of psychiatric disorders, such as depression, mood disorders, sleep disorders, and anxiety (Halstead & Walter, 2010). The presence of a genetic marker known as the apolipoprotein E4 gene recently has been considered a predisposing risk factor; however, insufficient evidence exists regarding outcomes of young athletes with this gene (Halstead & Walter, 2010). The new CDC Guideline Workgroup recommended careful monitoring of children with predisposing conditions to minimize recovery times (CDC, 2018). Continued research is required to more accurately identify predictors of prolonged recovery (McCrory et al., 2017).