Identifying Predictors of the Cognitive/Fatigue Clinical Profile in Adolescents with Sport-Related Concussion

Purpose Identify predictors of the cognitive/fatigue clinical profile in adolescents with sport-related concussion (SRC). Method A retrospective chart review was conducted on patients aged 13-18 years seeking care for a diagnosed SRC at a concussion specialty clinic. Participants were categorized by whether the cognitive/fatigue profile was assigned as primary or secondary profile at their first visit, determined by multi-domain assessment. Potential predictors, based on prior literature and clinician expertise, included sex, history of ADHD/LD, immediate removal from play, same-day return to play, continuing to practice/play in games in lieu of structured return-to-play protocol, days to first visit, Concussion Clinical Profiles Screening (CP-Screen) Tool cognitive/fatigue score, and age. Chi-square test of independence and independent t-test identified variables associated with cognitive/fatigue profile status. Variables with significant associations (p<.05) were entered into a logistic regression (LR) to determine their unique contribution in predicting the profile. Results 1331 patients (15.18+1.48yrs; 61% male) were included. Of these, 39% had a cognitive/fatigue profile. Participants with cognitive/fatigue profile were more likely to continue practice/play (p=.02), had longer time until first visit (p=.01), and higher cognitive/fatigue CP-screen scores (p<.001) than those without cognitive/fatigue profile. The LR model was significant (X2[3,1239]=56.24, p<.001) and all predictors remained independently associated with profile status (p-values<.05). The CP-screen score demonstrated the strongest association, with each 1-point increase associated with 21% increased odds of having a cognitive/fatigue profile (OR=1.21; 95%CI: 1.14-1.28). Conclusions These findings enhance the understanding of concussion clinical profiles by identifying factors associated with cognitive/fatigue among adolescents with SRC, supporting early and targeted treatment strategies.