The Effect of Impact Seizure on the Recovery of Children and Adolescents With Concussion: A Matched Case-Control Study

Objective: Management of sport-related and recreation-related concussions (SRCs) in children and adolescents is challenging as brain maturation affects prognosis. However, impact seizure was removed as a prognosis modifying factor in children and adolescents with SRCs in the 2017 consensus statement on concussion in sport, based mostly on adult literature. Therefore, this study evaluates the association of impact seizure on the recovery in children and adolescents with SRCs. Design: Retrospective matched case-control study. Setting: Tertiary pediatric sports medicine service, from January 1, 2015, to June 30, 2022. Patients: A cohort of 452 patients, aged 7 to 18 years, with new episode of SRC was seen. From this cohort, 396 patients were included in the analysis, including 22 with impact seizures. Controls were generated using the propensity score matching approach. Patients with moderate or severe traumatic brain injury or incomplete treatment were excluded. Independent Variable: Impact seizure during SRC. Main Outcome Measures: Primary outcome was recovery duration in number of days. Results: The median recovery duration was longer in the cases (73 days, interquartile range [IQR] = 38-143 days) as compared with controls (49.5 days, IQR = 30.5-93.5 days). There was no difference in patients with prolonged recovery (ie >28 days) between both groups (OR 1.6, 95% CI, 0.4-6.6, P = 0.505). Conclusions: Impact seizures prolonged the recovery duration in children and adolescents with SRCs and therefore have a potential concussion modifying prognostic role. These findings could help provide evidence-based management principles for children and adolescents with SRCs in subsequent concussion consensus statements.