B - 27 Images and Distorted Facts: Seeing beyond the Concussion in Patients with Persisting Symptoms after Concussion

Abstract Objective Persisting symptoms after concussion (PSaC) present significant challenges in clinical practice, with up to 30% of youth experiencing prolonged difficulties beyond one-month post-injury. This project aimed to characterize a sample of patients referred for neuropsychological evaluation due to PSaC and explore factors contributing to persisting symptoms. Method Data were retrospectively collected from 54 patients referred for neuropsychological evaluation at a rural academic medical center. On average, they were aged 16.35 ± 2.81 years (range = 7–24) with FSIQ of 105.39 ± 15.41 (range = 75–146). The sample was predominantly White (90.7%) and female (59.3%). Correlations with bootstrapped linear and logistic regressions were used to analyze relationships. Results Three-quarters (75.9%) of patients experienced symptoms attributable to factors other than concussion, and 90.7% did not receive/follow evidence-based recommendations (EBR) post-injury. Pre-existing migraines, anxiety, depression, and other psychiatric disorders, significantly correlated with symptom burden. Linear regression including anxiety, depression, migraines, other psychiatric disorders, and a lack of EBR predicted the number of symptoms reported [R2 = 0.314, F(5, 48) = 4.40, p = 0.002]. Any history of psychiatric disorders predicted current number of symptoms [R2 = 0.121, F(1, 52) = 7.129, p = 0.010]. Binomial logistic regression with migraines (Nagelkerke R2 = 0.389, p = 0.000) and depression (Nagelkerke R2 = 0.124, p = 0.033) significantly predicted non-concussion etiology. Non-concussion etiology was better predicted by robust logistic modeling of anxiety, depression, migraines, other psychiatric disorders, and not following EBR (Nagelkerke R2 = 0.575, p = 0.000). Conclusions Our findings, though limited in generalizability, underscore the need for individualized PSaC management. Early involvement of neuropsychology in concussion care may facilitate accurate diagnosis, tailored interventions, and improved outcomes, mitigating the risk of iatrogenic effects and optimizing patient recovery via EBR.