Symptom Severity Not NSAID Use Is Associated With PPCS In Adolescents With Concussion

PURPOSE: While non-steroidal anti-inflammatory medications (NSAIDs) are commonly used following concussion, the association between post-concussion NSAID use and clinical outcomes is not known. METHODS: We conducted a prospective cohort study of adolescents with concussion followed from initial evaluation through self-reported symptom resolution. Participants reported concussion symptom severity (Post-Concussion Symptom Inventory [PCSI]), medical history, and medication use information. Chi-square analyses and t-tests were used to compare groups (NSAID use vs. not). Logistic regression analyses evaluated the association of NSAIDs and persisting post-concussive symptoms (PPCS), symptoms lasting >28 days. RESULTS: We enrolled 118 participants with concussion (mean age = 15.4 ± 1.7 years of age, 54% female, 8.4 ± 3.1 days post-injury): 29 (25%) reported taking NSAIDs (N = 26 ibuprofen, N = 5 naproxen, N = 2 ibuprofen/naproxen) in the days preceding their evaluation. Those who reported NSAID use were seen earlier after concussion, weighed less, and had more severe concussion symptoms than those who did not (Table). A higher proportion of those reporting NSAID use sustained a sport-related concussion (SRC) compared to those who did not (Table), and a lower proportion of those reporting NSAID use started physical activity prior to initial evaluation compared to those who did not (Table). More severe symptoms were associated with significantly increased odds of NSAID use (Table). Sustaining a non-SRC and having a higher symptom severity rating at initial evaluation were associated with PPCS, but NSAID use was not (Table). CONCLUSIONS: NSAID use within 14 days post-concussion was associated with more severe symptoms, but not with development of PPCS in adolescents. Additionally, individuals who sustained a non-SRC were less likely to use NSAIDs and more likely to develop PPCS. Injury factors, rather than NSAID use, may influence recovery timing.