Factors Associated with Loss to Follow-Up in Pediatric Concussion Patients after Initial Visit: A Retrospective Study at a Concussion Clinic
Objective: The objective of this retrospective study is to identify factors associated with loss to follow-up for postconcussion clearance in pediatric patients by comparing loss to follow-up and full clearance patients. Study design: This retrospective single-center cohort study analyzed 140 consec...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-12-01
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| Series: | Journal of Pediatrics: Clinical Practice |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950541024000371 |
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| author | Emilia Núñez-Peña, MD Ryan P. Kelly, BS Santiago Campos, MD Maria C. Diaz, MD Pamela A. Castillo, MD Shivangi Kataria, MSAB Alexia M. Perez, MD Maria Dolores Beletanga, MD Alcy R. Torres, MD |
| author_facet | Emilia Núñez-Peña, MD Ryan P. Kelly, BS Santiago Campos, MD Maria C. Diaz, MD Pamela A. Castillo, MD Shivangi Kataria, MSAB Alexia M. Perez, MD Maria Dolores Beletanga, MD Alcy R. Torres, MD |
| author_sort | Emilia Núñez-Peña, MD |
| collection | DOAJ |
| description | Objective: The objective of this retrospective study is to identify factors associated with loss to follow-up for postconcussion clearance in pediatric patients by comparing loss to follow-up and full clearance patients. Study design: This retrospective single-center cohort study analyzed 140 consecutive patients at a pediatric concussion clinic of a safety-net hospital for loss to follow-up, defined as not achieving clearance at last appointment. Univariate and multivariate regression models were fit on variables of interest, including demographic, mechanism and severity of concussion, and characteristics of the first evaluation postconcussion and follow-up management. Results: Of the sample, 40% (n = 56) achieved clearance and 60% (n = 84) were lost to follow-up. Median age was 15 (IQR 11-17), with male predominance (60.7%). Living with a biological parent (OR = 0.145, 95% CI = 0.028-0.760) and sports involvement (OR = 0.256, 95% CI = 0.092-0.764) were protective factors, while being 10 years old or older (OR = 13.466, 95% CI = 2.792-64.958) and attending 2 or fewer follow-up appointments (OR = 19.027, 95% CI = 4.991-72.533) were risk factors for loss to follow-up. No significant differences were found between sex, race, driving distance, type of insurance, and mechanism of injury. Conclusions: Living with a biological parent and involvement in sports showed to be protective factors for loss to follow-up. Age at time of concussion and number of appointments were risk factors. A “golden window” of 2 appointments was identified, highlighting the need of a strong rapport and engagement in shared decision-making. Future directions include prospective studies implementing strategies targeting adolescents and building a strong patient-provider relationship. |
| format | Article |
| id | doaj-art-7ae0f3b1b04245c48e100752f0c22cf8 |
| institution | OA Journals |
| issn | 2950-5410 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Pediatrics: Clinical Practice |
| spelling | doaj-art-7ae0f3b1b04245c48e100752f0c22cf82025-08-20T02:38:06ZengElsevierJournal of Pediatrics: Clinical Practice2950-54102024-12-011420013110.1016/j.jpedcp.2024.200131Factors Associated with Loss to Follow-Up in Pediatric Concussion Patients after Initial Visit: A Retrospective Study at a Concussion ClinicEmilia Núñez-Peña, MD0Ryan P. Kelly, BS1Santiago Campos, MD2Maria C. Diaz, MD3Pamela A. Castillo, MD4Shivangi Kataria, MSAB5Alexia M. Perez, MD6Maria Dolores Beletanga, MD7Alcy R. Torres, MD8Tecnológico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, MexicoLarner College of Medicine at the University of Vermont, Burlington, VTDepartment of Pediatrics, Nicklaus Children's Hospital, Miami, FLDepartment of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, MA; Department of Biostatistics, Biometrics FSP 360, Syneos Health, Morrisville, NCDepartment of Pediatrics, Nicklaus Children's Hospital, Miami, FLDepartment of Biostatistics, Biometrics FSP 360, Syneos Health, Morrisville, NCDepartment of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, MA; Department of Biostatistics, Biometrics FSP 360, Syneos Health, Morrisville, NCDepartment of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, MA; Department of Biostatistics, Biometrics FSP 360, Syneos Health, Morrisville, NCDepartment of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, MA; Department of Biostatistics, Biometrics FSP 360, Syneos Health, Morrisville, NC; Reprint requests: Alcy R. Torres, MD, Department of Pediatrics, Boston Medical Center, 801 Albany St, Boston, MA 02482.Objective: The objective of this retrospective study is to identify factors associated with loss to follow-up for postconcussion clearance in pediatric patients by comparing loss to follow-up and full clearance patients. Study design: This retrospective single-center cohort study analyzed 140 consecutive patients at a pediatric concussion clinic of a safety-net hospital for loss to follow-up, defined as not achieving clearance at last appointment. Univariate and multivariate regression models were fit on variables of interest, including demographic, mechanism and severity of concussion, and characteristics of the first evaluation postconcussion and follow-up management. Results: Of the sample, 40% (n = 56) achieved clearance and 60% (n = 84) were lost to follow-up. Median age was 15 (IQR 11-17), with male predominance (60.7%). Living with a biological parent (OR = 0.145, 95% CI = 0.028-0.760) and sports involvement (OR = 0.256, 95% CI = 0.092-0.764) were protective factors, while being 10 years old or older (OR = 13.466, 95% CI = 2.792-64.958) and attending 2 or fewer follow-up appointments (OR = 19.027, 95% CI = 4.991-72.533) were risk factors for loss to follow-up. No significant differences were found between sex, race, driving distance, type of insurance, and mechanism of injury. Conclusions: Living with a biological parent and involvement in sports showed to be protective factors for loss to follow-up. Age at time of concussion and number of appointments were risk factors. A “golden window” of 2 appointments was identified, highlighting the need of a strong rapport and engagement in shared decision-making. Future directions include prospective studies implementing strategies targeting adolescents and building a strong patient-provider relationship.http://www.sciencedirect.com/science/article/pii/S2950541024000371 |
| spellingShingle | Emilia Núñez-Peña, MD Ryan P. Kelly, BS Santiago Campos, MD Maria C. Diaz, MD Pamela A. Castillo, MD Shivangi Kataria, MSAB Alexia M. Perez, MD Maria Dolores Beletanga, MD Alcy R. Torres, MD Factors Associated with Loss to Follow-Up in Pediatric Concussion Patients after Initial Visit: A Retrospective Study at a Concussion Clinic Journal of Pediatrics: Clinical Practice |
| title | Factors Associated with Loss to Follow-Up in Pediatric Concussion Patients after Initial Visit: A Retrospective Study at a Concussion Clinic |
| title_full | Factors Associated with Loss to Follow-Up in Pediatric Concussion Patients after Initial Visit: A Retrospective Study at a Concussion Clinic |
| title_fullStr | Factors Associated with Loss to Follow-Up in Pediatric Concussion Patients after Initial Visit: A Retrospective Study at a Concussion Clinic |
| title_full_unstemmed | Factors Associated with Loss to Follow-Up in Pediatric Concussion Patients after Initial Visit: A Retrospective Study at a Concussion Clinic |
| title_short | Factors Associated with Loss to Follow-Up in Pediatric Concussion Patients after Initial Visit: A Retrospective Study at a Concussion Clinic |
| title_sort | factors associated with loss to follow up in pediatric concussion patients after initial visit a retrospective study at a concussion clinic |
| url | http://www.sciencedirect.com/science/article/pii/S2950541024000371 |
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