Concussion Recovery at Risk: Why Are Kids Avoiding Follow-Up Care? | HEADCHECK Health

Concussions in children and adolescents are a growing public health concern. While many young patients will recover fully within a few weeks, many will experience lingering symptoms that require follow-up care.

Yet, a recent study published in The Journal of Pediatrics revealed a troubling trend—60% of pediatric concussion patients fail to complete their follow-up care.

So, today on the blog, we will cover the following questions: why do so many kids miss their concussion follow-ups? And what can be done to ensure better concussion management for young athletes?

The Study: Understanding Loss to Follow-Up

Researchers conducted a retrospective study analyzing 140 pediatric patients treated in the concussion clinic at Boston Medical Center. The patients included in the study had already attended at least one follow-up visit after their initial head injury.

The study sought to identify factors influencing  whether young patients returned for continued care until they were fully cleared to resume regular activities, including sports. Patients who did not return were considered “lost to follow-up.”

Key Finding

The study found that a staggering 60% of pediatric concussion patients were lost to follow-up before achieving full medical clearance.

Factors Influencing Attending Follow-Up Care

Protective Factors: Who Was More Likely to Complete Follow-Up Care?

1. Living with a Biological Parent – Children who lived with at least one biological parent had a significantly higher likelihood of attending all  necessary follow-up appointments. Researchers suggested that this may be due to greater parental involvement and
   understanding of concussion risks.
2. Participation in Sports – Patients who played organized sports were more likely to complete follow-up visits. This could be due to increased concussion awareness in sports communities and regulations requiring medical clearance before returning to play.

Risk Factors: Who Was More Likely to be Lost to Follow-Up?

1. Older Age (10 Years or Older) – Adolescents were at much greater risk of discontinuing their follow-up care, possibly due to increased independence, reluctance to take time away from school and activities, or underestimating the severity of their symptoms.
2. Attending Two or Fewer Follow-Up Appointments – Researchers identified a “golden window” of two appointments—patients who dropped off before their third visit were significantly more likely to never return for full clearance.

Implications for Pediatric Concussion Management

This research provides valuable insights that can shape future concussion care strategies. Some potential solutions include:

• Improved Patient Education – Clearly communicating the risks of premature return to activities.
• Engaging Parents and Coaches – Leveraging the role of guardians and sports organizations to reinforce follow-up care.
• Flexible Follow-Up Options – Using telemedicine to maintain patient engagement.
• Targeting Adolescents – Developing strategies tailored to older patients who may be more resistant to continued care.

Why Is This Important?

Pediatric concussions can have long-term effects on brain development, cognitive function, and emotional well-being. Ensuring proper follow-up care is critical for monitoring recovery and reducing the risk of long-term complications. This study highlights the need for stronger engagement strategies in the early follow-up period. Medical providers could focus on building trust with patients and families in the first two visits, reinforcing the importance of completing care, and offering flexible follow-up options like telemedicine or scheduled check-ins.

References

Núñez-Peña E, Kelly RP, Campos S, Diaz MC, Castillo PA, Kataria S, Perez AM, Beletanga MD, Torres AR. Factors Associated with Loss to Follow-Up in Pediatric Concussion Patients after Initial Visit: A Retrospective Study at a Concussion Clinic. J Pediatr Clin Pract. 2024 Oct 19;14:200131. doi: 10.1016/j.jpedcp.2024.200131. PMID: 39650262; PMCID: PMC11625348.

About the Author

Dr. Jennifer Hunnicutt is a licensed athletic trainer with a PhD in Health and Rehabilitation Science, who has worked with all types of athletes, including professionals and Olympians. She has held prominent research positions at Emory Sports Medicine and the NBA Hawks Center in Atlanta, GA, as well as serving on the national network of healthcare providers for U.S. Figure Skating. Now the owner of Hunnicutt Writing and Consulting, LLC, Dr. Hunnicutt collaborates with global institutions, spearheading innovation and research among professionals and businesses in Sports Medicine and Orthopedics. Learn more at www.drhunnicutt.com