History of Anxiety Associated with Head CT Following Sport-related Concussion

Background: CDC and AAP guidelines discourage routine neuroimaging following concussion, as CT scans are only indicated if severe intracranial injury is suspected. However, additional factors may play a role in the clinical decision to obtain a head CT following sport-related concussion (SRC). Previous literature has demonstrated that patients with anxiety have higher nonmental healthcare utilization. This study evaluated differences in symptom scores and clinical measures in athletes who did and did not receive a head CT following SRC.

Methods: Data were prospectively collected from participants enrolled in the North Texas Concussion Network Registry (ConTex) between August 2015-May 2021. Participants aged 5-18 diagnosed with SRC and presenting within 30 days of injury were included. Participants were separated into 2 groups based on whether they underwent a head CT following SRC: CT (negative scan) and no CT. Positive CTs were excluded. Groups were matched in age and time to presentation (within 5 days). Demographics, medical history, and clinical measures from initial presentation and 3-months post-enrollment were reviewed, including SCAT-5 Symptom Log, Generalized Anxiety Disorder (GAD-7) scale, Patient Health Questionnaire (PHQ-8), Brief Resilience Scale (BRS), and return-to-play (RTP). To compare variables between the groups a Chi-square or Fisher’s exact tests were used for categorical variables and Mann-Whitney test for continuous variables.

Results: 324 participants were included: 162 in each group. There were no significant differences between the groups in age, sex, race, ethnicity, or previous concussion history. There was no difference in depression history between the groups, but significantly more participants in the CT group reported a history of anxiety. Significantly higher rates of loss of consciousness (LOC), amnesia, and vomiting following SRC were reported in the CT group. Medical history and injury-related details are described in Table 1.

At initial clinic presentation, there was no difference between the groups in symptom log or clinical measure scores. However, at 3-months post-enrollment, the CT group reported significantly higher scores on the symptom log, GAD-7, and PHQ-8 (Table 2). The no CT group reported RTP a week sooner than the CT group (28.8±22.3 vs 35.7±27.3 days, p=0.019). However, there was no difference in prolonged recovery (>30 days: 29.6 vs 40.5%, p=0.07) or overall RTP rates (91.9 vs 85.8%, p=0.09) between the no CT and CT groups at 3-months post-enrollment.

Conclusion: Following SRC, a history of anxiety may play in role in patients obtaining a head CT. This information may be useful for providers with head CT decisions following sport-related head injuries. Further research regarding the role mental health may play regarding obtaining imaging following SRC is needed.