Abstract Title Psychiatric outcomes in patients with mild concussion following differential treatment timing by age Background The temporary pathophysiological changes after a mild concussion may offer a therapeutic window in which timely intervention can influence long-term post-concussion sequelae. We sought to understand if the risk of depression or anxiety, two well-established sequelae following mild concussion, could be affected by the choice of immediate treatment versus delayed treatment. Our study provides quantifiable risks to different treatment windows across multiple ages and treatment time periods.

Our goal was to examine if patients who received an immediate treatment within one week of mild concussion had different risks for subsequent depression or anxiety compared with those who received delayed treatment after one week of the event, stratified by age groups.

Methods This was a nationwide multicenter retrospective cohort study that used the TriNetX Analytics platform to access de-identified electronic health records of over 100 million patients. The study population was comprised of a total of 9,652 patients with a diagnosis of mild concussion, who received either immediate treatment defined as within 1 week (n = 5,266), or delayed treatment which was defined as 1 week to 6 months (n = 4,386) following the diagnosis of mild concussion. Each treatment group was separated into 3 age groups: <=25, 26-64, and 65+ years. Treatment was defined by CPT code and included one or more of the following neuro-rehabilitative services: CPT96132, CPT92507, CPT1013510, and CPT97165.

Results Among patients aged <=25, those who received immediate treatment had a significantly higher lower risk for depression (HR: 0.782, 95% CI 0.613 –0.998) and anxiety (HR: 0.68, 95% CI: 0.564–0.819) compared with those who received delayed treatment. For those aged 26–64 years, there was a significantly reduced risk of depression (HR: 0.726, 95% CI: 0.593–0.89) and anxiety (HR: 0.635, 95% CI: 0.54–0.747) in the immediate treatment group. However, among patients in the oldest cohort of 65+, there was no significant decrease in risk of depression (HR: 0.735, 95% CI: 0.538–1.004), but there was a significant decrease in anxiety (HR: 0.608, 95% CI: 0.444–0.831) in the immediate treatment group compared to delayed treatment.

Conclusion

This study indicates that patients with a mild concussion who received treatment within one week had significantly reduced risk of depression and anxiety disorders than those who received treatment after one week. Prompt treatment of even mild concussions may mitigate adverse psychiatric outcomes following mild concussion.