Abstract Details

Title Concussion and Court: The Role Litigation Plays in Time to Recovery

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) S30 - Sports Neurology and Neuro Trauma (4:30 PM-4:42 PM)

Poster/Presentation
Number 006

Objective Compare time to recovery (TTR) in patients with concussion who pursued litigation, no fault and/or workers’ compensation post-injury, with those who did not.

Background The relationship between litigation and recovery in concussion patients was studied to determine if the opportunity for financial gain influences TTR. At times, patients involved in litigation cases may be perceived as demonstrating malingering behavior rather than legitimate symptoms. This study compares patients based on litigation status while controlling for key variables.

Design/Methods Retrospective study of 1,155 patients (284 litigation, 871 non-litigation) ages 1-78 in an outpatient concussion clinic. TTR was evaluated through a full sample analysis and then a matched sample analysis controlling for key variables (sex, age, symptoms, medical history, and mechanism of injury(MOI)) using a 1:1 greedy matching approach. Propensity score matching resulted in 116 matched pairs of litigation and non-litigation patients.

Results Full sample MOIs included motor vehicle accidents (MVA) (n=272), falls (n=201), assaults (n=50), sports (n=479), and “other” (n=153). Kaplan-Meier curves and log-rank test showed in the full sample, patients engaging in litigation had prolonged recovery (p < 0.0001). Older patients (p < 0.0001) and those with MOI of MVA (p < 0.0001) or assault (p < 0.0001) were more likely to engage in litigation. Matched analysis with litigation-stratified survival curves and log-rank test for equality between strata (p = 0.9496) strongly suggests patients with similar key variables exhibit similar survival times, regardless of litigation status.

Conclusions While litigation patients are often stereotyped to malinger and exaggerate symptoms, this study found that with appropriate matched analysis, there was no difference in TTR between litigation/non-litigation patients. The desire to pursue litigation may be influenced by age and certain MOIs. These findings are important for physicians and attorneys to consider when focusing on TTR in litigation cases.

Authors/Disclosures
Virginia A. Headd PRESENTER	No disclosure on file
Mohammed Alwahaidy, MD (Upstate medical university)	Dr. Alwahaidy has nothing to disclose.
Michael Lillis, Jr., LMHC (Dent Neurologic Institute)	No disclosure on file
Dilpreet Kaur-Spencer, MD (Madigan Army Medical Center - JBLM)	No disclosure on file
Said Shukri, MD (University of Michigan)	Mr. Shukri has nothing to disclose.
Patrick Eugeni (1998)	Mr. Eugeni has nothing to disclose.
Rebecca A. Burgos (Dent Neurologic Institute)	No disclosure on file
Jennifer W. McVige, MD, FAAN (Dent Neurological Institute)	Dr. McVige has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Theranica. Dr. McVige has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lundbeck. Dr. McVige has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Allergan/AbbVie. Dr. McVige has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Amgen. Dr. McVige has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biohaven. Dr. McVige has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Eli Lilly. Dr. McVige has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Teva. Dr. McVige has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Neurelis. The institution of Dr. McVige has received research support from Amgen. The institution of Dr. McVige has received research support from Eli Lily. The institution of Dr. McVige has received research support from Biohaven. The institution of Dr. McVige has received research support from Lundbeck. The institution of Dr. McVige has received research support from Dent Family Foundation. Dr. McVige has a non-compensated relationship as a Neurology Board with UCNS that is relevant to AAN interests or activities. Dr. McVige has a non-compensated relationship as a Board Exam Board Member with ABPN that is relevant to AAN interests or activities.
Laszlo Mechtler, MD, FEAN, FASN, FAHS, FAAN (Dent Neurologic Institute)	Dr. Mechtler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Impel Pharma. Dr. Mechtler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Mechtler has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Abbvie. Dr. Mechtler has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Genomate Health. The institution of Dr. Mechtler has received research support from The Harry Dent Family Foundation, Inc. The institution of Dr. Mechtler has received research support from Alpheus medical. The institution of Dr. Mechtler has received research support from Shiratronics. The institution of Dr. Mechtler has received research support from Abbvie Inc. The institution of Dr. Mechtler has received research support from Amgen. The institution of Dr. Mechtler has received research support from Eli Lilly Company. The institution of Dr. Mechtler has received research support from H. Lundbeck HS. The institution of Dr. Mechtler has received research support from Pfizer. Dr. Mechtler has received personal compensation in the range of $100,000-$499,999 for serving as a Ownership interest with Neurology Practce Consortium GPO. Dr. Mechtler has a non-compensated relationship as a Board member with International Headache Society that is relevant to AAN interests or activities.

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