A Within-Subjects Comparison of Clinical Outcomes for Patients' First and Second Concussions

Abstract

Objectives: To examine the difference between an individual's first and second concussion using a comprehensive, multidomain assessment including symptoms, neurocognitive, vestibular, ocular, and individual demographic and medical history risk factors associated with protracted recovery. Setting: Concussion Specialty Clinic. Participants: Seventy-three patients (aged 13-21 years; 57% female) diagnosed with 2 separate concussions (380.5 ± 278.7 days between injuries) from August 2016 to August 2018. Design: Retrospective within-subjects cohort study. Main Measures: ImPACT, PCSS, and Vestibular-Ocular Motor Screen (VOMS) at each visit. Patients were divided into “normal” (≤30 days) and “protracted” recovery (>30 days) for χ2 analyses. Results: There were no differences between the first and second injuries in recovery time, VOMS, visual and verbal memory, or reaction time. Visual motor speed scores were higher at the second injury time point and reported sleep symptoms were higher at the first injury time point. In addition, participants reported to the clinic on average 3 days earlier for an evaluation for their second injury. Results from χ2 analyses indicated that female sex predicted protracted recovery (>30 days) from concussion at the first injury time point (OR = 4.1; 95% CI, 1.5-11.6; P = .006). Conclusions: The findings provide preliminary evidence that there is no clinical difference between patients' first and second concussions when both injuries were treated through a concussion specialty clinic.

Risk of Two Sport-Related Concussions in the Same Year: Is the Second Concussion Worse?

“…15 Our findings coincide with previous research suggesting that those with a history of migraine or other headaches are at an increased risk of sustaining a repeat concussion 2 and an initial concussion. 19 This differs from the findings of French et al 20 who reported that a history of migraines was not associated with sustaining a repeat concussion and did not prolong recovery. This may be because of the within-subjects study design of the current study, which did not include a comparison group.…”

“…Within our cohort, initial symptom severity scores were higher for their repeat versus initial concussion, which differs from previous studies showing no difference. 20,27 We also found amnesia to be more common after initial concussion, which has not been previously described to our knowledge. 27 Presentation or severity of an initial concussion may have an impact on the prevalence of future concussions.…”

“…These findings are in accordance previous evidence that recovery times do not differ for a single and repeat concussion. 20,25 Importantly, when caring for athletes recovering from a repeat injury, the management strategies should not differ from those used for initial or single concussive injuries. Similar recovery timelines can generally be expected, and more conservative measures are not necessarily needed after a repeat injury.…”