Clinical Outcome following Sport-Related Concussion among Children and Adolescents with a History of Prior Concussion: A Systematic Review

Cook, Nathan E.; Gaudet, Charles E.; Patten, Ryan Van; Kissinger-Knox, Alicia; Iverson, Grant L.

doi:10.1089/neu.2022.0078

Cited by 11 publications

(7 citation statements)

References 59 publications

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“…In terms of medical history, history of migraine is a known risk factor for complicated recovery; 55 however, the effects of prior concussion on clinical outcomes are more controversial. [89][90][91] Direct comparison yielded consistent results that students with multiple concussions showed lower academic performance than students with single concussions. 18,62 However, the number of effect sizes was too limited to confirm the moderating effect of prior concussion history.…”

Section: Contributors To Postconcussion Academic Outcomesmentioning

confidence: 72%

“…Consistent with prior literature, female students appear more susceptible to concussion effects, 87,88 including changes in academic outcomes. In terms of medical history, history of migraine is a known risk factor for complicated recovery; 55 however, the effects of prior concussion on clinical outcomes are more controversial 89‐91 . Direct comparison yielded consistent results that students with multiple concussions showed lower academic performance than students with single concussions 18,62 .…”

Section: Discussionmentioning

confidence: 97%

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Investigating the Student in Returning to Learn After Concussion: A Systematic Review and Meta‐Analysis

Kemp

O’Brien

2023

Journal of School Health

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PURPOSE:Examine concussion effects on academic outcomes, including student perspectives. METHODS:This study included a systematic review and meta-analysis examining post-concussion school attendance, academic performance, perceptions of academic difficulty, and accommodations for students in elementary through college settings. The analysis considered pre-and post-injury factors, along with injury factors that contribute to post-concussion academic outcomes. RESULTS:The systematic review showed that students with concussion miss more school days and perceive higher levels of academic difficulty, but results about academic performance varied. Meta-analysis yielded small concussion effects on school absence and academic performance and moderate effects on perceptions of academic difficulty. Female sex, older age, history of migraine, prior concussions, severe or persistent symptoms, vestibular-ocular motor, and cognitive disruptions are risk factors, but these moderators were not identified in the meta-analysis due to lack of effect sizes. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:This study confirmed negative concussion effects on academic absences, performance, and perceptions of academic difficulty. Identified contributing factors will guide future practices to support students returning to learn after concussion. CONCLUSIONS:Negative impacts to academics from concussion may be amplified by complicating factors. Future investigations are needed to confirm risk factors and mitigating effects of early identification and post-injury supports.

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Section: Contributors To Postconcussion Academic Outcomesmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 97%

Investigating the Student in Returning to Learn After Concussion: A Systematic Review and Meta‐Analysis

Kemp

O’Brien

2023

Journal of School Health

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“…For children presenting to concussion clinics within 1 month of injury, those reporting two or more prior concussions were more likely to have persisting symptoms at 1 month 23 . A recent systematic review of 51 studies, however, found no evidence to associate concussion history with outcome from a subsequent concussion 32 …”

Section: Risk Factors For Psacmentioning

confidence: 99%

“…23 A recent systematic review of 51 studies, however, found no evidence to associate concussion history with outcome from a subsequent concussion. 32…”

Section: Concussion Historymentioning

confidence: 99%

Persisting symptoms after concussion: Considerations for active treatment

Mucha

Pardini

Herring

et al. 2023

PM&R

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“…A more recent systematic review examined the association between prior concussion history and clinical recovery following sport-related concussion in children and adolescents. Across the 51 studies reviewed, the majority (37/51; 72.5%) did not find a statistically significant association between lifetime history of concussion and outcome following subsequent sport-related concussion [ 10 ]. However, associations between concussion history and clinical outcomes in collegiate athletes have not been specifically characterized—hence the need for an updated assessment of the literature.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcome Following Concussion Among College Athletes with a History of Prior Concussion: A Systematic Review

et al. 2022

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Background There is long-standing interest in, and concern about, whether collegiate athletes with a history of concussion will experience worse clinical outcomes, or prolonged recovery, should they sustain a subsequent concussion. Objectives This systematic review examined the association between prior concussion history and clinical outcomes following a subsequent sport-related concussion among college-age student athletes. Study Design Systematic review. Methods We screened 5,118 abstracts and 619 full-text articles that were appraised to determine whether they met inclusion criteria. We utilized a likelihood heuristic to assess the probability of observing a specific number of statistically significant and nonsignificant studies reporting an association between concussion history and clinical outcomes. We conducted a narrative synthesis of the study findings. Results Sixteen studies met the inclusion criteria. Thirteen studies reported the number of participants with a history of prior concussions (≥ 1), which totaled 1690 of 4573 total participants (on average 37.0% of study participants; median = 46.0%, range 5.6–63.8%). On the Newcastle–Ottawa Quality Assessment Scale, the risk of bias ratings ranged from 3 to 9 (mean = 5.4, SD = 1.4). Across all studies, 43.8% (k = 7/16) reported at least one statistically significant result among primary analyses showing an association between concussion history and worse clinical outcome. A minority of studies reporting on symptom duration (4/13, 30.8%) and time to return to play (2/7, 28.6%) found an association between concussion history and worse outcome. Studies included in the review reported limited information pertaining to the characteristics of prior concussions, such as presence or duration of loss of consciousness or posttraumatic amnesia, age at first lifetime concussion, time since most recent past concussion, or length of recovery from prior concussions. Conclusion The question of whether college athletes with a prior history of concussion have worse clinical outcome from their next sport-related concussion remains unresolved. The published results are mixed and in aggregate show modest evidence for an association. Many studies have small samples, and only three studies were designed specifically to address this research question. Important outcomes, such as time to return to academics, have not been adequately studied. Larger hypothesis-driven studies considering the number of prior concussions (e.g., 3 or more) are needed. Trial registration: PROSPERO CRD42016041479, CRD42019128300.

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Clinical Outcome following Sport-Related Concussion among Children and Adolescents with a History of Prior Concussion: A Systematic Review

Cited by 11 publications

References 59 publications

Investigating the Student in Returning to Learn After Concussion: A Systematic Review and Meta‐Analysis

Investigating the Student in Returning to Learn After Concussion: A Systematic Review and Meta‐Analysis

Persisting symptoms after concussion: Considerations for active treatment

Clinical Outcome Following Concussion Among College Athletes with a History of Prior Concussion: A Systematic Review

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