First-time sports-related concussion recovery revisited: management changes and impact on recovery

Abstract

Context Concussion is among the most common injuries in athletes. Over the past 10 years, concussion knowledge has expanded, and guidelines for management have changed. Recent changes include recommendations against strict mental and physical rest after sustaining a concussion, a better recognition of preexisting conditions predisposing protracted concussion recovery, and the addition of preliminary patient counseling and education about the expected course of concussion recovery. Objective To assess the impact of changes in concussion management on the duration of symptoms in middle school and high school athletes after sustaining a first-time, sports-related concussion. Methods A retrospective review was performed of medical records of athletes who sustained a concussion between 2016 and 2018 and were treated by the same primary care physician (J.M.N) using the revised approach to concussion management described. Patients were included if they were 11 to 18 years old and had a diagnosis of first-time concussion sustained while playing organized sports. Athletes who sustained a concomitant injury or sustained a concussion outside of organized sports were excluded from the study; athletes lost to follow-up or with incomplete forms were also excluded. Each athlete’s length of symptomatic time from his or her concussion was calculated. This data was then compared with a previously-published data set of athletes who sustained a concussion between 2011 and 2013, with the same inclusion criteria but a different approach to concussion management. Results A total of 110 male and 72 female athletes (N=182) met the study’s eligibility criteria. Collectively, athletes of both sexes from the 2016–2018 data set reported a higher incidence of preexisting conditions associated with prolonged concussion recovery compared with the data set of 2011–2013 athletes. However, both sexes from the 2016–2018 data set also reported a shorter median duration of concussion symptoms compared with the 2011–2013 athletes (median duration 5 vs. 11 days for male athletes and 7 vs. 28 days for female athletes, respectively; p<0.001). Conclusion Recent changes in concussion management have led to decreased duration of symptoms among 11- to 18-year-old athletes with first-time, sports-related concussions. These management changes include advocating for early activity, recognizing preexisting conditions, and educating athletes about the realities of concussion recovery.

Systematic Review of Pre-injury Migraines as a Vulnerability Factor for Worse Outcome Following Sport-Related Concussion

“…Of the 25 studies, most ( k = 19, 76%) did not find that pre-injury migraines were a risk factor for a worse clinical outcome following a sport-related concussion, two studies (8%) had both negative and positive findings, and four studies (16%) had positive findings; of note, one study did not conduct statistical analyses, ( 33 ) but based on the raw data reported in the paper, we conducted chi-squared tests and the p -values were >0.05; this study was included as one of the 19 studies with null results. Across all studies, 24% ( k = 6/25) reported at least one result (e.g., symptom duration, time to return to play) showing an association between pre-injury migraine history and worse clinical outcome.…”

“…It is essential to appreciate that only one study was designed specifically to examine migraine as a risk factor ( 45 ). All other studies included migraine as a secondary or exploratory variable; some studies discussed their rationale for examining pre-injury migraines ( 10 , 20 , 34 – 37 , 41 – 43 , 46 ), while others did not ( 13 , 14 , 16 – 19 , 21 , 30 , 32 , 33 , 38 – 40 , 44 ). Most studies ( n = 19/25, 76%) did not find a statistically significant association between having pre-injury migraines and a prolonged recovery or worse clinical outcome following concussion, two studies had both significant and null findings, and four studies showed only significant findings.…”

A comparison of public views about sports concussion recovery with current guidelines: where are the gaps and overlaps?

“…Instead, after a period of short rest, some of the current guidelines recommend 'relative rest and exercise' for SC (Patricios et al 2023, p. 71) or 'active recovery' (Australian Institute of Sport 2023, p. 35). This form of recovery for SC is now known to benefit patients (Neidecker et al 2021). The idea of relative rest supports an ongoing break from high-risk activities and exercise (such as contact sports) while other activities and exercises are gradually resumed.…”