Immediate Removal From Activity After Sport-Related Concussion Is Associated With Shorter Clinical Recovery and Less Severe Symptoms in Collegiate Student-Athletes

Asken, Breton M; Bauer, Russell M.; Guskiewicz, Kevin M.; McCrea, Michael; Schmidt, Julianne D.; Giza, Christopher C.; Snyder, Aliyah; Houck, Zachary M; Kontos, Anthony P.; McAllister, Thomas W.; Broglio, Steven P.; Clugston, James R.; Anderson, Scott; Bazarian, Jeff; Brooks, Alison; Buckley, Thomas A.; Chrisman, Sara P D; Collins, Michael W.; DiFiori, John P.; Duma, Stefan M.; Dykhuizen, Brian H; Eckner, James T.; Feigenbaum, Luis A.; Hoy, April; Kelly, Louise A.; Langford, T Dianne; Lintner, Laura; McGinty, Gerald; Mihalik, Jason P.; Miles, Christopher M.; Ortega, Justus D.; Port, Nicholas; Putukian, Margot; Rowson, Steven; Svoboda, Steven J.

doi:10.1177/0363546518757984

Cited by 130 publications

(97 citation statements)

References 50 publications

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“…9,19,28 If the play is continued there is a risk of additional injuries, as well as a delayed recovery. 7,29 In our present study, almost one third of players continued to play following a concussion. In addition, a subset of players had a shorter time from concussion to game play than recommended by the graduated return-to-play protocol.…”

supporting

confidence: 43%

“…If player symptoms, clinical observations and findings on examination suggest an SRC, initiation of a return‐to‐play protocol is mandated that includes 24‐48 hours of “brain rest” followed by a stepwise escalation of activity during a minimum of approximately 5 days . If the play is continued there is a risk of additional injuries, as well as a delayed recovery . In our present study, almost one third of players continued to play following a concussion.…”

Section: Discussionmentioning

confidence: 62%

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Concussion incidence and recovery in Swedish elite soccer — Prolonged recovery in female players

Vedung

Hänni

Tegner

et al. 2020

Scandinavian Med Sci Sports

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Objectives Sport‐related concussions are an increasingly recognized health problem. Soccer is the most popular sport in the world although recent studies on concussion incidence are scarce. Here, a nationwide prospective study on concussion incidence, symptom severity, risk factors, gender differences, and return‐to‐play after concussion was performed in 51 Swedish elite soccer teams during the 2017 season. Methods In the 1st and 2nd soccer leagues for men and women, a Sport Concussion Assessment Tool (SCAT)‐based questionnaire study was performed at preseason (baseline) and from 48 hours to 3 months post‐concussion. Results We followed 959 players (389 women, 570 men) for 25 146 player game hours (9867 hours for women, 15 279 hours for men). Concussion incidence (n = 36 concussions during the season) was 1.19/1000 player game hours (females 1.22/1000 hours, males 1.18/1000 hours; P = .85). Twenty‐seven percent of all players (8% of females, 40% of males) continued to play immediately after the concussion. When compared to male players, female players had worse initial symptom severity scores (median and IQR 30 (17‐50.5) vs 11 (4‐26.25), P = .02) on SCAT and longer return‐to‐play (P = .02). Risk factors for concussion were baseline symptoms and previous concussion. Conclusion In Swedish elite soccer, the concussion incidence was 1.19/1000 without gender differences. Most players recovered to play within 4 weeks post‐injury. Almost one third of players continued to play at time of concussion. Female players had worse initial symptoms and longer return‐to‐play time than males, and a prolonged recovery beyond 3 months was only observed among female players.

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supporting

confidence: 43%

Section: Discussionmentioning

confidence: 62%

Concussion incidence and recovery in Swedish elite soccer — Prolonged recovery in female players

Vedung

Hänni

Tegner

et al. 2020

Scandinavian Med Sci Sports

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“…In instances where an athlete has sustained an injury that is sufficient to cause a concussion but results in DSO, there is a similar risk that the athlete will remain in play or be returned to play in an asymptomatic state which may be associated with increased vulnerability to additional injury and could lead to more severe or prolonged symptoms as well as more severe forms of traumatic brain injury (3,4). In a recent study of collegiate athletes, Asken et al (13) found that those athletes who were immediately removed from their sporting activity reported less severe initial concussion symptoms, experienced a shorter duration of symptoms, and were at lower risk of taking >14 and >21 days to recovery from their injury. Among this cohort, 36% reported experiencing DSO (no standardized definition of delayed symptoms was provided).…”

Section: Discussionmentioning

confidence: 99%

“…Although previous studies have examined clinical outcomes among athletes who continued to play despite a symptomatic sport-related concussion (SRC) (8,9), little research attention has been paid to athletes who experience delayed symptom onset (DSO) and may be at risk of additional injury during continued sport participation (10)(11)(12). One prospective study among collegiate athletes found that athletes who underwent delayed removal from play were more likely to have reported DSO (13). To date, no prospective studies have examined the prevalence of DSO among children and adolescents with acute SRC and its effect on clinical outcomes and athlete sideline management.…”

Section: Introductionmentioning

confidence: 99%

Delayed Symptom Onset Following Pediatric Sport-Related Concussion

et al. 2020

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Objective: (1) To examine the prevalence of delayed symptom onset (DSO) among pediatric sport-related concussion (SRC) patients as well as the effect of symptom onset on initial symptom severity, length of recovery, and development of delayed recovery; (2) to evaluate the impact of symptom onset on sideline management. Methods: We conducted a prospective study of pediatric SRC patients (<20 years of age) evaluated at a multidisciplinary concussion program. Patients underwent initial medical assessment by a single neurosurgeon and a structured interview by a research assistant. Patients were classified as experiencing early symptom onset (symptom onset <15 min from the time of the suspected injury; ESO) or DSO (≥15 min from the time of the suspected injury).

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“…Furthermore, the players with concussions were identified from public sources, and it is likely that this approach, although previously used by multiple authors, did not detect all concussive events, as underreporting or delayed reporting of concussion is well established. [33][34][35] Our primary purpose was to examine the effect of concussion on player performance. Because of uneven positional distributions and oversampling of data, the effect of position was not explored, but no theoretical rationale in the literature suggests that position would be a key confounding variable in performance after concussion.…”

Section: Discussionmentioning

confidence: 99%

Concussion and National Hockey League Player Performance: An Advanced Hockey Metrics Analysis

Buckley

Bryk

Pelt

et al. 2019

Journal of Athletic Training

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Context: Postconcussion deficits in neurocognitive performance and postural control may persist at the time of return to sport participation. How these deficits, if present, affect athletic performance is largely unknown, with prior studies showing mixed results.Objective: To evaluate postconcussion National Hockey League player performance using advanced hockey metrics over short-(5 games), medium-(10 games), and long-term (remainder of the season) seasonal performance.Design: Retrospective cohort study. Patients or Other Participants: National Hockey League players who sustained a sport-related concussion (SRC; n ¼ 93) and returned during the same season and players (n ¼ 51) who missed time for non-injury-related reasons.Main Outcome Measure(s): Six performance metrics were used: (1) points per 60 minutes, (2) Corsi percentage, (3) personal Fenwick shooting percentage, (4) scoring chances per 60 minutes, (5) penalty difference, and (6) PDO (not an acronym but sometimes referred to as SVSP% [save percentage shooting percentage]). Performance was compared using 2 (group) 3 2 (time) repeated-measures analyses of variance for 3 time windows: (1) 65 games, (2) 610 games, and (3) the remainder of the season postconcussion. Alpha values were set at a conservative .01 to account for the lack of independence among dependent variables.Results: No significant interactions were present for any of the 6 dependent variables at any of the 3 time windows. Overall, none of the secondary variables differed.Conclusions: Using advanced, sport-specific metrics, we found that National Hockey League players did not display worse seasonal performance during 3 postinjury time frames after they sustained an SRC. Whereas laboratory studies have identified lingering neurologic deficits after concussion, our results suggest that these deficits, if present, either do not translate to worse athletic performance or were not captured by these 44 metrics. Further, prospective efforts are needed to accurately quantify performance after SRC among professional hockey players.

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Immediate Removal From Activity After Sport-Related Concussion Is Associated With Shorter Clinical Recovery and Less Severe Symptoms in Collegiate Student-Athletes

Abstract: I-RFA is a protective factor associated with less severe acute symptoms and shorter recovery after SRC. Conveying this message to athletes, coaches, and others involved in the care of athletes may promote timely injury reporting.

Cited by 130 publications

References 50 publications

Concussion incidence and recovery in Swedish elite soccer — Prolonged recovery in female players

Concussion incidence and recovery in Swedish elite soccer — Prolonged recovery in female players

Delayed Symptom Onset Following Pediatric Sport-Related Concussion

Concussion and National Hockey League Player Performance: An Advanced Hockey Metrics Analysis

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