Predicting Recovery Patterns After Sport-Related Concussion

Abstract

Context: Clinicians sometimes treat concussed individuals who have amnesia, loss of consciousness (LOC), a concussion history, or certain symptom types more conservatively, but it is unclear whether recovery patterns differ in individuals with these characteristics. Objective: To determine whether (1) amnesia, LOC, and concussion history influence the acute recovery of symptoms, cognition, and balance; and (2) cognition and balance are influenced by acute symptom type. Design: Cohort study. Setting: Seven sports at 26 colleges and 210 high schools. Patients or Other Participants: A total of 8905 collegiate (n = 1392) and high school (n = 7513) athletes. Main Outcome Measure(s): The Graded Symptom Checklist, Standardized Assessment of Concussion, and Balance Error Scoring System were administered to all athletes during the preseason. To allow us to track recovery patterns, athletes diagnosed with a concussion (n = 375) repeated these assessments immediately after the injury, 3 hours postinjury, 1 day postinjury, and at 2, 3, 5, 7, and 90 days after injury. Results: Athletes who experienced amnesia had markedly greater deficits in and a slower recovery trajectory on measures of symptoms, cognition, and balance. Athletes with 2 or more prior concussions demonstrated poorer balance than those with no previous history. Otherwise, LOC and concussion history largely did not affect symptoms, cognition, or balance. Greater deficits in balance scores were observed in athletes with all symptom types. Regardless of these characteristics, most athletes recovered within 7 to 10 days. Conclusions: Athletes who experienced amnesia had more symptoms and greater deficits in cognition and balance. Symptoms and cognitive or balance deficits were not consistently associated with LOC or concussion history. Acute symptoms had a strong influence on balance scores and, to a lesser extent, on cognition. However, we found no evidence to support more cautious return-to-play decisions for athletes with these characteristics, as group recovery occurred within normal timelines. Our study supports current clinical practice: recommending that athletes be withheld from activity until they are asymptomatic, followed by a graduated return-to-play progression.

Research at the Point of Care: Using Electronic Medical Record Systems to Generate Clinically Meaningful Evidence

“…Because clinicians using an EMR have existing data, retrospective studies are recommended as a first step. One retrospective approach is a case-control study 31 (Figure 1 and Table 2), in which the goal is to establish a relationship between exposures (ie, intervention, characteristic, or experience 32 ) and an outcome. Another approach is the cross-sectional study design 33 (Figure 2 and Table 2), which compares multiple groups at 1 point in time.…”

“…Teel et al 31 recently investigated the effect of several acute variables on concussion-recovery patterns in collegiate and high school athletes. Variables were collected at baseline (eg, concussion history) or at initial injury evaluation (eg, amnesia, loss of consciousness) by an AT participating in the Concussion Prevention Initiative.…”

“…Variables were collected at baseline (eg, concussion history) or at initial injury evaluation (eg, amnesia, loss of consciousness) by an AT participating in the Concussion Prevention Initiative. 31 Patients were tracked for 90 days postinjury and their data were extracted from the Concussion Prevention Initiative database by the investigators. 31 This is an example of a study that could have been conducted with an EMR.…”

“…31 Patients were tracked for 90 days postinjury and their data were extracted from the Concussion Prevention Initiative database by the investigators. 31 This is an example of a study that could have been conducted with an EMR. To comply with current recommendations for best practice, 35 ATs should already be documenting such variables in their EMRs.…”

Post-concussion recovery in children and adolescents: A narrative review

“…The 2017 Berlin Consensus Statement supports removing athletes from sport or high-intensity cognitive activity in the acute period of one to two days post-injury, 2 which reflects initial recovery in motor coordination and balance. 26,42 The need to remove patients from activity has been supported by two recent prospective studies. An observational study of children and adolescents between 11 and 19 years of age found an association between the time lapse from injury to the beginning of physical and cognitive rest and the time taken to recovery, which was defined as academic activity at pre-concussion levels.…”