Research Reports - Age differences in recovery after sport-related concussion

J Athl Train. 2016 Feb;51(2):142-52. doi: 10.4085/1062-6050-51.4.04. Epub 2016
Mar 14.

Nelson LD(1), Guskiewicz KM(2), Barr WB(3), Hammeke TA(1), Randolph C(4), Ahn
KW(1), Wang Y(5), McCrea MA(1).

CONTEXT: Younger age has been hypothesized to be a risk factor for prolonged
recovery after sport-related concussion, yet few studies have directly evaluated
age differences in acute recovery.
OBJECTIVE: To compare clinical recovery patterns for high school and collegiate
DESIGN: Prospective cohort study.
SETTING: Large, multicenter prospective sample collected from 1999-2003 in a
sports medicine setting.
SUBJECTS: Concussed athletes (n = 621; 545 males and 76 females) and uninjured
controls (n = 150) participating in high school and collegiate contact and
collision sports (79% in football, 15.7% in soccer, and the remainder in lacrosse
or ice hockey).
MAIN OUTCOME MEASURE(S): Participants underwent evaluation of symptoms (Graded
Symptom Checklist), cognition (Standardized Assessment of Concussion,
paper-and-pencil neuropsychological tests), and postural stability (Balance Error
Scoring System). Athletes were evaluated preinjury and followed serially at
several time points after concussive injury: immediately, 3 hours postinjury, and
at days 1, 2, 3, 5, 7, and 45 or 90 (with neuropsychological measures
administered at baseline and 3 postinjury time points).
RESULTS: Comparisons of concussed high school and collegiate athletes with
uninjured controls suggested that high school athletes took 1 to 2 days longer to
recover on a cognitive (Standardized Assessment of Concussion) measure.
Comparisons with the control group on other measures (symptoms, balance) as well
as direct comparisons between concussed high school and collegiate samples
revealed no differences in the recovery courses between the high school and
collegiate groups on any measure. Group-level recovery occurred at or before 7
days postinjury on all assessment metrics.
CONCLUSIONS: The findings suggest no clinically significant age differences exist
in recovery after sport-related concussion, and therefore, separate
injury-management protocols are not needed for high school and collegiate

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