Research Reports - Predicting recovery patterns after sport-related concussion

J Athl Train. 2017 Mar;52(3):288-298. doi: 10.4085/1062-6050-52.1.12.

Teel EF(1), Marshall SW(2,)(3), Shankar V(4), McCrea M, Guskiewicz KM(1,)(2).

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. 

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