OBJECTIVE: Despite increases in education and awareness, many athletes continue to play with signs and symptoms of a sport-related concussion (SRC). The impact that continuing to play has on recovery is unknown. This study compared recovery time and related outcomes between athletes who were immediately removed from play and athletes who continued to play with an SRC. METHODS:A prospective, repeated measures design was used to compare neurocognitive performance, symptoms, and recovery time between 35 athletes (mean ± SD age, 15.61 ± 1.65 years) immediately removed after an SRC (REMOVED group) compared with 34 athletes (mean ± SD age, 15.35 ± 1.73 years) who continued to play (PLAYED group) with SRC. Neurocognitive and symptom data were obtained at baseline and at 1 to 7 days and 8 to 30 days after an SRC. RESULTS:The PLAYED group took longer to recover than the REMOVED group (44.4 ± 36.0 vs 22.0 ± 18.7 days; P = .003) and were 8.80 times more likely to demonstrate protracted recovery (≥21 days) (P < .001). Removal from play status was associated with the greatest risk of protracted recovery (adjusted odds ratio, 14.27; P = .001) compared with other predictors (eg, sex). The PLAYED group exhibited significantly worse neurocognitive and greater symptoms than the REMOVED group.CONCLUSIONS: SRC recovery time may be reduced if athletes are removed from participation. Immediate removal from play is the first step in mitigating prolonged SRC recovery, and these data support current consensus statements and management guidelines. Dr Elbin conceptualized and designed the study, conducted the analyses, interpreted the results, and drafted the initial manuscript; Dr Sufrinko coordinated data collection and management, assisted with data analysis and interpretation, and drafted the initial manuscript; Dr Schatz conducted statistical analyses and drafted the initial manuscript; Dr French assisted with data collection, statistical analysis and interpretation, and manuscript preparation; Dr Henry conceptualized and designed the study and drafted the initial manuscript; Dr Burkhart conceptualized and designed the study and interpreted the results; Dr. Collins interpreted the results and contributed to the manuscript; Dr Kontos conceptualized and designed the study, assisted with interpreting the results, and drafted the initial manuscript; and all authors approved the fi nal manuscript as submitted. DOI WHAT'S KNOWN ON THIS SUBJECT:Immediate removal from play is recommended for athletes with suspected concussion. The majority of concussions go unreported, and the catastrophic consequences of continuing to play with concussion are documented. The impact of removal from play on recovery outcomes is unknown. WHAT THIS STUDY ADDS:Athletes who were not removed from play took longer to recover and demonstrated worse neurocognitive and symptom outcomes after a sport-related concussion. Removal from play status is a new predictor for protracted recovery and supports consensus guidelines. 3,5,6 These guidelines are based on d...

Decreased neurocognitive performance in individuals with self-reported attention deficit hyperactivity disorder (ADHD) and learning disability (LD) is well documented in the neuropsychological research literature. Previous studies employing paper-and-pencil neurocognitive assessments report lower performance in individuals with ADHD and LD. The purpose of the current study was to examine the influence of a self-reported diagnosis of LD, ADHD, and combined LD/ADHD on baseline computerized neurocognitive testing (CNT) used for the concussion assessment. Results revealed athletes with a self-reported diagnosis of LD, ADHD, and/or combined LD/ADHD demonstrated lower performance on baseline CNT and reported larger numbers of symptoms than did control athletes without these diagnoses. These findings provide evidence for the development of separate normative data for athletes with LD, ADHD, and LD/ADHD diagnoses on CNT batteries commonly used for concussion management.

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The VOMS displayed a false-positive rate of 2% in this high school student-athlete cohort. The K-D test's false-positive rate was 36% while maintaining a high level of test-retest reliability (0.91). Results from this study support future investigation of VOMS administration in an acutely injured high school athletic sample. Going forward, the VOMS may be more stable than other neurological and symptom report screening measures and less vulnerable to false-positive results than the K-D test.