Concussion-Recovery Trajectories Among Tactical Athletes: Results From the CARE Consortium

Abstract

Context Assessments of the duration of concussion recovery have primarily been limited to sport-related concussions and male contact sports. Furthermore, whereas durations of symptoms and return-to-activity (RTA) protocols encompass total recovery, the trajectory of each duration has not been examined separately. Objective To identify individual (eg, demographics, medical history), initial concussion injury (eg, symptoms), and external factors (eg, site) associated with symptom duration and RTA-protocol duration after concussion. Design Cohort study. Setting Three US military service academies. Patients or Other Participants A total of 10 604 cadets at participating US military service academies enrolled in the study and completed a baseline evaluation and up to 5 postinjury evaluations. A total of 726 cadets (451 men, 275 women) sustained concussions during the study period. Main Outcome Measure(s) Number of days from injury (1) until the participant became asymptomatic and (2) to complete the RTA protocol. Results Varsity athlete cadets took less time than nonvarsity cadets to become asymptomatic (hazard ratio [HR] = 1.75, 95% confidence interval = 1.38, 2.23). Cadets who reported less symptom severity on the Sport Concussion Assessment Tool, third edition (SCAT3), within 48 hours of concussion had 1.45 to 3.77 times shorter symptom recovery durations than those with more symptom severity. Similar to symptom duration, varsity status was associated with s shorter RTA-protocol duration (HR = 1.74, 95% confidence interval = 1.34, 2.25), and less symptom severity on the SCAT3 was associated with a shorter RTA-protocol duration (HR range = 1.31 to 1.47). The academy that the cadet attended was associated with the RTA-protocol duration (P < .05). Conclusions The initial total number of symptoms reported and varsity athlete status were strongly associated with symptom and RTA-protocol durations. These findings suggested that external (varsity status and academy) and injury (symptom burden) factors influenced the time until RTA.

Progress and Future Directions of the NCAA-DoD Concussion Assessment, Research, and Education (CARE) Consortium and Mind Matters Challenge at the US Service Academies

“…The duration of symptoms exceeded 1 month for a small portion (15%) of the cohort (33). This analysis also yielded that different intrinsic and acute injury characteristics contribute to both symptom duration and return to activity protocol durations (33). Among all concussions, male sex, varsity status, and low initial symptom burden were found to be associated with significantly shorter recovery timelines (33).…”

“…This analysis also yielded that different intrinsic and acute injury characteristics contribute to both symptom duration and return to activity protocol durations (33). Among all concussions, male sex, varsity status, and low initial symptom burden were found to be associated with significantly shorter recovery timelines (33). However, acute symptom burden was the most consistent and robust predictor of recovery time with endorsement of more than 11 symptoms, indicating longer recovery periods (33).…”

“…Among all concussions, male sex, varsity status, and low initial symptom burden were found to be associated with significantly shorter recovery timelines (33). However, acute symptom burden was the most consistent and robust predictor of recovery time with endorsement of more than 11 symptoms, indicating longer recovery periods (33). Return-to-play timelines in USAFA cadets (mean time of 29.4 days) have also exceeded the commonly cited recovery window of 10 to 14 days (34,35).…”

“…Additional Service Academy-specific publications have focused on describing the frequency of delayed reporting (31), characterizing factors that may influence concussion risk (32), and describing concussion recovery trajectories (33,34). In a cohort of roughly 300 concussed cadets, 51% failed to immediately report their injury (31).…”

“…Furthermore, freshman cadets were at an eight times (OR = 8.17; 95% CI = 5.87-11.37) greater risk of academy training-related (i.e., physical education, military training, boxing) concussion compared to non-freshman (32). In a separate analysis, this concussed cohort was also used to describe concussion recovery trajectories (33). The most significant finding was that duration of symptoms alone extends beyond the typical 14-day recovery window (35).…”