Frequency and Outcomes of a Symptom-Free Waiting Period After Sport-Related Concussion

Pfaller, Adam Y.; Nelson, Lindsay D.; Apps, Jennifer Niskala; McCrea, Michael

doi:10.1177/0363546516651821

Cited by 24 publications

(24 citation statements)

References 27 publications

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“…In contrast, only 5% of concussed players in CARE recovered within the first day, and nearly half of CARE athletes reported symptoms for more than 1 week after injury. Although our study does not allow us to directly determine the impact of specific educational initiatives targeted at college athletes during the 15-year interval between the NCAA Study and CARE,20 these findings further suggest that current-day athletes may be more aware of concussion symptoms and more likely to report their injury 26–28…”

Section: Discussionmentioning

confidence: 80%

Return to play and risk of repeat concussion in collegiate football players: comparative analysis from the NCAA Concussion Study (1999–2001) and CARE Consortium (2014–2017)

et al. 2019

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ObjectiveWe compared data from the National Collegiate Athletic Association (NCAA) Concussion Study (1999–2001) and the NCAA-Department of Defense Concussion Assessment, Research and Education (CARE) Consortium (2014–2017) to examine how clinical management, return to play (RTP) and risk of repeat concussion in collegiate football players have changed over the past 15 years.MethodsWe analysed data on reported duration of symptoms, symptom-free waiting period (SFWP), RTP and occurrence of within-season repeat concussion in collegiate football players with diagnosed concussion from the NCAA Study (n=184) and CARE (n=701).ResultsCARE athletes had significantly longer symptom duration (CARE median=5.92 days, IQR=3.02–9.98 days; NCAA median=2.00 days, IQR=1.00–4.00 days), SFWP (CARE median=6.00 days, IQR=3.49–9.00 days; NCAA median=0.98 days, IQR=0.00–4.00 days) and RTP (CARE median=12.23 days, IQR=8.04–18.92 days; NCAA median=3.00 days, IQR=1.00–8.00 days) than NCAA Study athletes (all p<0.0001). In CARE, there was only one case of repeat concussion within 10 days of initial injury (3.7% of within-season repeat concussions), whereas 92% of repeat concussions occurred within 10 days in the NCAA Study (p<0.001). The average interval between first and repeat concussion in CARE was 56.41 days, compared with 5.59 days in the NCAA Study (M difference=50.82 days; 95% CI 38.37 to 63.27; p<0.0001).ConclusionOur findings indicate that concussion in collegiate football is managed more conservatively than 15 years ago. These changes in clinical management appear to have reduced the risk of repetitive concussion during the critical period of cerebral vulnerability after sport-related concussion (SRC). These data support international guidelines recommending additional time for brain recovery before athletes RTP after SRC.

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Section: Discussionmentioning

confidence: 80%

Return to play and risk of repeat concussion in collegiate football players: comparative analysis from the NCAA Concussion Study (1999–2001) and CARE Consortium (2014–2017)

et al. 2019

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“…Many researchers have examined total time loss, [4][5][6][7][19][20][21][22] yet distinct but related processes contribute to concussion recovery. Authors [4][5][6][7][19][20][21][22] assessing total time loss have evaluated the effects of predictors on symptom and RTAprotocol durations. This method of analysis may wash out the effects that are present in only the symptomatic and RTA-protocol periods.…”

Section: Discussionmentioning

confidence: 99%

“…If symptoms reemerge, the clinician reduces the athlete's physical exertion, and the protocol extends until the athlete can complete the prescribed physical activity without symptoms. 1 To date, most researchers [4][5][6][7] have investigated factors related to total time loss without assessing the 2 recovery subcomponents individually. Moreover, to our knowledge, no authors have examined factors associated with the duration of the RTA protocol.…”

mentioning

confidence: 99%

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

Pelt

Allred

Brodeur

et al. 2020

Journal of Athletic Training

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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.

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“…For most injured adult athletes, cognitive deficits, balance and symptoms improve rapidly during the first 2 weeks following injury . Some authors have suggested that the longer recovery times reported in more recent studies in part are due to changes in the medical management of concussion, with adoption of the gradual return to play recommendations from the Concussion in Sport Group statements . This topic was the subject of a recent detailed systematic review .…”

Section: Clinical Management In the Acute Stage Of Sports‐related Conmentioning

confidence: 99%

Treatments and rehabilitation in the acute and chronic state of traumatic brain injury

et al. 2019

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Traumatic brain injury (TBI) is a major cause of acquired disability globally, and effective treatment methods are scarce. Lately, there has been increasing recognition of the devastating impact of TBI resulting from sports and other recreational activities, ranging from primarily sport‐related concussions (SRC) but also more severe brain injuries requiring hospitalization. There are currently no established treatments for the underlying pathophysiology in TBI and while neuro‐rehabilitation efforts are promising, there are currently is a lack of consensus regarding rehabilitation following TBI of any severity. In this narrative review, we highlight short‐ and long‐term consequences of SRCs, and how the sideline management of these patients should be performed. We also cover the basic concepts of neuro‐critical care management for more severely brain‐injured patients with a focus on brain oedema and the necessity of improving intracranial conditions in terms of substrate delivery in order to facilitate recovery and improve outcome. Further, following the acute phase, promising new approaches to rehabilitation are covered for both patients with severe TBI and athletes suffering from SRC. These highlight the need for co‐ordinated interdisciplinary rehabilitation, with a special focus on cognition, in order to promote recovery after TBI.

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Frequency and Outcomes of a Symptom-Free Waiting Period After Sport-Related Concussion

Cited by 24 publications

References 27 publications

Return to play and risk of repeat concussion in collegiate football players: comparative analysis from the NCAA Concussion Study (1999–2001) and CARE Consortium (2014–2017)

Return to play and risk of repeat concussion in collegiate football players: comparative analysis from the NCAA Concussion Study (1999–2001) and CARE Consortium (2014–2017)

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

Treatments and rehabilitation in the acute and chronic state of traumatic brain injury

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