Initial symptom burden predicts duration of symptoms after concussion

Meehan, William P.; O’Brien, Michael J.; Geminiani, Ellen; Mannix, Rebekah

doi:10.1016/j.jsams.2015.12.002

Cited by 64 publications

(42 citation statements)

References 25 publications

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“…This is consistent with prior studies suggesting that LOC is not consistently associated with worse outcomes after a concussion and is often associated, perhaps surprisingly, with better outcomes. 3 , 4 , 14 , 19 – 21 , 27 , 28 While it is unclear why LOC might be associated with better outcomes after a concussion, it is possible that athletes with obvious on-field LOC are more likely to be removed from play and begin a treatment protocol right away. Thus, athletes with LOC may avoid recurrent collisions during the immediate vulnerable period.…”

Section: Discussionmentioning

confidence: 99%

Sport-Related Concussions: Symptom Recurrence After Return to Exercise

O’Brien

Howell

Pepin

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Current guidelines dictate a gradual exercise progression after a concussion; however, it is unclear what proportion of athletes experience a recurrence of symptoms once they are symptom free at rest. Estimating the proportion of athletes and predictors of symptom recurrence would help shape return-to-play protocols.Purpose:To determine the proportion and associated risk factors of athletes who have a recurrence of concussion symptoms with exercise after being symptom free at rest.Study Design:Case-control study; Level of evidence, 3.Methods:Between October 1, 2009 and July 31, 2011, we studied patients from a sport concussion clinic located within a tertiary care regional children’s hospital. Patients were queried at every visit using a standardized questionnaire. Our main outcome variable was recurrence of symptoms with exercise after being symptom free at rest at some point in their recovery. Cofactors included age, sex, loss of consciousness with injury, prior concussion (diagnosed and undiagnosed), Post-Concussion Symptom Scale (PCSS) score, time until clinical presentation, and duration of symptoms.Results:Of the 217 patients included, 25 (12%) experienced a return of symptoms. Losing consciousness at the time of injury and a longer duration between injury and clinical presentation were associated with a decreased risk of symptoms recurring with exercise. Conversely, athletes who had sustained previously undiagnosed concussions and had suffered a longer duration of symptoms at rest were at an increased risk of symptom recurrence with exercise.Conclusion:Relatively few athletes who are symptom free at rest after a concussion will have a recurrence of symptoms when they resume exercise. The risk of symptoms recurring with exercise may be greater among those athletes who sustained previously undiagnosed concussions and had a longer period of symptoms at rest. The early identification of athletes who may be at risk of symptom recurrence will help mold treatment guidelines and exercise progression protocols.

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Section: Discussionmentioning

confidence: 99%

Sport-Related Concussions: Symptom Recurrence After Return to Exercise

O’Brien

Howell

Pepin

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…Concussion symptoms typically resolve within 7 to 10 days after injury, 9 but a significant percentage of adults who presented to a specialty concussion clinic had symptoms beyond 30 days. 10 In addition, SRCs have also been associated with an increase in subsequent symptoms of depression [11][12][13] and deficits in health-related quality of life (HRQoL). 14,15 Many of the studies that demonstrated disablement associated with SRCs enrolled participants from specialized medical settings or those who experienced severe or prolonged symptoms.…”

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confidence: 99%

A Prospective Study of Concussions and Health Outcomes in High School Football Players

McGuine

Pfaller²,

Hetzel

et al. 2020

Journal of Athletic Training

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Context Football is the most popular sport among US high school students and among the highest for sport-related concussion (SRC) incidence. Limited data detail how SRCs affect high school football players' psychosocial and health status beyond short-term injury recovery. Objective To longitudinally assess how SRCs affected symptoms, depression, and health-related quality of life (HRQoL) in high school football players up to 12 months after SRC. Design Prospective cohort study. Setting Thirty-one Wisconsin high schools. Patients or Other Participants A total of 176 interscholastic football players (age = 16.0 ± 1.2 years). Main Outcome Measure(s) Participants completed the Postconcussion Symptom Scale (PCSS) from the Sport Concussion Assessment Tool 3 (SCAT3), Patient Health Questionnaire-9 (PHQ-9) for depression, and Pediatric Quality of Life Inventory 4.0 (PedsQL) for HRQoL at enrollment. Participants who sustained an SRC repeated each measure within 72 hours of their injury (onset) and at 7 days (D7), return to play (RTP), 3 months (M3), 6 months (M6), and 12 months (M12) after SRC. Scores at each time point were compared with each participant's baseline using linear mixed models for repeated measures whilecontrolling for age and previous SRC with participant as a random effect. Results Sixty-two participants sustained an SRC. Participants reported a higher number of PCSS symptoms, greater symptom severity, and lower PedsQL physical summary scores at onset and D7. From RTP through M12, PCSS symptoms, PCSS severity scores, PedsQL total scores, physical summary, and psychosocial summary were unchanged or improved relative to baseline. The PHQ-9 scores were not higher than baseline at any post-SRC interval. Conclusions High school football players in this study who sustained an SRC described no sustained adverse health outcomes (increased PCSS symptoms or symptom severity, increased depression symptoms, or lower HRQoL) after their RTP through M12 after injury.

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“…In the same study, those with ≥ 4 errors on the Balance Error Scoring System (BESS) and symptoms including headache, noise sensitivity, and fatigue on the Post-Concussion Symptom Scale (PCSS) experienced prolonged recoveries [7]. Higher initial symptoms on the PCSS [5,8] -specif-…”

Section: Introductionmentioning

confidence: 94%

Symptom Presentation After Concussion and Pre-existing Anxiety Among Youth Athletes

et al. 2020

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Our purpose was to evaluate the effect of self-reported pre-injury anxiety diagnosis on persistent symptom development, vestibular symptom severity, and balance control among youth who sustained a concussion. We performed a retrospective study of patients seen at a specialty pediatric concussion clinic. Patients were 18 years of age or younger, examined within 10 days of concussion, and received care until full recovery. A questionnaire was used to assess pre-existing medical and psychiatric conditions, including anxiety. Our main outcomes were prolonged symptom recovery defined as persistent symptoms for > 28 days after concussion) and severity of vestibular symptoms. Patients who reported pre-injury anxiety (n=43; median age=14.9 years; 37% female) were more likely to experience symptoms>28 days post-injury (76 vs. 54%; p=0.04) than those without pre-existing anxiety (n=241; median age=14.9 years; 53% female). After adjusting for sex, history of migraine, depression and ADHD, however, there was no independent association between pre-existing anxiety and prolonged symptom duration (adjusted odds ratio=2.34; 95% CI=0.083–6.63; p=0.11). Pre-existing anxiety was independently associated with self-reported nausea/vomiting severity (β coefficient=0.59, 95% CI=0.07–1.11). A pre-existing anxiety diagnosis does not appear to be associated with persistent symptoms after concussion, although it may be associated with post-injury nausea.

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Initial symptom burden predicts duration of symptoms after concussion

Cited by 64 publications

References 25 publications

Sport-Related Concussions: Symptom Recurrence After Return to Exercise

Sport-Related Concussions: Symptom Recurrence After Return to Exercise

A Prospective Study of Concussions and Health Outcomes in High School Football Players

Symptom Presentation After Concussion and Pre-existing Anxiety Among Youth Athletes

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