Return to Sport Following Adolescent Concussion: Epidemiologic Findings From a High School Population

Abstract

High school athletes sustaining a concussion require careful attention when determining return-to-sport (RTS) readiness. The purpose of this study was to determine epidemiological and RTS data of a large cohort of high school athletes who sustained 1 or more concussions. Records of 357 consecutive youth patients who sustained concussions and presented to a single health care system between September 2013 and December 2016 were reviewed. Demographic data, RTS, and concussion-related variables were obtained via chart review. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) scores at baseline and following concussions were performed by neuropsychologists. The average age at injury was 15.5 years (range, 14–18 years), 61.9% of patients were male, 6.7% reported a loss of consciousness, and 14.3% reported amnesia, requiring 30.4±23.3 days of recovery prior to RTS. The most common sport of injury was football (27.7%). There was a high incidence of previous concussion (33.1%), and 32 athletes sustained a recurrent concussion. A multivariate model demonstrated that females, players with a history of concussion, and those diagnosed in-clinic rather than in-game required increased time to RTS. Memory ImPACT scores were found to increase as players had recurrent concussions. Visual motor speed and reaction time scores decreased with recurrent concussions. [ Orthopedics . 2020;43(4):e306–e310.]

Sports-Related Concussion Affects Cognitive Function in Adolescents: A Systematic Review and Meta-analysis

“…These results were not in line with some previous studies. 65,111,121 Data from our study also coincide with a narrative interview study which found that adolescent athletes who had sustained 2 to 9 concussions experienced continuing difficulty with cognitive, emotional, social, and mental well-being at 1 to 5 years after treatment and did not feel “recovered” after their clinical assessment of “good to go.” 27 Adolescent players with a concussion history need increased time to return to play, 67 in line with our finding advising more cautious return-to-play decisions in adolescents after SRC. Our results emphasize the need for SRC-specific guidelines to protect adolescents from multiple SRCs.…”

“…52,59,77 Surprisingly, some studies found that memory score increased with recurrent concussions. 67…”

“…5,38,117,129 Nonetheless, 1 study reported higher scores for verbal memory and visual memory in participants who had experienced 1 or 2 concussions, compared with baseline, but lower scores for processing speed and reaction in adolescents who experienced multiple concussions when compared with nonconcussed peers. 67…”

“…52,59,77 Surprisingly, some studies found that memory score increased with recurrent concussions. 67 3. What factors are associated with the observed changes in cognitive functioning after SRC?…”

“…5,38,117,129 Nonetheless, 1 study reported higher scores for verbal memory and visual memory in participants who had experienced 1 or 2 concussions, compared with baseline, but lower scores for processing speed and reaction in adolescents who experienced multiple concussions when compared with nonconcussed peers. 67 Additional factors modulate the relationship between SRC and cognitive function. The age at which an individual has one's first concussion may be an important factor in determining long-lasting cognitive effects.…”