The Natural History of Postconcussion Recovery Among High School Athletes

Abstract

Objective: Evaluate postconcussive symptom reporting and recovery. Setting: Public high school. Participants: Unmatched controls (n = 760); students who sustained a sports-related concussion (n = 77); matched controls (gender, grade, sport) (n = 77). Design: Prospective longitudinal cohort study. Outcome measure: Immediate Postconcussion Assessment and Cognitive Testing. Results: At baseline, athletes who went on to sustain concussions were more likely than unmatched controls to be younger (P = .02), male (P = .001), and participate in different sports (P < .0001) such as football (concussed = 52%, unmatched controls = 20%). Differences were also noted regarding a previous history of concussion (P = .045; concussed athletes = 26%; unmatched control athletes = 16%) and lifetime number of concussions (P = .05). At baseline, those whose sustained concussions during the study period were more likely than matched controls to report numbness (P = .01) and concentration problems (P = .01) and more likely than unmatched controls to report dizziness (P = .02), sensitivity to light (P = .01), sensitivity to noise (P = .002), and numbness (P = .02). However, when data were reanalyzed and those with a previous history of concussion were removed, differences between those who sustained concussions during the study period and matched controls were no longer significant; when compared to unmatched controls, sensitivity to light (P = .01) and vision problems (P = .04) remained significant. Among those who sustained concussions, median time to recovery was 6 days (95% confidence interval: 4-9), and 71 out of 77 (92%) recovered by the fourth postinjury evaluation (median: 20 days postinjury). Conclusions: Course and time frame of recovery were variable. Data also suggest that a previous history of concussion may be contributing to baseline symptom reporting and highlight the potential enduring impact of history of concussion on sensorimotor function. However, further research as to whether preinjury measures of sensorimotor function may increase understanding regarding concussion risk is warranted.

Risk and recovery among high school athletes who sustained at least one sports-related concussion

“…Our findings indicate that those who sustained one SRC during the study period had similar concussion histories compared with those who sustained multiple SRCs. There is high-quality evidence indicating that past concussion increases risk for future concussion [7,9]; however, these findings typically emerge from prospective studies simply comparing those who were concussed during the study period to the nonconcussed. Further, these findings are often derived using samples from medical settings, which may be comprised of patients who experience atypically severe injuries [6].…”

“…Complete details of the study design can be found in the original study [9]. Briefly, this was a prospective longitudinal study that investigated pre and post-injury Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) performance over a 3-year study period.…”

“…A SRC was defined as "a blow to the head, followed by altered mental status, as assessed by the athletic trainer present at the sports event or corroborated by the student athletic trainer (under the supervision of the athletic trainer)" [9].…”

“…Mixed evidence concerning factors associated with concussion risk and recovery may be explained by methodological limitations. For example, investigations of SRC that are relevant to HS athletes contain significant methodological limitations [8], including retrospective designs and studies conducted in medical settings [9].…”

“…Dise-Lewis et al [9] advanced our understanding of risk for and recovery from SRC in HS athletes, while avoiding the above methodological limitations. The present study is a secondary analysis of their prospective longitudinal study of HS athletes.…”