Time-to-Event Analyses: Return to Unrestricted Participation After Sport-Related Concussion in a Cohort of High School Athletes

Abstract

Context Understanding time loss resulting from sport-related concussion (SRC) within individual sports allows high school athletic trainers to provide accurate and evidence-based clinical information. Currently, research regarding patterns of clinical recovery outcomes in high school student-athletes across sports is lacking. Objective To describe the time to authorized unrestricted return to participation (RTP) after SRC in a large cohort of high school student-athletes in a variety of sports using a time-to-event analysis. Design Descriptive epidemiology study. Setting Aggregate injury and player exposure data from the Michigan High School Athletic Association Head Injury Reporting System. Patients or Other Participants High school student-athletes. Main Outcome Measure(s) Dates for SRC injury events and authorized unrestricted RTP were entered into the Head Injury Reporting System for each case and were used to calculate time to unrestricted RTP. Survival analysis indicated the time to authorized RTP for males and females in weekly increments across sports and academic years. Separate Kaplan-Meier analyses adjusted for SRC cases with a history of concussion also identified the proportions of student-athletes who obtained authorized medical clearance in weekly increments. Results A total of 15 821 SRCs, 10 375 (65.6%) in males and 5446 (34.4%) in females, were reported during the 2015–2016 through 2018–2019 academic years. The median time to authorized unrestricted RTP was 11 days for all patients. Approximately 30% of concussed student-athletes were not cleared for unrestricted RTP by 14 days after their SRC diagnosis, with 13% taking longer than 21 days to return to unrestricted RTP after SRC. Conclusions The results from this multisite, state-based injury surveillance system indicated that it is not abnormal for high school student-athletes to take longer than 14 days to fully recover from an SRC. This information may be useful for educating high school student-athletes and sport stakeholders, normalizing SRC recovery trajectory perceptions, and establishing realistic RTP timeline expectations.

Acute Sport-Related Concussion Management and Return to Sport Time in High School Athletes

“…39 Previous work in the high school setting demonstrated that approximately 13% of athletes with SRC took >3 weeks to RTS. 12 Thus, we dichotomized return as RTS ≤21 days and RTS >21 days to enable a sample size that would demonstrate longer recovery in this setting.…”

Sport-related concussion disclosure in women's rugby—A social identity approach

“…15-1.49]. This may have implications for SRC management as, while many players who sustain an SRC are reported to recover within 1 month of injury, between 6% and 28% report symptoms that persist beyond this timeframe (26)(27)(28).…”

The Role of Level of Play in Concussions in High School Athletes

“…Data from the 2017 national Youth Risk Behavior Survey indicate that, overall, 15.1% (estimated number of 2.5 million) of high school students self-reported 1 or more sports- and physical activity–related concussions during the previous 12 months of the survey and 6.0% (estimated number of 1 million) reported 2 or more concussions 11. In addition, a large, state-based injury surveillance system among high school athletes found that the median number of days for unrestricted return to play (RTP) was 11 days, with 71.8% taking more than 7 days to return and 13.1% taking longer than 21 days to return after being diagnosed for a sports-related concussion 12. Thus, identifying factors associated with risk for more severe outcomes due to sports-related concussions is important, given the increased concern about high school sports concussion, especially as participation in high school sports continues to increase 13…”

“…11 In addition, a large, state-based injury surveillance system among high school athletes found that the median number of days for unrestricted return to play (RTP) was 11 days, with 71.8% taking more than 7 days to return and 13.1% taking longer than 21 days to return after being diagnosed for a sports-related concussion. 12 Thus, identifying factors associated with risk for more severe outcomes due to sports-related concussions is important, given the increased concern about high school sports concussion, especially as participation in high school sports continues to increase. 13 Current national surveillance methods for TBI (including mild TBIs/concussions) in the United States are largely based on health care administration data, such as emergency department visits and hospitalizations.…”