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Incidence, Clinical Course, and Predictors of Prolonged Recovery Time Following Sport-Related Concussion in High School and College Athletes

Published online by Cambridge University Press:  12 October 2012


Michael McCrea
Affiliation:
Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
Kevin Guskiewicz
Affiliation:
Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Orthopedics; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Christopher Randolph
Affiliation:
Department of Neurology, Loyola University Medical School, Maywood, Illinois
William B. Barr
Affiliation:
Departments of Neurology and Psychiatry, New York University School of Medicine, New York, New York
Thomas A. Hammeke
Affiliation:
Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Stephen W. Marshall
Affiliation:
Department of Orthopedics; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Matthew R. Powell
Affiliation:
Department of Neuropsychology, Marshfield Clinic – Minocqua Center, Minocqua, Wisconsin
Kwang Woo Ahn
Affiliation:
Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
Yanzhi Wang
Affiliation:
Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
James P. Kelly
Affiliation:
U.S. Department of Defense, National Intrepid Center of Excellence, Bethesda, Maryland
Corresponding
E-mail address:

Abstract

Sport-related concussion (SRC) is typically followed by clinical recovery within days, but reports of prolonged symptoms are common. We investigated the incidence of prolonged recovery in a large cohort (n = 18,531) of athlete seasons over a 10-year period. A total of 570 athletes with concussion (3.1%) and 166 controls who underwent pre-injury baseline assessments of symptoms, neurocognitive functioning and balance were re-assessed immediately, 3 hr, and 1, 2, 3, 5, 7, and 45 or 90 days after concussion. Concussed athletes were stratified into typical (within 7 days) or prolonged (> 7 days) recovery groups based on symptom recovery time. Ten percent of athletes (n = 57) had a prolonged symptom recovery, which was also associated with lengthier recovery on neurocognitive testing (p < .001). At 45–90 days post-injury, the prolonged recovery group reported elevated symptoms, without deficits on cognitive or balance testing. Prolonged recovery was associated with unconsciousness [odds ratio (OR), 4.15; 95% confidence interval (CI) 2.12–8.15], posttraumatic amnesia (OR, 1.81; 95% CI, 1.00–3.28), and more severe acute symptoms (p < .0001). These results suggest that a small percentage of athletes may experience symptoms and functional impairments beyond the typical window of recovery after SRC, and that prolonged recovery is associated with acute indicators of more severe injury. (JINS, 2012, 18, 1–12)


Type
Research Articles
Copyright
Copyright © The International Neuropsychological Society 2012

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References

Bakhos, L.L., Lockhart, G.R., Myers, R., Linakis, J.G. (2010). Emergency department visits for concussion in young child athletes. Pediatrics, 126(3), e550e556.CrossRefGoogle ScholarPubMed
Barr, W.B., McCrea, M. (2001). Sensitivity and specificity of standardized neurocognitive testing immediately following sports concussion. Journal of the International Neuropsychological Society, 7(6), 693702.CrossRefGoogle ScholarPubMed
Belanger, H.G., Vanderploeg, R.D. (2005). The neuropsychological impact of sports-related concussion: A meta-analysis. Journal of the International Neuropsychological Society, 11(4), 345357.CrossRefGoogle ScholarPubMed
Broglio, S.P., Puetz, T.W. (2008). The effect of sport concussion on neurocognitive function, self-report symptoms and postural control: A meta-analysis. Sports Medicine, 38(1), 5367.CrossRefGoogle ScholarPubMed
Collins, M.W., Grindel, S.H., Lovell, M.R., Dede, D.E., Moser, D.J., Phalin, B.R., McKeag, D.B. (1999). Relationship between concussion and neuropsychological performance in college football players. Journal of the American Medical Association, 282(10), 964970.CrossRefGoogle ScholarPubMed
DeKosky, S.T., Ikonomovic, M.D., Gandy, S. (2010). Traumatic brain injury--Football, warfare, and long-term effects. New England Journal of Medicine, 363(14), 12931296.CrossRefGoogle ScholarPubMed
Field, M., Collins, M.W., Lovell, M.R., Maroon, J. (2003). Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. Journal of Pediatrics, 142(5), 546553.CrossRefGoogle ScholarPubMed
Guskiewicz, K.M. (2003). Assessment of postural stability following sport-related concussion. Current Sports Medicine Reports, 2(1), 2430.CrossRefGoogle ScholarPubMed
Guskiewicz, K.M., McCrea, M., Marshall, S.W., Cantu, R.C., Randolph, C., Barr, W., Kelly, J.P. (2003). Cumulative effects associated with recurrent concussion in collegiate football players: The NCAA Concussion Study. Journal of the American Medical Association, 290(19), 25492555.CrossRefGoogle ScholarPubMed
Guskiewicz, K.M., Weaver, N.L., Padua, D.A., Garrett, W.E. Jr (2000). Epidemiology of concussion in collegiate and high school football players. American Journal of Sports Medicine, 28(5), 643650.CrossRefGoogle ScholarPubMed
Halstead, M.E., Walter, K.D. (2010). American Academy of Pediatrics. Clinical report--Sport-related concussion in children and adolescents. Pediatrics, 126(3), 597615.CrossRefGoogle Scholar
Kelly, J.P. (1999). Traumatic brain injury and concussion in sports. Journal of the American Medical Association, 282(10), 989991.CrossRefGoogle ScholarPubMed
Kelly, J.P., Rosenberg, J.H. (1997). Diagnosis and management of concussion in sports. Neurology, 48(3), 575580.CrossRefGoogle ScholarPubMed
Langlois, J.A., Rutland-Brown, W., Wald, M.M. (2006). The epidemiology and impact of traumatic brain injury: A brief overview. Journal of Head Trauma Rehabilitation, 21(5), 375378.CrossRefGoogle ScholarPubMed
Lau, B., Lovell, M., Collins, M.W., Pardini, J. (2009). Neurocognitive and symptom predictors of recovery in high school athletes. Clinical Journal of Sport Medicine, 19(3), 216221.CrossRefGoogle ScholarPubMed
Lau, B.C., Collins, M.W., Lovell, M.R. (2012). Cutoff scores in neurocognitive testing and symptom clusters that predict protracted recovery from concussions in high school athletes. Neurosurgery, 70(2), 371379.CrossRefGoogle ScholarPubMed
Lovell, M.R., Collins, M.W., Iverson, G.L., Field, M., Maroon, J.C., Cantu, R., Fu, F.H. (2003). Recovery from mild concussion in high school athletes. Journal of Neurosurgery, 98(2), 296301.CrossRefGoogle ScholarPubMed
Macciocchi, S.N., Barth, J.T., Alves, W., Rimel, R.W., Jane, J.A. (1996). Neuropsychological functioning and recovery after mild head injury in collegiate athletes. Neurosurgery, 39(3), 510514.CrossRefGoogle ScholarPubMed
Makdissi, M., Darby, D., Maruff, P., Ugoni, A., Brukner, P., McCrory, P.R. (2010). Natural history of concussion in sport: Markers of severity and implications for management. American Journal of Sports Medicine, 38(3), 464471.CrossRefGoogle ScholarPubMed
McCrea, M. (2001). Standardized mental status testing on the sideline after sport-related concussion. Journal of Athletic Training, 36(3), 274279.Google ScholarPubMed
McCrea, M., Barr, W.B., Guskiewicz, K., Randolph, C., Marshall, S.W., Cantu, R., Kelly, J.P. (2005). Standard regression-based methods for measuring recovery after sport-related concussion. Journal of the International Neuropsychological Society, 11(1), 5869.CrossRefGoogle ScholarPubMed
McCrea, M., Guskiewicz, K.M., Marshall, S.W., Barr, W., Randolph, C., Cantu, R.C., Kelly, J.P. (2003). Acute effects and recovery time following concussion in collegiate football players: The NCAA Concussion Study. Journal of the American Medical Association, 290(19), 25562563.CrossRefGoogle ScholarPubMed
McCrory, P., Johnston, K., Meeuwisse, W., Aubry, M., Cantu, R., Dvorak, J., Schamasch, P. (2005). Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. British Journal of Sports Medicine, 39(4), 196204.CrossRefGoogle ScholarPubMed
McCrory, P., Meeuwisse, W., Johnston, K., Dvorak, J., Aubry, M., Molloy, M., Cantu, R. (2009). Consensus statement on concussion in sport: The 3rd International Conference on Concussion in Sport held in Zurich, November 2008. British Journal of Sports Medicine, 43(Suppl 1), i76i90.CrossRefGoogle ScholarPubMed
Nonfatal traumatic brain injuries from sports and recreation activities--United States, 200 1-2005 (2007). MMWR. Morbidity and Mortality Weekly Report, 56(29), 733737.Google Scholar
Powell, J.W., Barber-Foss, K.D. (1999). Traumatic brain injury in high school athletes. Journal of the American Medical Association, 282(10), 958963.CrossRefGoogle ScholarPubMed
Practice parameter: The management of concussion in sports (summary statement). Report of the Quality Standards Subcommittee. (1997). Neurology, 48(3), 581–585.Google Scholar
Rubin, D.B. (1987). Multiple imputation for nonresponse in surveys. New York: Wiley.CrossRefGoogle Scholar
Thurman, D.J., Branche, C.M., Sniezek, J.E. (1998). The epidemiology of sports-related traumatic brain injuries in the United States: Recent developments. Journal of Head Trauma Rehabilitation, 13(2), 18.Google ScholarPubMed
Yeates, K.O., Kaizar, E., Rusin, J., Bangert, B., Dietrich, A., Nuss, K., Taylor, G. (2012). Reliable change in postconcussive symptoms and its functional consequences among children with mild traumatic brain injury. Archives of Pediatrics and Adolescent Medicine, Online First E1E8.Google ScholarPubMed

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Incidence, Clinical Course, and Predictors of Prolonged Recovery Time Following Sport-Related Concussion in High School and College Athletes
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