Faculty Collaboration Database

"Playing Through It": Delayed Reporting and Removal From Athletic Activity After Concussion Predicts Prolonged Recovery. J Athl Train 2016 Apr;51(4):329-35

Date

04/26/2016

Pubmed ID

27111584

Pubmed Central ID

PMC4874376

DOI

10.4085/1062-6050-51.5.02

Scopus ID

2-s2.0-84975113458 (requires institutional sign-in at Scopus site)   211 Citations

Abstract

CONTEXT: Preclinical research has demonstrated a window of vulnerability in the immediate aftermath of concussion wherein continued activity and stimulation can impair or prolong neurobehavioral recovery. However, this concept has not been quantified in a human population.

OBJECTIVE: To examine the effect of delayed reporting and removal from athletic activity after concussion on recovery time.

DESIGN: Cross-sectional study.

SETTING: A National Collegiate Athletic Association Division I university.

PATIENTS OR OTHER PARTICIPANTS: Ninety-seven athletes who sustained a sport-related concussion between 2008 and 2015 were analyzed (age = 20.4 ± 1.3 years). Athletes were grouped as immediate removal from activity (I-RFA) or delayed removal from activity (D-RFA).

MAIN OUTCOME MEASURE(S): Days missed was defined as the number of days between the concussion-causing event and clearance for return to contact. Associations between RFA group and prolonged (8 or more days') versus normal (7 or fewer days') recovery were also analyzed.

RESULTS: Fifty (51.5%) of the 97 athletes did not immediately report concussion symptoms. The D-RFA athletes averaged 4.9 more days missed than the I-RFA athletes. Membership in the specific RFA group predicted days missed even after controlling for sex, concussion history, learning disability or attention-deficit/hyperactivity disorder diagnosis, diagnosed psychological disorder, and acute symptom severity (R( 2) change = 0.097, β = .319, P = .002). The D-RFA athletes were approximately 2.2 times more likely to have a prolonged recovery (8 or more days) compared with the I-RFA athletes (χ(2) = 10.268, P = .001, ϕ = 0.325).

CONCLUSIONS: Athletes who do not immediately report symptoms of a concussion and continue to participate in athletic activity are at risk for longer recoveries than athletes who immediately report symptoms and are immediately removed from activity. Continuing to participate in athletic activity during the immediate aftermath of a concussion potentially exposes the already injured brain to compounded neuropathophysiologic processes.

Author List

Asken BM, McCrea MA, Clugston JR, Snyder AR, Houck ZM, Bauer RM

Author

Michael McCrea PhD Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Athletes
Athletic Injuries
Brain Concussion
Cross-Sectional Studies
Delayed Diagnosis
Female
Humans
Male
Neuropsychological Tests
Recovery of Function
Retrospective Studies
Return to Sport
Universities
Young Adult