Risk factors for concussive symptoms 1 week or longer in high school athletes
Chrisman SP, Rivara FP, Schiff MA, Zhou C, Comstock RD. Brain Injury. 2013; 27(1): 1-9.
Most athletes’ concussive symptoms are alleviated within 1 week; however, some athletes’ concussive symptoms may last longer. If we could identify risk factors for concussive symptoms that persists for over 1 week then this could lead to better evidence-based return-to-play policies since we could apply more cautious restrictions on patients with those risk factors. The purpose of this study was to determine the risk factors for concussive symptoms that persist for over 1 week among high school athletes. Additionally, the authors wanted to determine whether risk factors were different for football compared to other sports. Researchers analyzed data from the National High School Sports-Related Injury Surveillance System Reporting Information Online from fall of 2006 to spring of 2009. This data included 1412 concussions from a nationally representative set of data from 100 different high schools. Athletic trainers were asked to report on concussion symptom duration categorically: <15 minutes, 15 to 29 minutes, 30 to 59 minutes, 1 to 11 hours, 12 to 23 hours, 1 to 3 days, 4 to 6 days, 1 week to 1 month, or >1 month. Health logs were obtained from a randomly selected 5% sample of reporting high schools to verify what they report on the surveillance system, and each year the data was considered very accurate. Most of the concussions occurred in football (58%). The next most common contributors were girls’ soccer (10%) and girls’ basketball (7%). Most athletes with concussions reported 4 or more symptoms at the time of injury (61%). Some athletes reported 3 symptoms (20%), but very few reported 2 (14%) or just 1 (5%) symptoms at the time of injury. Athletes presenting with 4 or more symptoms were 2 times more likely to have concussion symptoms ≥ 1 week in both football and non-football sports. Furthermore, athletes that reported feeling drowsy, nausea, or confusion with concentration difficulties at the time of the injury were more likely to have concussion symptoms ≥ 1 week in all sports. Concentration difficulties (without confusion) were associated with a 2.3-fold greater risk for concussion symptoms lasting ≥ 1 week in football players. Finally, sensitivity to both light and noise was associated with a 2.7-fold increase of risk for concussive symptoms lasting ≥ 1 week in non-football players but not in football players.
Researchers found that there are concussion symptoms at the time of an injury that may predict who is at risk for a longer duration of the symptoms (e.g., drowsiness, nausea). Interestingly, some risk factors were different for football players compared to non-football players. The authors also found that having 4 or more symptoms at the time of injury was associated with greater risk of symptoms lasting ≥ 1 week. However, this could be due to the severity of injury, where the more severe injury would seem to take longer time to recover. Some of the specific symptoms found to increase risk of a longer recovery of symptoms were drowsiness, difficulty concentrating, and sensitivity to light and noise. Drowsiness has been previously shown to be a predictive factor of a severe brain injury. Future research may want to investigate these symptoms further to confirm if they are truly predictive of longer recovery of symptoms because this could improve concussion guidelines and safety. What symptoms after a concussion have you suspected might predict who will have a slower recovery of symptoms? Why do you think there is a difference in concussion symptoms in football players compared to non-football players?
Written by: Jane McDevitt MS, ATC, CSCS
Reviewed by: Jeffrey Driban
Typical vs Prolonged Recovery Time and PredictorsFollowing Concussion in High School and College AthletesChrisman SP, Rivara FP, Schiff MA, Zhou C, & Comstock RD (2013). Risk factors for concussive symptoms 1 week or longer in high school athletes. Brain Injury, 27 (1), 1-9 PMID: 23252433