Removal from play after concussion and recovery time
Elbin RJ, Sufrinko A, Schatz P, French J, Henry L, Burkhart S, Collins MW, Kontos AP. Pediatrics. 2016; 138(3):e20160910 [Epub ahead of print]
Take Home Message: An athlete who is removed from play after a concussion is more likely to have a shorter recovery time than an athlete who continues to play.
Despite the educational efforts, 50 to 70% of sports-related concussions (SRC) remain underreported or undetected due to factors such as sports culture and/or lack of education or access to quality medical care. To educate our athletes it is imperative to understand the consequences of staying in the game after a SRC. Therefore, Elbin and colleagues compared neurocognitive performance, symptoms, and overall recovery time between athletes who sustained a SRC and were removed from play and athletes who continued to play. The researchers recruited 69 athletes (35 removed from play, 34 continued to play; age 12-19 years) who completed Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) to measure neurocognitive deficits after a SRC. Athletes also had baseline (pre-injury) ImPACT scores. Hence, each athlete had ImPACT scores pre-injury, 1 to 7 days post injury, and 8 to 30 days post injury. The researchers defined recovery as the total number of days from the date of injury until receiving full return-to-play medical clearance. Most of the athletes played American football or soccer. The researchers found that the group who continued to play after a SRC scored worse than the athletes who were removed in verbal and visual memory, processing speed, and reaction time, particularly during the first week after injury. Furthermore, except for reaction time, these deficits lingered for up to 30 days within the group that continued to play compared with those who were removed. The group who continued to play had greater symptoms when compared to the removed group. The researchers noted that 80% of the athletes who remained in play had a protracted recovery time (≥ 21 days), or on average twice the length of time, than the athletes who were removed from play.
This study provides important information regarding neurocognitive performance and recovery after a SRC. The research highlights how critical healthcare professionals are as educators in this matter. Education efforts are ongoing; parents, coaches, and athletes may still not report symptoms to healthcare providers. Parents, coaches, and athletes need to be aware of the risks associated with continuing to play through SRC symptoms as athletes run the risk of lengthier recovery time and/or permanent damage if they continue. The researchers admit that the recruitment of athletes from a specialty clinic hindered the study because they excluded athletes who are unable to receive specialty treatment, and the athletes included a large quantity of American football and female soccer players in a small sample size, which limits the generalizability of the findings. However, it is reassuring that these findings complement another study we recently described on Sports Med Res that found that athletes who immediately stopped activity and reported symptoms of a concussion typically returned to activity sooner than athletes who delayed reporting such symptoms. These findings can, and should, be used by on-the-field healthcare providers as a way to underscore the importance of SRC detection, awareness, and reporting.
Questions for Discussion: How often do you see your athletes, coaches, or parents downplay sports-related concussions? What methods do you use to maximize reporting of SRC symptoms in your practice?
Written by: Catherine E. Lewis
Reviewed by: Jeffrey Driban
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Elbin RJ, Sufrinko A, Schatz P, French J, Henry L, Burkhart S, Collins MW, & Kontos AP (2016). Removal From Play After Concussion and Recovery Time. Pediatrics, 138 (3) PMID: 27573089