Sports Medicine Research: In the Lab & In the Field: A Delay Today with Removal for Play may lead to a Delay in Return to Play (Sports Med Res)

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Wednesday, May 2, 2018

A Delay Today with Removal for Play may lead to a Delay in Return to Play

Immediate Removal From Activity After Sport-Related Concussion Is Associated With Shorter Clinical Recovery and Less Severe Symptoms in Collegiate Student-Athletes

Asken BM, Bauer RM, Guskiewicz KM, McCrea MA, Schmidt JD, Giza CC, Snyder AR, Houck ZM, Kontos AP, McAllister TW, MD, Broglio SP, Clugston JR, The CARE Consortium Investigators, Anderson S, Bazarian J, Brooks A, Buckley T, EdD, Chrisman S, Collins M, DiFiori J, Duma S, Dykhuizen B, Eckner JT, Feigenbaum L, Hoy A, Kelly L, Langford T.D, Lintner L,  McGinty G, Mihalik J, Miles C,Ortega J, Port N, Putukian M, Rowson S. Am J Sport Med. 2018. [Epub Ahead of Print].

Take Home Message: An athlete immediately removed from activity after a concussion was more likely to have a faster recovery in symptoms and return to play than someone who had a delay in removal from play.

Athletes who delay reporting a concussion often have longer recovery periods. However, many of these studies were limited by a having too few people or relying on retrospective data. Therefore, the authors prospectively examined the relationship between timing of removal from athletic activity and sport time lost due to sports-related concussion and performance on acute clinical measures in 506 collegiate athletes. The authors obtained data on 506 sports-related concussions sustained between August 2014 to September 2016 from the Concussion Assessment, Research, and Education (CARE) Consortium. The concussions occurred during 18 different sports at 22 different institutions (62% male). Immediate or delayed removal from play was determined via two questions that the clinicians answered: “Did the athlete immediately report the injury?” and “Was the athlete immediately removed from play?” Athletes were placed into immediate removal if a clinician reported “yes” for both questions. All other responses led to an athlete being classified as a delayed removal. Additional factors that were analyzed were clinical assessment (SCAT3, BESS) and sport participation. Overall, 64% of this cohort had a delayed removal. The delayed removal group had a higher mean time lost (~15 days vs ~12 days) and longer duration of concussion symptoms (~7 days vs ~4 days), compared with the immediate removal group. Furthermore, immediate removal was associated with 39% lower chance of missing 2 or more weeks and 47% lower chance of missing 3 or more weeks than those with a delayed removal. This is despite a larger percentage of immediate removal athletes reported loss of consciousness or altered consciousness.  

The authors found that an athlete who was immediately removed from play after a concussion was likely to lose less playing time and experience shorter duration of concussion signs and symptoms. It was interesting to note that athletes in the immediate removal groups had a greater percentage of loss of consciousness and altered consciousness. These symptoms may have prompted these athletes to report the concussion. However, this group still returned to play quicker and reported fewer days of concussion symptomology. Therefore, this suggests that though loss of consciousness and altered consciousness are typically associated with a more severe concussion if removed immediately from play the brain may have an easier time recovering. It also should be noted that there were a lot of cases that were unable to be analyzed due to insufficient data. Still, this research suggests that one of the most critical components of concussion care is immediately removing an athlete from participation. Medical professionals should educate athlete, coaches, and parents on the potential positives such as quicker return to play and less time suffering with concussion signs and symptom when an athlete is immediately removed from play.

Questions for Discussion: How do you educate your athletes on the importance of reporting possible concussion injuries? Do you find that athletes that delay in reporting his/her injury take a longer time to recover?

Written by: Jane McDevitt
Reviewed by: Jeffrey Driban

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