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

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

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

Written by: Jane McDevitt
Reviewed by: Jeffrey Driban

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