of postconcussion syndrome after sports-related concussion in young athletes: a
matched case-control study

Morgan CD, Zuckerman SL,
Lee YM, King L, Beaird S, Sills AK, Solomon GS. Journal of Neurosurgery:
Pediatrics. 2015. Doi: 10.3171/2014.10.PEDS14356 [Epub]

Home Message: Delayed onset of symptoms after sport-related concussion puts
young athletes at a 20.7 times greater risk for postconcussion syndrome.

The majority of
sports-related concussion (SRC) symptoms resolve within 1 week of the initial
injury; however, there is a group of individuals that remain symptomatic for
longer periods of time. These individuals are classified as having
postconcussion syndrome (PCS) with somatic, cognitive, sleep, and emotional
symptoms. Risk factors such as previous concussion, loss of consciousness, and
migraine headache have been identified as predictors of PCS; however, some of
these predictors have been disputed when high school and young adult
populations were studied. In this case-control study,
the authors set-out to identify which risk factors in young athletes (9-18 years)
predicted those who would experience PCS and those who would not, after SRC. They
retrospectively identified young athletes that sustained a SRC, diagnosed by an
athletic trainer or team physician. Individuals that reported symptoms for
greater than 3 months were classified as having PCS (40 patients), and control
subjects were those who sustained a concussion but had resolution of symptoms
in 3 weeks or less (80 patients who were age- and sex-matched). Variables of
interest included demographics; past medical, psychiatric and family history; and
acute (0-24 hours) and subacute (0-3 weeks) postconcussion symptoms. The
patient or health care provider also identified additional life stressors or
major life events that might interfere with concussion recovery. No difference
was found between those with PCS and controls for age, sex, sport of concussion,
race, body mass index, and type of health insurance. Loss of consciousness,
amnesia, learning disability, or use of a helmet was not predictive of PCS in
this young population. The authors found that patients with PCS were more
likely to have a previous concussion, history of mood disorders, history of
psychiatric illness, family history of mood disorders, or delayed symptom onset
compared with controls. However, a history of mood disorders (Relative Risk
17.9) and delayed onset of symptoms (Relative Risk 20.7) were the key variables
related with an increased risk for PCS.

The results of this study
bring to light potential risk factors for PCS in a young athletic population.
History of mood disorders or psychiatric illness among the athlete or family
members, as well as a history of concussion confirms what has been reported in
older athletic populations. What is concerning is the delayed onset of
concussive symptoms (> 3 hrs) within the PCS group. These individuals have a
20.7 times greater risk for developing PCS. Young athletes that experience a
significant hit during athletic competition and do not display concussive
symptoms may be cleared to return to the game. This puts the player at risk for
a second hit within a short period of time, which is a known risk factor for delayed
recovery. This is particularly concerning since we recently saw evidence that 29% of young athletes return to play on the same day as their injury.
This study reinforces position statements and guidelines that advocate that
athletes should not return to play the same day of a suspected concussion
because we may need to monitor the patient for an onset of symptoms several
hours after a suspected injury. Furthermore, this study should remind
clinicians that they need to know the psychiatric status of an athlete and
his/her family because it could affect performance on neurocognitive testing and risk for PCS.

for Discussion: Do you think our criteria to allow athletes to return to the
game after a suspected concussion should be more stringent? Do you think more
strict criteria would help identify those with delayed symptoms? Do you think
we should have different criteria for younger athletes (< 18 y/o)?

Written by: Kathleen Cummer
Reviewed by: Jeffrey

Related Posts:

Morgan, C., Zuckerman, S., Lee, Y., King, L., Beaird, S., Sills, A., & Solomon, G. (2015). Predictors of postconcussion syndrome after sports-related concussion in young athletes: a matched case-control study Journal of Neurosurgery: Pediatrics, 1-10 DOI: 10.3171/2014.10.PEDS14356