“Play through it”: Delayed reporting and removal from athletic activity after concussion predicts prolonged recovery

Asken BM, McCrea MA, Clugston JR, Snyder AR, Houck ZM, and Bauer RM. J Ahtl Training. 2016. 51(4): 329-335.
Full Text Freely Available

Take Home Message: Athletes who immediately stopped activity and reported symptoms of a concussion typically missed fewer days before returning to activity than athletes who delayed reporting such symptoms.

Despite increased awareness about concussions and their consequences, some athletes fail to report their concussive symptoms to a medical professional and continue to participate in sport. To date, no one has evaluated the consequences of continuing to play after a concussion on recovery time. Therefore, Asken and colleagues completed a retrospective study to examine the association between delayed reporting and removal from athletic activity on concussion recovery time. Researchers reviewed medical records of 97 athletes diagnosed with a sports-related concussion. They extracted data pertaining to learning disabilities, psychological disorders, concussion history, and symptoms. Overall, 47 athletes were removed from activity immediately following a concussive event while 50 athletes delayed reporting their symptoms. The researchers found that athletes who were not immediately removed from activity were more likely to have a delayed recovery period (approximately 5 days longer) than those athletes who were immediately removed from sport. The athletes who failed to immediately report their symptoms and continued to play were also more than twice as likely to need more than a week before returning to play.

Overall, these results help clinicians by providing evidence that immediately reporting concussion symptoms may be associated with less time missed due to a concussion. While not part of this study, it is believed that some athletes do not report symptoms for fear of not being able to participate; however, the current study suggests that not reporting symptoms may result in more time being missed. One reasonable explanation for these results is that athletes who withhold reporting their symptoms may actually be exposing themselves to more head impacts, which may result in a more severe injury. One note of caution, however is that all data in the current study were ascertained via medical records and thus are subject to human error and bias. Further, not all athletes were assessed by the same clinicians or with the same assessment tools. To better understand the impact of delayed reporting of concussions, future studies should attempt to track athletes prospectively, which would allow researchers to standardize the assessment component much more clearly. Until this can be done, however, this study should be used by clinicians as an educational tool for athletes to encourage timely and honest reporting of all concussion-like symptoms.

Questions for Discussion: What do you currently do to encourage your athletes to self-report concussions? Do you feel these approaches have been successful? Why or why not?

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

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Asken BM, McCrea MA, Clugston JR, Snyder AR, Houck ZM, & Bauer RM (2016). “Playing Through It”: Delayed Reporting and Removal From Athletic Activity After Concussion Predicts Prolonged Recovery. Journal of Athletic Training, 51 (4), 329-35 PMID: 27111584