Post-injury outcomes following non-sport related concussion: A CARE Consortium Study.
Roby PR, Mozel AE, Arbogast KB, Buckley T, Caccese JB, Chrisman SP, Clugston JR, Eckner JT, Esopenko C, Hunt T, Kelly LA, McDevitt J, Perkins SM, Putukian M, Susmarski A, Broglio SP, Pasquina PF, McAllister TW, McCrea M, Master CL; CARE Consortium Investigators. J Athl Train. 2023 Sep 8. doi: 10.4085/1062-6050-0181.23. Epub ahead of print. PMID: 37681681.
Athletes who sustain a non-sport-related concussion compared to a sport-related concussion are more likely to delay reporting, take longer to return to play, and have more symptoms.
Most concussions are unrelated to sport, yet most research on concussions includes only sport-related concussions. When non-sport-related concussions are reported in the literature, the participants come from either a concussion specialty clinic or emergency department, possibly biasing the population to those with more severe injuries or longer recoveries.
The authors examined reporting characteristics and clinical outcomes of non-sport-related concussions among collegiate athletes.
The authors used data from the NCAA-DOD CARE Consortium. They grouped participants based on the mechanism of their concussion: sport-related or non-sport-related. The authors analyzed only a person’s first concussion. Demographic information, injury information, and outcomes include but are not limited to age, sex, race, ethnicity, sport, concussion history, the clinician who made the initial diagnosis, timing of reporting, delayed symptom onset, and a graded symptom checklist. The authors also analyzed recovery outcomes that included symptom duration, the provider who cleared the patient, and if the patient experienced a slow recovery, which was defined as ≥14 days to asymptomatic or ≥24 days to unrestricted return to play.
The authors were able to analyze 3,500 people who sustained a concussion, 555 of which were non-sport related. Females sustained more than twice the number (23% vs. 10%) of non-sport-related concussions than males. The most frequent mechanisms of non-sport-related concussions were falls, slips, or trips (28%), struck by an object (26%), motor vehicle crashes (20%), and unintentional contact with another person (9%). Patients who sustained a non-sport-related concussion were less likely to report it immediately. They were 4 times more likely to require hospital transport, had a greater symptom severity, longer duration of symptoms, and more days lost to injury. Athletes with a non-sports-related concussion were 1.5 times more likely to experience a slow recovery and more likely to be diagnosed and cleared by a primary care physician than those with a sport-related concussion.
Providers must consider that patients who sustain a non-sport-related concussion are more likely to delay reporting, have a higher symptom burden, and take longer to recover. Athletic trainers need to appreciate the unique challenges a patient with a non-sport related concussion experiences to provide the same level of high-quality care.
Sports medicine personnel can serve as resources and advocates for education and referrals for patients who sustain a non-sport-related concussion. It is also important to stress to athletes the importance of promptly reporting all concussions, regardless of whether they occurred in sport.
Written by Mitch Barnhart
Reviewed by Jeffrey Driban