Abstract
Background & Objectives: Some athletes experience a slow recovery after sport-related concussion (SRC). There is little agreement on what constitutes slow recovery, however, and minimal data on the prevalence, predictors, or prognosis for this group. The objectives were to apply an operationalized definition of slow recovery and characterize predictors and long-term prognosis of these individuals.
Methods: This is a prospective multi-site observational study of collegiate athletes. Participants underwent multimodal assessments preseason and five additional timepoints following SRC. Time from injury to initiation of return to play progression (asymptomatic timepoint), and from injury to return to play (RTP) were the primary markers of recovery.
Results: 1,751 concussed male and female collegiate athletes were studied. 80% of participants reached the asymptomatic and/or RTP timepoints by days 14 and 24, respectively. Slow recovery was thus defined as exceeding one or both of those intervals (n=399). This group was significantly more likely to be female (41.1% versus 35.6%, p=0.05), have higher initial post-injury SCAT symptom severity scores (mean [SD]: 36.6 [23.4] versus 25.4 [19.9], p<0.01), lower post-injury SAC scores (mean [SD]:25.74 [2.98] versus 26.26 [2.85], p=0.004), perform worse on the post-injury BESS (mean [SD]: 17.8 [8.9] versus 15.9 [8.5], p<0.01), have fewer assessments in the first 14 days after injury (mean [SD]: 48.8 [29.7] versus 67.9 [24.6], p<0.01), and be injured in practice (70.7% versus 65.1%, p=0.04). 77.6% of the slow recovery group returned to play within 60 days of injury, and 83.4% (n=349) returned to play within 90 days of injury. Only 10.6% had not returned to play 6 months postinjury.
Discussion: This study suggests an overall favorable prognosis for slowly recovering athletes and provides data for athletes and medical teams to consider in calibrating return to play expectations, and making decisions about medical disqualification versus ongoing engagement in their sport.
- Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.
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