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Incidence, Clinical Course, and Predictors of Prolonged Recovery Time Following Sport-Related Concussion in High School and College Athletes

Published online by Cambridge University Press:  12 October 2012

Michael McCrea ,
Kevin Guskiewicz ,
Christopher Randolph ,
William B. Barr ,
Thomas A. Hammeke ,
Stephen W. Marshall ,
Matthew R. Powell ,
Kwang Woo Ahn ,
Yanzhi Wang  and
James P. Kelly
Michael McCrea*
Affiliation:
Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
Kevin Guskiewicz
Affiliation:
Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Orthopedics; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Christopher Randolph
Affiliation:
Department of Neurology, Loyola University Medical School, Maywood, Illinois
William B. Barr
Affiliation:
Departments of Neurology and Psychiatry, New York University School of Medicine, New York, New York
Thomas A. Hammeke
Affiliation:
Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Stephen W. Marshall
Affiliation:
Department of Orthopedics; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Matthew R. Powell
Affiliation:
Department of Neuropsychology, Marshfield Clinic – Minocqua Center, Minocqua, Wisconsin
Kwang Woo Ahn
Affiliation:
Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
Yanzhi Wang
Affiliation:
Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
James P. Kelly
Affiliation:
U.S. Department of Defense, National Intrepid Center of Excellence, Bethesda, Maryland
*
Correspondence and reprint requests to: Michael McCrea, Department of Neurosurgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226. E-mail: mmccrea@mcw.edu
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Abstract

Sport-related concussion (SRC) is typically followed by clinical recovery within days, but reports of prolonged symptoms are common. We investigated the incidence of prolonged recovery in a large cohort (n = 18,531) of athlete seasons over a 10-year period. A total of 570 athletes with concussion (3.1%) and 166 controls who underwent pre-injury baseline assessments of symptoms, neurocognitive functioning and balance were re-assessed immediately, 3 hr, and 1, 2, 3, 5, 7, and 45 or 90 days after concussion. Concussed athletes were stratified into typical (within 7 days) or prolonged (> 7 days) recovery groups based on symptom recovery time. Ten percent of athletes (n = 57) had a prolonged symptom recovery, which was also associated with lengthier recovery on neurocognitive testing (p < .001). At 45–90 days post-injury, the prolonged recovery group reported elevated symptoms, without deficits on cognitive or balance testing. Prolonged recovery was associated with unconsciousness [odds ratio (OR), 4.15; 95% confidence interval (CI) 2.12–8.15], posttraumatic amnesia (OR, 1.81; 95% CI, 1.00–3.28), and more severe acute symptoms (p < .0001). These results suggest that a small percentage of athletes may experience symptoms and functional impairments beyond the typical window of recovery after SRC, and that prolonged recovery is associated with acute indicators of more severe injury. (JINS, 2012, 18, 1–12)

Keywords

Brain injuryConcussionNeuropsychological testsSport injuriesNeurological disordersClosed head injury
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 19 , Issue 1 , January 2013 , pp. 22 - 33
Copyright
Copyright © The International Neuropsychological Society 2012

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