Sport-related concussion (SRC) may take longer to recover than previously thought

It is often said that the majority of cases of SRC recover predictably within 7 to 10 days of injury. This prospective cohort study, from one of our FIFA Medical Centres of Excellence and published in this month’s edition of the CJSM, challenges this commonly held belief1.

This week’s FastFact highlights a prospective cohort study of 574 patients who presented following an SRC. The patients had a mean age of 20.2 years and were primarily male (77%). For analysis the patients were grouped into three age cohorts: children (12 years or under), adolescents (13-18 years) and adults (over 18 years of age). Patients in this cohort received a standardised clinical assessment and treatment regime. Clinical recovery was defined as having:

• A SCAT5 symptom score and symptom severity score of less than 5 (for males) and 6 (for females)
• Resolution of any previous abnormal clinical examination findings
• Normal exercise tolerance (defined as being asymptomatic when exercising at 85% to 90% of predicted heart rate) or return to the participants’ usual pre-injury exercise levels).

While the majority of players in this cohort recovered spontaneously, only forty-five percent of participants showed clinical recovery within 14 days of injury. This finding is at odds with what is widely reported by the concussion in sport group (CISG) in their Consensus Statements. This number rose to 77% by 4 weeks after injury and to 96% by 8 weeks after their injury. Another interesting finding was that there was no significant difference in recovery time between the three different age groups. Prolonged recovery was however more common in females (P = 0.001), participants with “concussion modifiers” (P = 0.001), and with increased time between injury and the initial appointment (P = 0.003).

The rate of recovery documented in this study is slower than described in previous CISG and other position statements. It is only at 28 days post-injury that recovery is comparable with the rates quoted in these publications. The current study’s authors argue that this likely reflects the relatively poor data available on clinical recovery and suggest that their data may more accurately represent that true rate of recovery following SRC. The results also suggest that the recovery timeline for SRC is similar irrespective of age. It is possible that the current data may more accurately also more closely represent the true recovery trajectory, given that all participants, regardless of age or level of sport, followed a standardized treatment protocol across groups.

To learn more about SRC complete the concussion module in the FIFA Diploma in Football Medicine.

Reference
1.Kara S, Crosswell H, Forch K et al. Less Than Half of Patients Recover Within 2 Weeks of Injury After a Sports-Related Mild Traumatic Brain Injury. A 2-Year Prospective Study. Clinical Journal of Sport Medicine: March 2020 – Volume 30 – Issue 2 – p 96-101

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Dr Aniemena-George Chidi Chinenye
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Dr Aniemena-George Chidi Chinenye

There has always been the practical need for SRC, not to be considered trival, but this to a larger extent has been kept in the dark.

After players suffer concussion, less emphasis are made on the standadised return to play time and criteria, rather the unopposed need for players especially elite ones, to return play as soon as possible, irrespective of their safety and well-being is the other of the day.

‘THERE IS NOTHING LIKE IT IS JUST A CONCUSSION’. I applaud this latest study.

bangoura
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bangoura

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