No significant difference in clinical outcomes, recovery in college athletes with concussion

Key takeaways:

• No significant differences were found in days to symptom resolution between groups.
• The findings should not diminish the importance of timely removal after concussion, researchers wrote.

No significant differences were found in clinical outcomes or recovery time in college athletes who returned to play following concussion compared with those immediately removed, according to research from Neurosurgical Focus.

"Underreporting of concussions has been linked to factors such as lack of knowledge about the injury and risks of continued play as well as fear of removal from play and of disappointing teammates or coaches,” Megan C. Loftin, MS, a graduate assistant in the department of kinesiology at Michigan State University, and colleagues wrote. “Yet athletes still delay reporting their symptoms and continue to play.”

Loftin and colleagues attempted to determine whether a return to play immediately following a concussion influenced clinical outcomes and recovery time in collegiate athletes within a clinical setting.

Their prospective, repeated-measures cohort study was conducted between October 2020 and February 2024, and included 93 individuals who sustained concussion (58.1% men; 65.6% white; those who continued to play, n = 37; those who were immediately removed, n = 56). All participants were aged 18 to 30 years, had to have completed their visit within 5 days of injury, and were not previously diagnosed with a moderate-to-severe traumatic brain injury or neurological disease. Return to play was assessed via simple yes or no responses, with those grouped in “continued to play” whether the return was immediate or not.

Full medical clearance (FMC; ± 3 days), assessed by a health care professional, was determined by the Sport Concussion Assessment Tool-5th edition (SCAT5), Vestibular/Ocular Motor Screening assessment and High-Level Mobility Assessment Tool.

Loftin and colleagues utilized Mann-Whitney U-tests to assess differences in clinical outcomes between groups and employed Cox proportional hazards regression models to examine relationships between factors associated with days to symptom resolution and days to FMC, while covariates — such as previous concussion history, total concussion symptoms at acute visit — were selected a priori based on previous literature.

The majority of study participants played football (34.4%), soccer (14%) or rugby (8.8%).

According to results, significant differences were found in SCAT5 concentration composite scores (P = 0.01) and SCAT5 delayed recall composite scores (P = 0.045) at the acute visit and near point of convergence average distance (cm; P = 0.005) at the FMC visit between the participants who continued to play and those who were immediately removed.

Data did not reveal any significant differences in days to symptom resolution (10 days vs. 7 days) or days to clearance (13 days vs. 11.5 days) between the “continue to play” group and “removal” group.

Additionally, no significant association between groups and days to symptom resolution (2[4] = 5.052, P = 0.282), or days to clearance (2[4] = 3.624, P = 0.459) were found when adjusting for covariates.

The researchers, however, posited that results of the analysis were influenced by study-specific differences such as sample size, care setting and timing of the acute visit.

“Our findings should not diminish the dangers of continued play and the importance of timely removal after concussion, but rather highlight the need for ongoing efforts to improve policies,” Loftin and colleagues wrote.