Early concussion care yielded faster recovery vs late care
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Published results showed athletes who presented for clinical care within the first week of concussion injury experienced faster recovery compared with athletes who had delayed care postinjury.
Anthony P. Kontos , PhD, and colleagues categorized 162 athletes aged 12 to 22 years with diagnosed, symptomatic concussion into groups based on whether they received treatment within 7 days of injury (early group; n=98) or between 8 and 20 days of injury (late group; n=64). Researchers considered recovery time to be the main outcome and collected demographic factors, medical history and injury information. Researchers also measured concussion symptom severity, neurocognitive performance, and vestibular and ocular symptoms and impairment using the post-concussion symptom scale, the immediate post-concussion assessment and cognitive testing computerized test, and the vestibular/ocular motor screening tool, respectively.
Results showed similar symptom severity, cognitive, ocular and vestibular outcomes at the first clinical visit between the early and late groups. Patients in the late group had a 5.8-times increased likelihood of recovery longer than 30 days, according to results of the logistical regression. Researchers also found an association between a visual motion sensitivity score of more than 2 points with a 4.5-times increased likelihood of recovery longer than 30 days.
Based on these results, Kontos told Healio Orthopedics that patients should seek specialty care following a concussion as early as possible, which should involve “a comprehensive assessment and clinical exam that allows for more targeted treatment for specific symptoms and impairments.”
“Earlier care with a trained clinician allows patients to begin behavioral management strategies involving physical and cognitive activity, sleep, nutrition, hydration and stress management, all of which can enhance the recovery process,” Kontos said. “Patients should not wait for a week or more to seek care to see if things improve on their own, rather they should seek care as soon as they can to enhance their recovery process.” – by Casey Tingle
Disclosures: Kontos reports he received grants from National Football League, personal fees from APA Books and other support from University of Pittsburgh. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Christina L. Master, MD, FAAP, CAQSM, FACSM
This study addresses time to clinical care for concussion. There has been a lot of attention focused on preexisting factors that may influence outcomes in concussion such as migraine headaches, mood or learning disorders — these factors, however, are likely not modifiable. This study examines a potentially modifiable external factor that may influence concussion outcomes — time to specialized concussion care. Earlier presentation to care appears to be associated with shorter recovery by an average of 20 days. This may relate to the active management approach that is taken with concussions in specialty care today and highlights the importance of being up to date with the current state of concussion research and its implications for management.
We published a study last year that found that girls took longer to recover from concussions than boys, but that earlier presentation for specialty concussion care for girls eliminated those gender differences if they presented for specialty care within 14 days. As you can see, this is a potentially powerful intervention that could impact outcomes. Raising the awareness of the importance of 1) disclosing symptoms, 2) identifying concussions and 3) seeking timely specialty care for concussion for active management could improve outcomes for all.
Reference:
Desai N, et al. Clin J Sport Med. 2019;doi:10.1097/JSm.000000000000646.
Perelman School of Medicine at the University of Pennsylvania
Pediatric and adolescent sports medicine, division of pediatric orthopedics
The Children’s Hospital of Philadelphia
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