Correlates to concussion recovery in college athletes: prospective evaluation of pre-injury modifiers and post-injury clinical and neuropsychological assessments

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Abstract

Objective

valuate relationships among pre-injury modifiers and post-injury assessments on sport-related concussion (SRC) recovery.

Design

Prospective-correlational.

Setting

Single University.

Participants

208 SRCs; 173 athletes (males=132, females=41).

Assessment of risk factors

Baseline modified sideline concussion assessment tool (m-SCAT):symptom checklist, Standardised Assessment of Concussion (SAC), modified-Balance Error Scoring System (m-BESS), Generalised Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9), and history of concussion, learning disorder (LD), headaches/migraines, and depression/anxiety. m-SCAT and hybrid neuropsychological tests 48-hours post-injury

Outcome measures

Days to symptom free (DSF) and return to full play (DFP).

Main results

Expected concussion modifiers, (gender, prior concussion, LD, headaches/migraines, depression/anxiety, PHQ-9 or GAD-7) were NOT significantly associated with DSF or DFP (p >.05). Although males (M=9.83, SD=12.22) became SF sooner (1.75 days) than females (M=11.58, SD=9.79), Mann-Whitney test indicated that differences for gender were not statistically significant, U=1249, p=0.11 and males (M=21.20,SD=20.75) and females (M=17.33, SD=14.86) didn’t differ significantly on DFP, U=613, p=0.25. ≤48-hours m-SCAT performance Athletes reporting more symptoms and higher symptom-severity score, took more DSF (rs=0.32, p<0.01, rs=0.35, p<0.01, respectively) and DFP (rs=0.19, p<0.05, rs=0.20, p<0.05, respectively). No statistically significant relationship between SAC or m-BESS and recovery existed. Four symptoms positively and significantly correlated with number of DSF and DFP: headache (SF:rs=0.27, p<0.01; FP:rs=0.23, p<0.05), neck-pain (SF:rs=0.36, p<0.05; FP, rs=0.38, p<0.05), feeling slowed down (SF:rs=0.21, p<0.01; FP:rs=0.19, p<0.05), and nervous/anxious (SF:rs=0.28, p<0.01; FP:rs=0.21, p<0.05). Athletes with slower RT on ImPACT took more DSF (rs=0.27, p<0.01) and DFP (rs=0.25, p<0.01). Athletes scoring lower/worse on ImPACT visual-motor speed composite had higher DSF (rs=-0.24, p<0.01) and DFP (rs=-0.35, p<0.01).

Conclusions

While pre-injury “modifiers” aren’t correlated with clinical recovery, acute assessments after SRC may indicate prolonged recovery.

Competing interests

None.

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