Continued Play Post-Concussion Does Not Impact Clinical Outcomes, Recovery Times

Clinical outcomes and recovery times among collegiate athletes who continued to play following concussion vs those who were immediately removed following concussion are not worse, according to study findings published in Neurosurgical Focus.

Researchers conducted a prospective, repeated-measures study between October 2020 and February 2024 to compare clinical outcomes and recovery times of collegiate athletes who continued to play vs those who were immediately removed from play following a concussion.

Collegiate athletes aged between 18 and 30 who completed their acute visit within 5 days of their concussion and did not have a neurologic disease or were previously diagnosed with a moderate or severe traumatic brain injury (TBI) were eligible for inclusion. The researchers used the Sport Concussion Assessment Tool-5th edition (SCAT5), Vestibular/Ocular Motor Screening (VOMS) assessment, and High-Level Mobility Assessment Tool (HiMAT) to assess athletes within 5 days of concussion and at full medical clearance. Differences in clinical outcomes between groups were determined via Mann-Whitney U-tests. The relationship between factors linked to days to symptom resolution and days to full medical clearance were examined using Cox proportional hazards regression models.

A total of 93 athletes (men, 58.1%; White, 65.6%) with a diagnosed concussion were included in the final analysis, 37 (mean age, 20.8; men, 64.9%; White, 56.8%) of whom continued play and 56 (mean age, 21.0; men, 53.6%; White, 71.4%) of whom were removed from play following the concussion. Contact sports were played by 84.9% of the athletes, the most popular of which were football (34.4%), soccer (14.0%), and rugby (8.6%).

The median SCAT5 concentration composite score at the acute visit was significantly different between the continued play and removed from play groups (4.00 vs 4.50, respectively; P =.01). Similarly, the median SCAT5 delayed recall composite score was also significantly different between the 2 groups (5.00 vs 6.00, respectively; P =.04). These differences indicated that athletes in the continued vs removed from play group performed worse on SCAT5 concentration and delayed recall.

The median near point of convergence average distance at the full medical clearance visit was statistically different between the continued and removed from play groups (0.73 vs 2.60, respectively; P =.005), indicating that athletes in the continued vs removed from play group performed better on near point of convergence average distance at this visit.

Overall, the median days to symptom resolution and median days to full medical clearance were 9 and 12, respectively. No differences in median days to symptom resolution (10 vs 7; P =.05) or days to full medical clearance (13 vs 11.50; P =.13) were observed between the continued and removed from play groups.

Study limitations included the small sample size, reliance on self-reported information, missing data, and reduced generalizability of results to more diverse patient populations.

“[O]ur 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, education, and stakeholders’ awareness to ensure the identification and immediate removal of athletes from play,” the study authors concluded.