The Natural History of Sport-Related Concussion in Collegiate Athletes: Findings from the NCAA-DoD CARE Consortium

• Published in: Sports medicine (Auckland) Vol. 52; no. 2; pp. 403 - 415
• Main Authors: Broglio, Steven P., McAllister, Thomas, Katz, Barry P., LaPradd, Michelle, Zhou, Wenxian, McCrea, Michael A.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-02-2022; Springer Nature B.V
• Subjects: Athletes; Attention deficit hyperactivity disorder; Concussion; Consortia; Medicine; Medicine & Public Health; Natural history; Neurosciences; Original Research Article; Participation; Sports; Sports injuries; Sports Medicine; Student athletes; Training; Variables; United States > US
• ISSN: 0112-1642; 1179-2035
• DOI: 10.1007/s40279-021-01541-7

Background
Sport-related concussion is recognized as a significant injury with variable recovery rates.
Objective
This study defined the acute natural history of sport concussion in male and female collegiate athletes participating in a broad array of sports.
Methods
We conducted a prospective, longitudinal investigation among collegiate student athletes (
n
 = 34,709) from 30 academic institutions. Primary outcomes included the time (days) from injury until initiation of a return to participation (RTP) protocol and time from injury until medical clearance for unrestricted RTP.
Results
Concussed athletes (
n
 = 1751, 19.2 years, 63.2% male) participating in 22 different sports began the RTP protocol in a median 6.4 (IQR 3.7–11.8) days. Time to initiate the RTP protocol was lengthened by less frequent post-injury assessments, greater initial post-injury symptom severity, limited contact sports participation, practice/training injuries, and three or more prior concussions. The median total RTP duration was 12.8 (IQR 8.7–20.1) days. Total RTP duration was shorter with ADHD medication usage, males, and greater assessment frequency; while greater initial post-injury symptom severity, practice-/training-related injuries, and three or more prior concussions had longer recoveries.
Conclusion
Although median recovery times are consistent with previous guidelines, it was not until 1 month post-injury that a preponderance of collegiate athletes were cleared to begin the RTP protocol (92%) or cleared for unrestricted sport participation (85%). Intrinsic and extrinsic factors had a small effect, altering recovery trajectories by up to 2 days, suggesting a largely unified approach to post-injury monitoring and management across all athletes. These data represent a shift from previous classification parameters of normal clinical recovery.