Research Reports - Additional post-concussion impact exposure may affect recovery in adolescent athletes

J Neurotrauma. 2015 Sep 30. [Epub ahead of print]

Terwilliger V(1), Pratson L(2), Vaughan C(3), Gioia G.

Author information:
(1)Children's National Medical Center , 111 Michigan Ave , Washington, District
of Columbia, United States , 20010 ; virginia.k.terwilliger@gmail.com.
(2)Greenville, North Carolina, United States ; Lincoln.pratson@gmail.com.
(3)Children's National Medical Center, Neuropsychology, Rockville, Maryland,
United States ; cvaughan@childrensnational.org.

Repeat concussion has been associated with risk for prolonged and pronounced
clinical recovery in athletes. In this study of adolescent athletes, we examined
whether an additional head impact within 24 hours of a sports-related concussion
(SRC) is associated with higher symptom burden and prolonged clinical recovery
compared to a single-injury group. Forty-two student-athletes (52% male, mean
age=14.9 years) diagnosed with an SRC in a concussion clinic were selected for
this study: (1) 21 athletes sustained an additional significant head impact
within 24 hours of the initial injury (additional-impact group), (2) 21
single-injury athletes, age and gender matched, who sustained only one discrete
concussive blow to the head (single-injury group). Groups did not differ on
initial injury characteristics or pre-injury risk factors. The effect of injury
status (single- versus additional-impact) was examined on athlete and parent
reported symptom burden (at first clinic visit) and length of recovery (LOR).
Higher symptom burden was reported by the athletes and parents in the
additional-impact group at the time of first visit. The additional-impact group
also had a significantly longer LOR compared with the single-injury group. These
findings provide preliminary, hypothesis-generating evidence for the importance
of immediate removal from play following an SRC to protect athletes from
re-injury, which may worsen symptoms and prolong recovery. The retrospective
study design from a specialized clinical sample points to the need for future
prospective studies of the relationship between single and additional-impact
injuries on symptom burden and length of recovery. 

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