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

J Neurotrauma. 2015 Dec 24. [Epub ahead of print]

Terwilliger VK(1), Pratson L(2), Vaughan CG(1,)(3), Gioia GA(1,)(3).

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 h of a sports-related concussion
(SRC) is associated with higher symptom burden and prolonged clinical recovery
compared with 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 who sustained an additional significant head impact
within 24 h 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-
vs. 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 LOR. 

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