Examining how time from sport-related concussion to initial assessment predicts return-to-play clearance

ABSTRACT

Objective

(i) To analyze data of adolescents who have sustained a sport-related concussion (SRC) through the use of Complete Concussion Management Inc. (CCMI) concussion database system; and (ii) to determine an optimal time to assess and manage an athlete with an SRC by prospectively analyzing data from CCMI concussion database system.

Method

A cohort of patients, ages 8–18 years, who sustained an SRC, assessed 30 days or less from injury and were treated at partnered CCMI clinics across Canada were prospectively followed. The primary outcome measure was recovery, defined as CCMI discharge, which includes an athlete having completed all return-to-school and return-to-play steps and passed the Gapski–Goodman test without symptom exacerbation.

Results

1213 athletes (482 female) were included for analysis. Days between injury and initial assessment (p = 0.00), male sex (p = 0.00), and previous concussion history (p = 0.00) were significant predictors of time to discharge. A log-rank test revealed a significant difference (p = 0.00) in time to discharge with athletes assessed <10 days of injury discharged at a mean of 23.5 days (95% CI, 22.5, 24.5) and those assessed at day 10 to 30 were discharged at a mean of 37.1 days (95% CI, 33.7, 40.5). Athletes who were assessed at 0 to 9 days from injury were two times more likely to be discharged sooner compared to those athletes assessed 10 to 30 days from injury (HR 2.03, p = 0.00).

Conclusion

Time from SRC to initial assessment significantly predicted time to discharge, with those being evaluated earlier experiencing a faster discharge. The results aid in establishing recommended timelines for evaluation following an SRC in order to prevent or mitigate athletes experiencing a prolonged recovery and encourage timely access to care and a quicker return to life post-concussive injury.

KEYWORDS:

• Concussion
• sport-related concussion return-to-play
• recovery
• discharge

Acknowledgments

The corresponding author would like to recognize the contribution of Carol DeMatteo for overseeing this research project for the Master of Science degree through the Department of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada. A thank you to Complete Concussion Management Inc. for providing access to their concussion database system in order to complete the study.

Disclosure of interest

Cameron Marshall is the founder and shareholder of Complete Concussion Management Inc. (CCMI) which is a private company. The work submitted however was completed using extracted de-identified data from CCMI’s clinical database system. There were no payments made at any time for extraction, analysis, or use of this data. Taylor Pratile is a independent contractor to Complete Concussion Management Inc., however, no remuneration was made for the completion of this study. No other author declares a conflict of interest.

Additional information

Funding

The authors have not received any funding for the study.