Study: Age difference not a factor in concussion recovery
The authors of this multicenter prospective study analyzed concussed athletes (a total of 621 — 545 males and 76 females) and a control group of 150 non-injured athletes participating in high school and collegiate contact and collision sports. Seventy-nine percent participated in football; 15.7 percent in soccer and the remainder in lacrosse or ice hockey.Their findings suggest that there is no clinically significant age difference in recovery following sports-related concussions (SRC), and therefore, separate injury management protocols for high school and collegiate athletes are not needed.
There are numerous biomechanical and neurologic factors why children and adolescents may manifest differences in response to head trauma and recovery following SRC than adults. Prior research has revealed poorer outcomes after moderate to severe traumatic brain injuries in children as compared to adults and has suggested that children are particularly sensitive to rare cerebral edema after mild head injuries.
Due to concern that immature brains may demonstrate more prolonged or incomplete recovery, current consensus guidelines regarding SRC encourage caution in managing youth. The authors studied multiple measures commonly used in clinical practice, including components of the Sport Concussion Assessment Tool and traditional paper and pencil neuropsychological measures. They expected to observe minimal to no differences between the two age groups in the rate of symptom recovery, with slightly longer (roughly two days) cognitive recovery for high school athletes.
Data collection was from 1999-2003 and aggregated from the NCAA Concussion Study, composed of Division I, II and III football players at 15 universities across the United States; Project Sideline, which followed high school football, hockey and soccer players in the Milwaukee, Wis., area; and the Concussion Prevention Initiative, a study of male and female high school and college athletes mostly in the southeastern U.S. Athletes were evaluated by an athletic trainer or team physician at baseline, immediately following injury and at intervals from day one to 90 post-injury.
“From a historic perspective, it is interesting to note that these findings were determined well before the rapid increase in concussion education and awareness and advances regarding diagnoses of concussion,” said lead author Lindsay Nelson, PhD, assistant professor of neurosurgery and neurology, Medical College of Wisconsin, Milwaukee. “Importantly, we continue to see the same findings in more recent studies of concussed athletes.”
Comparisons of concussed high school and collegiate athletes to each other and to non-injured controls revealed equivalent rates of recovery in symptom and balance measures. Cognitive recovery appeared equivalent or 1-2 days longer in high school athletes, depending on the type of comparison performed. Group level recovery occurred at or before 7 days post injury on all assessments metrics.
“Our findings differ from current consensus guidelines suggesting that more conservative injury management practices may be needed for child and adolescent athletes versus adults,” said Nelson. “Our finding of high overlap in the rate of clinical recovery implies that protocols need not differ, at least not due to assumptions of differences in clinical recovery rates. Further study will be needed to understand whether neurobiological recovery occurs at equivalent rates for athletes of different ages or developmental levels.”
Nelson also notes that guidelines to allow concussed athletes to rest after injury need to be weighed against practical demands such as attending school, particularly for younger athletes. “Participating in cognitively demanding activity soon after concussive injury can exacerbate symptoms, but in general concussed athletes are encouraged to re-engage in school as soon as they are able and to prioritize return-to-school over return-to-sport participation.” The authors also observe that validating assessment for protocols younger than the high school level remains another area for continued research.
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