Concussion Recovery May Be Slower Than Current Estimates
Laird Harrison
June 09, 2015
SAN DIEGO — Recovery from a concussion might take much longer than the previously established 7 to 14 days, a new study shows.
"More and more people are starting to realize that you need to take a comprehensive approach so that you don't send a kid back who might be recovered on one measure but not another," said Anthony Kontos, PhD, from the University of Pittsburgh.
In fact, in the study conducted by Dr Kontos and his colleagues, athletes took 3 to 4 weeks to recover, and women took longer than men.
The established 7- to 14-day recovery period — reported in peer-reviewed journals and a consensus statement (Br J Sports Med. 2013;47:250-258) — was estimated from studies of male American football players that looked only at neurocognitive tests and symptoms, he explained.
To test the accuracy of this, Dr Kontos's team followed 24 female and 42 male high-school and college athletes after a diagnosis of concussion in accordance with established medical guidelines. Mean age of the athletes was 16.5 years.
Dr Kontos presented the findings here at the American College of Sports Medicine 62nd Annual Meeting.
The athletes were tested every week for 4 weeks after the diagnosis. Measures of symptoms, verbal memory, visual memory, visual motor processing speed, reaction time, dizziness, and vestibular and oculomotor symptoms were self-reported.
The biggest improvements in self-reported symptoms occurred in the first 2 weeks, but they continued to improve up to 4 weeks.
Vestibular and oculomotor symptoms lasted 1 to 3 weeks, and verbal memory impairment continued up to 4 weeks.
The male athletes were 2.5 times more likely than the female athletes to have recovered by week 4, which was statistically significant (P < .006).
In addition, females reported more dizziness and more vestibular and oculomotor symptoms than males.
The study ran out of funding after 4 weeks, but some imaging studies have suggested abnormalities beyond that time period, said Dr Kontos.
On the basis of these findings, clinicians should use more than one measure to assess whether an athlete has recovered from a concussion, he said. "It's not a homogenous injury. You need to do a thorough, comprehensive exam."
After the presentation, some audience members pointed out that the results confirm their experiences as team physicians. "We've always known that 2 weeks was not reasonable," said one.
It is hard to interpret the significance of these findings without knowing the scores of the athletes before their injuries, said session moderator Margot Putukian, MD, from Princeton University in New Jersey.
She wondered whether the researchers had compared the scores of the athletes with a control group.
There was a control group, Dr Kontos reported. "We see an absolute flat lining. They essentially showed nothing."
Still, clinicians should be wary of judging concussions on the basis of patients' symptoms, Dr Putukian told Medscape Medical News. "The majority of concussions do resolve in 10 to 14 days," she said.
Because of the increased attention to concussions, athletes are becoming fearful of potential symptoms. "We have athletes who come in even though they don't recall an injury. They have a headache and feel dizzy and they play a contact sport so they are concerned that they might have a concussion," said Dr Putukian.
The study was supported by the National Institute on Deafness and Other Communication Disorders and ElMindA. Dr Kontos and Dr Putukian have disclosed no relevant financial relationships.
American College of Sports Medicine (ACSM) 62nd Annual Meeting: Abstract 113. Presented May 27, 2015.
This is literally the only concern I have about DD playing in college. Her school has a really good process for diagnosing and assessing recovery so I am comfortable with that aspect. But the whole thing is terrifying to an extent. There is risk in just about anything, but it would be nice to minimize it.
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Out of all the lies I have told, "just kidding" is my favorite !
