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01-07-2021 | Traumatic Brain Injuries | Systematic Review

The Influence of Timing of Reporting and Clinic Presentation on Concussion Recovery Outcomes: A Systematic Review and Meta-Analysis

Authors: Mitchell Barnhart, R. Curtis Bay, Tamara C. Valovich McLeod

Published in: Sports Medicine | Issue 7/2021

Abstract

Background

Identifying risk factors for prolonged recovery following concussion can assist clinicians with appropriate management strategies. It is thought that athletes who continue to participate following a hit to the head or body may take longer to recover following a concussion diagnosis.

Objective

To systematically review the body of literature regarding the effect of delayed reporting and delayed presentation to medical providers on concussion recovery times.

Design

Systematic review with meta-analysis.

Data Sources

PubMed, Ovid Medline, SPORTDiscus, Cochrane Central Register of Controlled Trials and hand searches of reference lists. All the searches were performed in April 2020.

Eligibility criteria for selected studies

Studies included an investigation of immediate versus delayed reporting or early versus late presentation following a concussion, were published in the past ten years, and were level 4 evidence or higher.

Results

12 studies were included. Patients who continued play or delayed reporting their concussion had significantly longer recovery times (standardized mean difference = 0.36 days (95%CI 0.066, 0.662) than those who immediately reported or were removed from play (p = 0.017). Expressed in raw scores, those who immediately reported recovered in 5.4 days (95% CI − 10.14, − 0.75) fewer than delayed reporters. Comparable results were found for post-concussion symptom scores (p = 0.034) with immediate reporters demonstrating lower symptom severity scores. Our qualitative synthesis found patients who presented earlier to a concussion specialist tended to recover faster than those who presented later.

Conclusions

Patients who delayed reporting or continued play had longer recovery times compared to their immediately-reporting peers. Providers should ask concussion patients approximately how long they waited to report their injury, and also focus educational efforts on encouraging immediate reporting of concussion.

McCrea M, Broglio S, McAllister T, Zhou W, Zhao S, Katz B, et al. Return to play and risk of repeat concussion in collegiate football players: comparative analysis from the NCAA Concussion Study (1999–2001) and CARE Consortium (2014–2017). Br J Sports Med. 2019:bjsports-2019–100579. https://doi.org/10.1136/bjsports-2019-100579.

McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838. https://doi.org/10.1136/bjsports-2017-097699.CrossRefPubMed

Makdissi M, Schneider KJ, Feddermann-Demont N, Guskiewicz KM, Hinds S, Leddy JJ, et al. Approach to investigation and treatment of persistent symptoms following sport-related concussion: a systematic review. Br J Sports Med. 2017;51(12):958–68. https://doi.org/10.1136/bjsports-2016-097470.CrossRefPubMed

McCrea M, Guskiewicz K, Randolph C, Barr WB, Hammeke TA, Marshall SW, et al. Incidence, clinical course, and predictors of prolonged recovery time following sport-related concussion in high school and college athletes. J Int Neuropsychol Soc. 2013;19(1):22–33. https://doi.org/10.1017/S1355617712000872.CrossRefPubMed

Asken BM, McCrea MA, Clugston JR, Snyder AR, Houck ZM, Bauer RM. “Playing through it”: delayed reporting and removal from athletic activity after concussion predicts prolonged recovery. J Athl Train. 2016;51(4):329–35. https://doi.org/10.4085/1062-6050-51.5.02.CrossRefPubMedPubMedCentral

Kontos AP, Elbin RJ, Sufrinko A, Marchetti G, Holland CL, Collins MW. Recovery following sport-related concussion: integrating pre-and postinjury factors into multidisciplinary care. J Head Trauma Rehabil. 2019;34(6):394–401.CrossRefPubMed

Meehan WP 3rd, Mannix RC, O’Brien MJ, Collins MW. The prevalence of undiagnosed concussions in athletes. Clin J Sport Med. 2013;23(5):339–42. https://doi.org/10.1097/JSM.0b013e318291d3b3.CrossRefPubMedPubMedCentral

Iverson GL, Gardner AJ, Terry DP, Ponsford JL, Sills AK, Broshek DK, et al. Predictors of clinical recovery from concussion: a systematic review. Br J Sports Med. 2017;51(12):941–8. https://doi.org/10.1136/bjsports-2017-097729.CrossRefPubMed

Zemek R, Barrowman N, Freedman SB, Gravel J, Gagnon I, McGahern C, et al. Clinical risk score for persistent postconcussion symptoms among children with acute concussion in the ED. JAMA. 2016;315(10):1014–25. https://doi.org/10.1001/jama.2016.1203.CrossRefPubMed

10.

Asken BM, Bauer RM, Guskiewicz KM, McCrea MA, Schmidt JD, Giza CC, et al. Immediate removal from activity after sport-related concussion is associated with shorter clinical recovery and less severe symptoms in collegiate student-athletes. Am J Sports Med. 2018;46(6):1465–74. https://doi.org/10.1177/0363546518757984.CrossRefPubMedPubMedCentral

11.

Charek DB, Elbin RJ, Sufrinko A, Schatz P, D’Amico NR, Collins MW, et al. Preliminary evidence of a dose-response for continuing to play on recovery time after concussion. J Head Trauma Rehabil. 2020;35(2):85–91.CrossRefPubMedPubMedCentral

12.

Elbin RJ, Sufrinko A, Schatz P, French J, Henry L, Burkhart S, et al. Removal from play after concussion and recovery time. Pediatrics. 2016;138(3):1–8. https://doi.org/10.1542/peds.2016-0910.CrossRef

13.

Heyer GL, Schaffer CE, Rose SC, Young JA, McNally KA, Fischer AN. Specific factors influence postconcussion symptom duration among youth referred to a sports concussion clinic. J Pediatr. 2016;174:33–8.CrossRefPubMed

14.

Howell DR, OBrien MJ, Fraser J, Meehan WP. Continuing play, symptom severity, and symptom duration after concussion in youth athletes. Clin J Sport Med. 2020;30(1):42–6. https://doi.org/10.1097/JSM.0000000000000570.CrossRef

15.

Kontos AP, Jorgensen-Wagers K, Trbovich AM, Ernst N, Emami K, Gillie B, et al. Association of time since injury to the first clinic visit with recovery following concussion. JAMA Neurol. 2020;77(4):435–40.CrossRefPubMedPubMedCentral

16.

Bookbinder HA, Houston MN, Peck KY, Habecker S, Colsant BJ, Kelly TF, et al. Factors associated with delayed concussion reporting by United States Service Academy cadets. J Athl Train. 2020. https://doi.org/10.4085/1062-6050-362-19.CrossRefPubMedPubMedCentral

17.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700. https://doi.org/10.1136/bmj.b2700.CrossRefPubMedPubMedCentral

18.

OCEBM Levels of Evidence Working Group. The Oxford 2011 Levels of Evidence. Oxford Centre for Evidence-Based Medicine (OCEBM): University of Oxford; 2011

19.

Stang A. Critial evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.CrossRefPubMed

20.

Zynda AJ, Sabatino MJ, Ellis HB, Miller SM. Continued play following sport-related concussion in United States youth soccer. Intl J Exerc Sci. 2020;13(6):87–100.

21.

Bock S, Grim R, Barron TF, Wagenheim A, Hu YE, Hendell M, et al. Factors associated with delayed recovery in athletes with concussion treated at a pediatric neurology concussion clinic. Childs Nerv Syst. 2015;31(11):2111–6. https://doi.org/10.1007/s00381-015-2846-8.CrossRefPubMed

22.

Desai N, Wiebe DJ, Corwin DJ, Lockyer JE, Grady MF, Master CL. Factors affecting recovery trajectories in pediatric female concussion. Clin J Sport Med. 2019;29(5):361–7.CrossRefPubMed

23.

Eagle SR, Puligilla A, Fazio-Sumrok V, Kegel N, Collins MW, Kontos AP. Association of time to initial clinic visit with prolonged recovery in pediatric patients with concussion. J Neurosurg Pediatr. 2020;1:1–6. https://doi.org/10.3171/2020.2.Peds2025.CrossRef

24.

Kara S, Crosswell H, Forch K, Cavadino A, McGeown J, Fulcher M. Less than half of patients recover within 2 weeks of injury after a sports-related mild traumatic brain injury: a 2-year prospective study. Clin J Sport Med. 2020;30(2).

25.

McCrea M, Guskiewicz KM, Marshall SW, Barr W, Randolph C, Cantu RC, et al. Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. JAMA. 2003;290(19):2556–63. https://doi.org/10.1001/jama.290.19.2556.CrossRefPubMed

26.

Register-Mihalik J, Baugh C, Kroshus E, Z YK, Valovich McLeod TC. A multifactorial approach to sport-related concussion prevention and education: application of the socioecological framework. J Athl Train. 2017;52(3):195–205. https://doi.org/10.4085/1062-6050-51.12.02.

27.

Chrisman SP, Quitiquit C, Rivara FP. Qualitative study of barriers to concussive symptom reporting in high school athletics. J Adol Health. 2013;52(3):330–5.CrossRef

28.

Baugh CM, Kroshus E, Daneshvar DH, Stern RA. Perceived coach support and concussion symptom-reporting: differences between freshmen and non-freshmen college football players. J Law Med Ethics. 2014;42(3):314–22. https://doi.org/10.1111/jlme.12148.CrossRefPubMed

29.

Register-Mihalik JK, Williams RM, Marshall SW, Linnan LA, Mihalik JP, Guskiewicz KM, et al. Demographic, parental, and personal factors and youth athletes’ concussion-related knowledge and beliefs. J Athl Train. 2018;53(8):768–75.CrossRefPubMedPubMedCentral

30.

Wayment HA, Huffman AH. The indirect influence of organizational safety climate on football players’ concussion reporting intentions. Health Ed Behav. 2020;47(1):91–100. https://doi.org/10.1177/1090198119879216.CrossRef

31.

Warmath D, Winterstein AP. Reporting Skill: the missing ingredient in concussion reporting intention assessment. Sports Health. 2019;11(5):416–24. https://doi.org/10.1177/1941738119856609.CrossRefPubMedPubMedCentral

32.

Weber Rawlins ML, Johnson BR, Register-Mihalik JK, DeAngelis K, Schmidt JD, D’Lauro CJ. United States Air Force Academy cadets’ perceived costs of concussion disclosure. Mil Med. 2019. https://doi.org/10.1093/milmed/usz162.CrossRef

33.

Kroshus E, Cameron KL, Coatsworth JD, D’Lauro C, Kim E, Lee K, et al. Improving concussion education: consensus from the NCAA-Department of Defense Mind Matters Research & Education Grand Challenge. Br J Sports Med. 2020;54(22):1314–20. https://doi.org/10.1136/bjsports-2020-102185.CrossRefPubMed

34.

Shahab I, Meili R. Examining non-attendance of doctor’s appointments at a community clinic in Saskatoon. Can Fam Phys. 2019;65(6):e264–8.

35.

Douthit N, Kiv S, Dwolatzky T, Biswas S. Exposing some important barriers to health care access in the rural USA. Public Health. 2015;129(6):611–20. https://doi.org/10.1016/j.puhe.2015.04.001.CrossRefPubMed

36.

Leddy JJ, Haider MN, Hinds AL, Darling S, Willer BS. A preliminary study of the effect of early aerobic exercise treatment for sport-related concussion in males. Clin J Sport Med. 2019;29(5)

37.

Leddy JJ, Haider MN, Ellis MJ, Mannix R, Darling SR, Freitas MS, et al. Early subthreshold aerobic exercise for sport-related concussion: a randomized clinical trial. JAMA Pediatr. 2019;173(4):319–25. https://doi.org/10.1001/jamapediatrics.2018.4397.CrossRefPubMedPubMedCentral

38.

Micay R, Richards D, Hutchison MG. Feasibility of a postacute structured aerobic exercise intervention following sport concussion in symptomatic adolescents: a randomised controlled study. BMJ Open Sport Exerc Med. 2018;4(1):e000404. https://doi.org/10.1136/bmjsem-2018-000404.CrossRefPubMedPubMedCentral

39.

Langevin P, Frémont P, Fait P, Dubé MO, Bertrand-Charette M, Roy JS. Aerobic exercise for sport-related concussion: a systematic review and meta-analysis. Med Sci Sports Exerc. 2020. https://doi.org/10.1249/mss.0000000000002402.CrossRefPubMed

40.

Willer BS, Haider MN, Bezherano I, Wilber CG, Mannix R, Kozlowski K, et al. Comparison of rest to aerobic exercise and placebo-like treatment of acute sport-related concussion in male and female adolescents. Arch Phys Med Rehabil. 2019;100(12):2267–75. https://doi.org/10.1016/j.apmr.2019.07.003.CrossRefPubMedPubMedCentral

Title: The Influence of Timing of Reporting and Clinic Presentation on Concussion Recovery Outcomes: A Systematic Review and Meta-Analysis
Authors: Mitchell Barnhart
R. Curtis Bay
Tamara C. Valovich McLeod
Publication date: 01-07-2021
Publisher: Springer International Publishing
Keyword: Traumatic Brain Injuries
Published in: Sports Medicine / Issue 7/2021
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI: https://doi.org/10.1007/s40279-021-01444-7

At a glance: The STEP trials

Springer Medicine

The Influence of Timing of Reporting and Clinic Presentation on Concussion Recovery Outcomes: A Systematic Review and Meta-Analysis

Abstract

Background

Objective

Design

Data Sources

Eligibility criteria for selected studies

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Objective

Design

Data Sources

Eligibility criteria for selected studies

Results

Conclusions

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