title: A retrospective clinical analysis of moderate to severe athletic concussions.
abstract: OBJECTIVE
  To investigate differences in clinical outcomes on the basis of gender and age after a moderate or severe concussion in a cohort of physically active subjects examined by a single clinician.
  
  
  METHODS
  A descriptive, cross-sectional, retrospective chart review of consecutive patients.
  
  
  METHODS
  Outpatient assessments by a single clinician with expertise in sports concussion.
  
  
  METHODS
  Physically active subjects seen for evaluation after a concussion experienced while participating in sports (N = 194; 215 concussions; age mean ± standard deviation = 19.19 ± 8.53 years) were included. INTERVENTIONS (INDEPENDENT VARIABLES): Intergroup differences and associations were examined by gender, age group (<18 years and 18+ years), and concussion grade for all outcome measures.
  
  
  METHODS
  Separate χ² tests were used to assess associations between gender, age group, and symptom duration group (≤ 7 days, 8-90 days, > 90 days), the presence of depression, the presence of loss of consciousness, altered school or work, and concussion grade. Separate independent samples t-tests was used to examine differences in symptom reporting and time to recovery.
  
  
  RESULTS
  No association was observed between gender and any measured characteristics (P > .05). Subjects 18 years or older took longer to recover (315.77 days), compared with younger subjects (91.31 days) (t₂₁₃ = -2.01, P = .049). Older subjects also reported more concussions than did younger ones, 4.33 and 2.37, respectively (t₂₁₃ = -3.77, P < .001).
  
  
  CONCLUSIONS
  All concussions included in this study were moderate to severe in nature as defined by the Revised Cantu Grading Scale. Contrary to existing literature regarding gender differences in concussion of a lesser severity, no gender differences were observed in this sample. Age differences were observed, with the population of subjects who were 18 years and older experiencing a greater number and duration of concussion symptoms than the younger group. Developing evidence-based return-to-play progressions and rehabilitation strategies in this population is the next frontier for concussion researchers.
authors.affiliation: Department of Surgery, Emerson Hospital, 131 ORNAC, Suite 820 Concord, MA 01742, USA. rcantu@emersonhosp.org
authors.forename: Robert C
authors.initials: RC
authors.lastname: Cantu
authors.forename: Kevin
authors.initials: K
authors.lastname: Guskiewicz
authors.forename: Johna K
authors.initials: JK
authors.lastname: Register-Mihalik
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001265:Athletic Injuries / Q000453:epidemiology*; D001924:Brain Concussion / Q000145:classification / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D020127:Recovery of Function; D012189:Retrospective Studies; D013177:Sports / Q000706:statistics & numerical data; D014474:Unconsciousness / Q000453:epidemiology; D055815:Young Adult