title: Additional Post-Concussion Impact Exposure May Affect Recovery in Adolescent Athletes.
abstract: Repeat concussion has been associated with risk for prolonged and pronounced clinical recovery in athletes. In this study of adolescent athletes, we examined whether an additional head impact within 24 h of a sports-related concussion (SRC) is associated with higher symptom burden and prolonged clinical recovery compared with a single-injury group. Forty-two student-athletes (52% male, mean age = 14.9 years) diagnosed with an SRC in a concussion clinic were selected for this study: (1) 21 athletes who sustained an additional significant head impact within 24 h of the initial injury (additional-impact group); (2) 21 single-injury athletes, age and gender matched, who sustained only one discrete concussive blow to the head (single-injury group). Groups did not differ on initial injury characteristics or pre-injury risk factors. The effect of injury status (single- vs. additional-impact) was examined on athlete- and parent-reported symptom burden (at first clinic visit) and length of recovery (LOR). Higher symptom burden was reported by the athletes and parents in the additional-impact group at the time of first visit. The additional-impact group also had a significantly longer LOR compared with the single-injury group. These findings provide preliminary, hypothesis-generating evidence for the importance of immediate removal from play following an SRC to protect athletes from re-injury, which may worsen symptoms and prolong recovery. The retrospective study design from a specialized clinical sample points to the need for future prospective studies of the relationship between single- and additional-impact injuries on symptom burden and LOR.
authors.affiliation: 1 Division of Pediatric Neuropsychology, Children's National Health System , Washington, DC.
authors.forename: Virginia K
authors.initials: VK
authors.lastname: Terwilliger
authors.affiliation: 2 Brody School of Medicine, East Carolina University , Greenville, North Carolina.
authors.forename: Lincoln
authors.initials: L
authors.lastname: Pratson
authors.affiliation: 1 Division of Pediatric Neuropsychology, Children's National Health System , Washington, DC.|3 Department of Psychiatry and Behavioral Sciences, George Washington University , Washington, DC.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Vaughan
authors.affiliation: 1 Division of Pediatric Neuropsychology, Children's National Health System , Washington, DC.|3 Department of Psychiatry and Behavioral Sciences, George Washington University , Washington, DC.
authors.forename: Gerard A
authors.initials: GA
authors.lastname: Gioia
mesh_terms: D000293:Adolescent; D056352:Athletes / Q000523:psychology; D001265:Athletic Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D001924:Brain Concussion / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D038223:Post-Concussion Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D057566:Self Report; D016037:Single-Blind Method
keywords: athletes; brain injury; concussion; mTBI