"Playing Through It": Delayed Reporting and Removal From Athletic Activity After Concussion Predicts Prolonged Recovery.
BACKGROUND
Preclinical research has demonstrated a window of vulnerability in the immediate aftermath of concussion wherein continued activity and stimulation can impair or prolong neurobehavioral recovery. However, this concept has not been quantified in a human population.


OBJECTIVE
To examine the effect of delayed reporting and removal from athletic activity after concussion on recovery time.


METHODS
Cross-sectional study.


METHODS
A National Collegiate Athletic Association Division I university.


METHODS
Ninety-seven athletes who sustained a sport-related concussion between 2008 and 2015 were analyzed (age = 20.4 ± 1.3 years). Athletes were grouped as immediate removal from activity (I-RFA) or delayed removal from activity (D-RFA).


METHODS
Days missed was defined as the number of days between the concussion-causing event and clearance for return to contact. Associations between RFA group and prolonged (8 or more days') versus normal (7 or fewer days') recovery were also analyzed.


RESULTS
Fifty (51.5%) of the 97 athletes did not immediately report concussion symptoms. The D-RFA athletes averaged 4.9 more days missed than the I-RFA athletes. Membership in the specific RFA group predicted days missed even after controlling for sex, concussion history, learning disability or attention-deficit/hyperactivity disorder diagnosis, diagnosed psychological disorder, and acute symptom severity (R( 2) change = 0.097, β = .319, P = .002). The D-RFA athletes were approximately 2.2 times more likely to have a prolonged recovery (8 or more days) compared with the I-RFA athletes (χ(2) = 10.268, P = .001, ϕ = 0.325).


CONCLUSIONS
Athletes who do not immediately report symptoms of a concussion and continue to participate in athletic activity are at risk for longer recoveries than athletes who immediately report symptoms and are immediately removed from activity. Continuing to participate in athletic activity during the immediate aftermath of a concussion potentially exposes the already injured brain to compounded neuropathophysiologic processes.
Department of Clinical and Health Psychology.
Breton M
BM
Asken
Michael A
MA
McCrea
Department of Community Health and Family Medicine, and University Athletic Association, University of Florida, Gainesville;
James R
JR
Clugston
Department of Clinical and Health Psychology.
Aliyah R
AR
Snyder
Department of Clinical and Health Psychology.
Zachary M
ZM
Houck
Department of Clinical and Health Psychology.
Russell M
RM
Bauer
D000293:Adolescent; D056352:Athletes / Q000706:statistics & numerical data; D001265:Athletic Injuries / Q000175:diagnosis* / Q000503:physiopathology; D001924:Brain Concussion / Q000175:diagnosis* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D000068958:Return to Sport / Q000502:physiology; D014495:Universities / Q000706:statistics & numerical data; D055815:Young Adult
collegiate athletes; mild traumatic brain injuries; symptom reporting; window of vulnerability