title: Frequency and Outcomes of a Symptom-Free Waiting Period After Sport-Related Concussion.
abstract: Guidelines and practices for the management of sport-related concussion (SRC) have evolved swiftly over the past 2 decades. Despite common recommendations for a symptom-free waiting period (SFWP) before returning to sport, past reports have suggested poor utilization rates for this intervention.
  
  
  
  To obtain current estimates of the utilization and characterization of SFWPs with high school and collegiate athletes.
  
  
  
  Descriptive epidemiology study.
  
  
  
  Data were extracted from a larger prospective study that followed athletes with SRC across 13 institutions in southeastern Wisconsin from 2012 to 2014. Participants included 143 contact and collision sport athletes who were followed serially through their recoveries after SRCs.
  
  
  
  In the current study sample, 99.3% of athletes used an SFWP. The mean self-reported symptom duration was 6.35 days (median, 5 days), with 72.7% reporting symptom recovery within 1 week of injury, 93.7% within 2 weeks, and 99.3% within 30 days. Rate of same-season repeat concussion was low (3.8%) and was similar to or lower than the overall rate of concussion (4.3%). Five same-season repeat concussions occurred at a range of 8 to 42 days after initial injuries.
  
  
  
  In comparison with prior published data collected from 1999 to 2004, utilization and duration of SFWPs were higher in the current study samples (99.3% vs 60.3% of athletes reported an SFWP; mean duration, 6.1 vs 3.2 days), and athletes were withheld from sports for more days than previously reported (12.3 vs 7.4 days). Rate of same-season repeat concussion was equivalent to that of prior published data. The findings support improved adherence to clinical management guidelines through increased utilization of SFWPs after SRC.
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA apfaller@mcw.edu.
authors.forename: Adam Y
authors.initials: AY
authors.lastname: Pfaller
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.|Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Lindsay D
authors.initials: LD
authors.lastname: Nelson
authors.affiliation: Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Apps
authors.affiliation: Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.|Department of Pediatric and Adolescent Sports Medicine, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Walter
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.|Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: McCrea
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000209:etiology / Q000628:therapy*; D001924:Brain Concussion / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D000068958:Return to Sport / Q000706:statistics & numerical data; D057832:Watchful Waiting / Q000706:statistics & numerical data*; D014922:Wisconsin; D055815:Young Adult
keywords: clinical management; concussion; head injury; mild traumatic brain injury; sports; symptom-free waiting period