Immediate removal from play tied to faster recovery from concussion

By Kathryn Doyle (Reuters Health) - High school athletes who stop playing immediately after they experience a concussion take about half as long to recover as those who continue to play, according to a new study. “This was one of the first studies to tie-in a recovery consequence to staying in the game and playing with a concussion,” said lead author Robert J. Elbin of the University of Arkansas in Fayetteville. Continuing to play with a concussion may worsen the injury, and now there’s evidence that it also keeps you from returning to play for a longer period. The researchers studied 95 athletes, including boys and girls aged 12 to 19 who sought care for a sport-related concussion at a specialty clinic in the fall of 2014. In interviews, the athletes, who were playing football, soccer, hockey, volleyball or basketball when injured, reported their own medical history, injury-related information and how quickly they had been removed from play after the concussion. They also underwent a battery of neurocognitive tests at the clinic, one to seven days after the concussion, and again eight to 30 days later. Researchers followed-up to determine how many days it took for each player to be cleared to return to their sport. Being cleared to return meant having no symptoms, either at rest or after physical exertion. The researchers compared 35 teens who were removed from play immediately to 34 who continued to play, on average for another 19 minutes, before sitting out. Those who kept playing took an average of 44 days to return to the sport, compared to 22 days for those who were removed, according to the results in Pediatrics. Those who kept playing also had more severe neurocognitive symptoms and a greater number of symptoms than those who were removed, as well as being nearly nine times more likely to have a protracted recovery period of more than 21 days. “All post-concussion guidelines recommend immediate removal from play to avoid risk of worsened injury,” said Dr. Christopher C. Giza of UCLA Brain Injury Research Center, who was not involved in the new findings. It’s not clear if the continued physical exertion made recovery time longer, or if some athletes may have sustained additional head impacts after the concussion when they continued playing, Elbin told Reuters Health. “Also, it is possible that some athletes not immediately removed from play may be underreporting symptoms so as not to miss playing time, but eventually if the symptoms are severe enough they then report in a delayed fashion,” Giza said by email. Another study published in April in the Journal of Athletic Training found similar patterns of delayed return to play among athletes in National Collegiate Athletic Association (NCAA) Division 1sports who played through a concussion. Sitting out for a short time after a concussion, with a concussion that is properly diagnosed and managed, may ultimately help an athlete recover more rapidly, miss less school and miss less of their sport, Giza said. “Since sometimes a concussed athlete may actually not be fully aware of their impediments very early after concussion, teammates should look out for each other,” Giza added. “If they see a team member who shows impairment – earlier removal from play may stop a repeat injury and/or may help with more rapid recovery,” he said. “For youth athletes that present with a head injury, it’s recommended that they’re immediately removed from play and seek medical evaluation,” Elbin said. “Unfortunately 50 percent of concussions go unreported.” Players may not want to let their team down by sitting out, but staying in the game appears to mean that you miss twice as much actual playing time, he said. “According to these data, continuing to play will let the team down more,” Elbin said.