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  1. Martin P Schwellnus
  1. University of Cape Town, South Africa

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Following a concussion, a delay in return to sport was associated with an initial greater symptom load, prolonged headache or subjective concentration deficits – computerised cognitive tests took 2–3 days longer to recover and this may indicate that these tests are more sensitive to detect impairment.

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Evidence-based clinical data are required for safe return to play after concussion in sport.

Research question/s:

What is the natural history of concussion in sport and which clinical features and special tests for cognitive function are associated with more severe concussive injury?


Subjects: 1015 male elite senior and junior and community-based Australian rules football players (16–35 years).

Experimental procedure: All the subjects underwent pre-season baseline testing (Digit Symbol Substitution Test – DSST, Trail-Making Test – Part B – TMT and CogSport (CGS) computerised test battery). Players were followed up during the season (a total of four competitive seasons) and 78 players sustained 88 concussions. The concussed players were then tested serially until all clinical features of their injury had resolved.

Measures of outcome: Time to symptom recovery (as an indication of severity) and cognitive recovery (DSST/TMT, CGS).

Main finding/s:

  • Symptoms lasted 48.6 h (95% CI, 39.5 to 57.7 h) and correlated with recovery in DSST and TMT tests – CGS recovery was only 2–3 days later and was still impaired in 35% of concussed players after resolution of symptoms.

  • A delayed return to sport was related to >4 symptoms, headache lasting >60 h or self-reported ‘fatigue/fogginess’.


Following a concussion, a delay in return to sport was …

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  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.