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Return to play issues in sports concussion
The University of Toronto Concussion Symptom Scale: do initial symptoms predict outcome?
  1. Doug Richards1,
  2. Michael Hutchison1,2,*,
  3. Seper Ekhtiari1,
  4. Paul Comper1
  1. 1David L. Macintosh Sport Medicine Clinic, The University of Toronto, Toronto, Canada
  2. 2St. Michael's Hospital, Toronto, Canada


    Objective To explore symptoms during initial physician evaluation and time to return-to-play experienced by university level athletes.

    Design Prospective case series of concussions during three athletic seasons (2009–2012).

    Setting University of Toronto, Ontario, Canada.

    Subjects Athletes who sustained concussions while involved in inter-university sports (practice or competition) in the following sports: volleyball, fencing, rugby, basketball, track, hockey, soccer, cheerleading, football, lacrosse, field hockey, and figure skating. A total of 85 concussions were reported from 68 athletes (37 males, 31 females)

    Intervention David L. Macintosh Sport Medicine Clinic physicians documented athletes' post-concussion symptoms and recorded the date when a player was medically cleared to return to play.

    Main Outcome Measures Symptoms as measured by the University of Toronto Concussion Symptom Scale (UTCSS) scores, time loss from competition, loss of consciousness, amnesia, and history of concussion.

    Results 90.6% of athletes reported at least one symptom on the UTCSS at the first office-visit, with somatic symptoms most frequently reported. The average UTCSS score at 3 days following injury was 13.1 (range, 0–51), with female athletes reporting significantly more symptoms than males (p<0.01). Time loss was not significantly different between males and females. The only factor that predicted poor outcome (>14 days out) was endorsement of cognitive symptoms of the UTCSS (OR 1.30, 95% CI 1.03 to 1.68).

    Conclusions Female athletes reported significantly more symptoms than male athletes following concussion. Cognitive symptoms of the UTCSS were significant predictors of time loss among university level athletes.

    Acknowledgements The authors wish to acknowledge the David L. Macintosh Sport Medicine Clinic, The University of Toronto Varsity Blues athletes, therapists, and support staff.

    Competing interests None.

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