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Correlates to concussion recovery in college athletes: prospective evaluation of pre-injury modifiers and post-injury clinical and neuropsychological assessments
  1. Margot Putukian1,2,
  2. Riegler Kaitlin1,
  3. Amalfe Stephanie1,
  4. Echemendia Ruben3,4,
  5. Pasquale G. Frisina1
  1. 1Athletic Medicine, Princeton University,University Health Services,Princeton, New Jersey
  2. 2Rutgers-Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey,Princeton, New Jersey
  3. 3University Orthopaedics Comprehensive Concussion Care Clinic, State College, Pennsylvania
  4. 4Department of Psychology, University of Missouri Kansas City, Kansas City, Missouri


Objective valuate relationships among pre-injury modifiers and post-injury assessments on sport-related concussion (SRC) recovery.

Design Prospective-correlational.

Setting Single University.

Participants 208 SRCs; 173 athletes (males=132, females=41).

Assessment of risk factors Baseline modified sideline concussion assessment tool (m-SCAT):symptom checklist, Standardised Assessment of Concussion (SAC), modified-Balance Error Scoring System (m-BESS), Generalised Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9), and history of concussion, learning disorder (LD), headaches/migraines, and depression/anxiety. m-SCAT and hybrid neuropsychological tests 48-hours post-injury

Outcome measures Days to symptom free (DSF) and return to full play (DFP).

Main results Expected concussion modifiers, (gender, prior concussion, LD, headaches/migraines, depression/anxiety, PHQ-9 or GAD-7) were NOT significantly associated with DSF or DFP (p >.05). Although males (M=9.83, SD=12.22) became SF sooner (1.75 days) than females (M=11.58, SD=9.79), Mann-Whitney test indicated that differences for gender were not statistically significant, U=1249, p=0.11 and males (M=21.20,SD=20.75) and females (M=17.33, SD=14.86) didn’t differ significantly on DFP, U=613, p=0.25. ≤48-hours m-SCAT performance Athletes reporting more symptoms and higher symptom-severity score, took more DSF (rs=0.32, p<0.01, rs=0.35, p<0.01, respectively) and DFP (rs=0.19, p<0.05, rs=0.20, p<0.05, respectively). No statistically significant relationship between SAC or m-BESS and recovery existed. Four symptoms positively and significantly correlated with number of DSF and DFP: headache (SF:rs=0.27, p<0.01; FP:rs=0.23, p<0.05), neck-pain (SF:rs=0.36, p<0.05; FP, rs=0.38, p<0.05), feeling slowed down (SF:rs=0.21, p<0.01; FP:rs=0.19, p<0.05), and nervous/anxious (SF:rs=0.28, p<0.01; FP:rs=0.21, p<0.05). Athletes with slower RT on ImPACT took more DSF (rs=0.27, p<0.01) and DFP (rs=0.25, p<0.01). Athletes scoring lower/worse on ImPACT visual-motor speed composite had higher DSF (rs=-0.24, p<0.01) and DFP (rs=-0.35, p<0.01).

Conclusions While pre-injury “modifiers” aren’t correlated with clinical recovery, acute assessments after SRC may indicate prolonged recovery.

Competing interests None.

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