Objective To compare return to play time (RTP) across race and sport contact level among university student-athletes with sport-related concussion (SRC).

Design Prospective.

Setting Civilian (n=26) and military (n=4) universities in the United States.

Participants College varsity student-athletes (n=1584) with SRC.

Assessment of Risk Factors Race (White, Black, Underrepresented Races [Asian/Hawaiian/Pacific Islander/American Indian/Alaskan Native/Multiple Races]), sport type (contact, limited/noncontact).

Outcome Measures Time to unrestricted RTP (in days).

Main Results Overall, 1584 SRCs were examined. Kaplan-Meier estimates (median, interquartile range [IQR]) delineated differences in RTP between White (14; IQR 13, 14), Black (12; IQR 11, 13), and Racially Underrepresented student-athletes (14; IQR 12, 15; p<.001). Among SRCs in contact sports, differences in RTP between White (13; IQR 13, 14), Black (12; IQR 11, 13), and Racially Underrepresented student-athletes (14; IQR 12, 15); p<.01) were also observed. Conversely, no difference in RTP was indicated across races among SRCs occurring in limited/noncontact sports.

Conclusions These findings suggest race (likely representative of some phenomenon driven by other underlying factors [i.e., clinician bias, differences in healthcare engagement, resource availability, etc.]) may partially explain RTP duration, particularly for injuries occurring in contact sports. While statistically significant differences in time to RTP were present across all races in contact sports, the clinical inference may be limited considering that the median difference across race was minimal (approximately one day). Interestingly, RTP across race was comparable in limited/noncontact sports, suggesting a more uniform RTP process or the absence of factors that may be driving these differences in contact sports. Further examinations are needed to elucidate the underpinnings of these observations.