Objective Utilize simultaneous helmeted accelerometers and GPS-monitoring equipment to investigate the effects of delayed removal/continued participation (DRCP) following sport-related concussion (SRC) on clinical outcomes and recovery.

Design Prospective Observational Study.

Setting Sports Medicine Research Laboratory in United States.

Participants Eight (20.7±2.6 years of age) male Division-I college football players during the 2017–2019 seasons. Of which, 4 (50%) experienced DRCP after suspected SRC, and the remaining 4 underwent immediate removal (IR) after injury.

Interventions (or Assessment of Risk Factors) Helmets were equipped with Head Impact Telemetry (HIT) System to quantify peak linear (g) and rotational (rad/s²) accelerations and HIT severity profile. Participants wore the Catapult Vector GPS monitoring system to collect player load (plLoad), plLoad rate (plLoad/min), and distance travelled.

Outcome Measures Symptom severity was self-reported with the Sport Concussion Assessment Tool, and clinical recovery was defined as duration from SRC onset to medical clearance to return to sport.

Main Results DRCP sustained an additional 10.8±8.7 impacts after suspected SRC. IR and DRCP sustained SRC events of similar peak linear and rotational accelerations and HIT severity profile (P>0.01). Following SRC, IR had a lower plLoad rate than DRCP [0.41±0.33 vs. 2.50±0.77 plLoad/min; P=.002, Cohen’s d=.59; 95% Confidence Interval: -2.51- (-0.95)]. However, total plLoad, traveled distance, symptom severity, and duration until medical clearance (24.3±11.9 vs. 10.8±10.2 days) were similar (P values >.01).

Conclusions Continued participation after SRC did not affect self-reported symptoms or clinical recovery duration. Concomitant head impact measurement and GPS-player monitoring may be an intuitive approach to quantify physical activity following SRC.