Shorter time to clinic assessment linked to improved recovery time following concussion

January 10, 2020
James England and Anees Daud-2 Minute Medicine

1. In this single-center, cross-sectional study, longer time from injury to sports medicine clinic assessment was linked with an increased time to recovery.

2. Visual motion sensitivity symptoms were also significantly associated with recovery time in the analysis of this cohort.

Evidence Rating Level: 3 (Average)

Study Rundown: Concussion is a common injury affecting many children and young adults participating in sports, and is associated with significant short- and long-term impact on function. Many factors have been shown to impact time to recovery following concussion including pre-injury function, comorbidities, and sex. Graded activity strategies and other interventions for specific ocular or vestibular symptoms have been shown to decrease recovery period, but the optimal timing of these interventions is not known. There has been concern that introducing activity too early following injury may exacerbate symptoms, which has led to low rate of referral to specialized clinics for further intervention beyond the initial injury assessment. The current study sought to evaluate whether time from injury to first sports medicine clinic visit would impact time to recovery from the concussion. The study found that later clinical assessment was linked with longer recovery time.

The strengths of the study include the novelty of evaluating time to specialized clinic assessment as a risk factor for recovery time in a relatively large cohort with long-term follow-up. The main limitations of the study include the possible introduction of bias with the retrospective, single-center design, and the large proportion of excluded patients due to incomplete data on recovery.

Click to read the study in JAMA Neurology

Relevant Reading: Feasibility of Early Active Rehabilitation for Concussion Recovery in Youth

In-Depth [cross-sectional study]: This study is a cross-sectional review of data obtained from an ongoing research study at a single sports medicine concussion clinic between August 2016 and March 2018. Patients were included if they were between 12 to 22 years of age, with a symptomatic sport associated concussion. Patients were excluded if they had moderate to severe traumatic brain injury, pre-existing neurologic/vestibular disorder, or had incomplete data on recovery. The primary outcome was recovery time defined as clearance for a full return to play which was dependent on return to baseline function and no increase in symptoms with exertion. The cohort was grouped into those with early (<7 days from injury to first clinic visit) and late (8 to 20 days) assessments. The study included an initial 416 participants, but 254 (61.1%) were excluded due to incomplete recovery data. The study found that late assessment (adjusted odds ratio, 5.8 [95%CI, 1.9-17.6]; P = .001) and visual motion sensitivity symptoms greater than 2 (adjusted odds ratio, 4.5 [95%CI, 1.1-18.0]; P = .04) were linked with longer recovery time.

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