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Preinjury and Postinjury Factors That Predict Sports-Related Concussion and Clinical Recovery Time

Putukian, Margot, MD*,†; Riegler, Kaitlin*,‡; Amalfe, Stephanie*,§; Bruce, Jared, PhD¶,║; Echemendia, Ruben, PhD¶,**

doi: 10.1097/JSM.0000000000000705
Original Research: PDF Only

Objectives: To evaluate the relationship between preinjury risk factors (RFs) and subsequent occurrence of concussion and examine whether preinjury RFs or postinjury assessments predict clinical recovery in collegiate athletes.

Methods: Risk factors (sex, sport, and self-report history of concussion, migraine, attention-deficit disorder, learning disability, depression, and anxiety) and Sport Concussion Assessment Tool (SCAT), depression/anxiety screenings, and neuropsychological testing were obtained before the season. For athletes who sustained concussion, RFs, postinjury SCAT, neuropsychological assessment, and clinical recovery were assessed.

Results: We assessed 1152 athletes (69% male) at baseline and 145 (75% male) after subsequent concussion diagnosis. Only sport type (Wald = 40.29, P = 0.007) and concussion history (Wald = 9.91, P = 0.007) accounted for unique variance in subsequent concussion. Of athletes followed until full recovery, mean days until symptom-free (DUSF) was 9.84 ± 11.11 days (n = 138, median = 5 days, range = 1-86) and mean days until full return to play (DUFRTP) was 20.21 ± 19.17 (n = 98, median = 20.21, range = 4-150). None of the RFs or baseline testing measures were associated with DUSF or DUFRTP (P's > 0.05). After injury, athletes who reported more total symptoms (r s = 0.31, P < 0.001) and higher symptom severity (r s = 0.33, P < 0.001) exhibited longer DUSF. Days until symptom-free correlated with DUFRTP (r s = 0.75, P < 0.001). Among athletes assessed within 2 days after injury, DUSF was associated with Immediate Postconcussion Assessment and Cognitive Test visual motor (r s = −0.31, P = 0.004), reaction time (r s = 0.40, P < 0.001), and symptom score (r s = 0.54, P < 0.001).

Conclusions: Only sport type and concussion history predicted subsequent occurrence of concussion, and none of the RFs or baseline measures predicted clinical recovery. Immediate postinjury assessments, including symptom number and severity, and select clinical measures predicted longer clinical recovery.

*Department of Athletic Medicine, Princeton University, University Health Services, Princeton, New Jersey;

Rutgers-Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Princeton, New Jersey;

Department of Psychology, Penn State University, State College, Pennsylvania;

§Fairleigh Dickinson University, Teaneck, New Jersey;

Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri;

Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, Missouri; and

**University Orthopedics Comprehensive Concussion Care Clinic, State College, Pennsylvania.

Corresponding Author: Margot Putukian, MD, University Health Services, Princeton University, Washington Rd, Princeton, NJ 08540 (

This study received partial funding from the National Collegiate Athletic Association-Department of Defense Grand Alliance: Concussion Assessment, Research and Education (CARE) Consortium study. Dr. Putukian is a consultant to Major League Soccer's Sporting, Kansas City, Dr. Ruben Echemendia. Dr. Bruce is a part-time employee and consultant to the National Hockey League.

Received March 17, 2018

Accepted October 30, 2018

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