Original Articles
Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes

https://doi.org/10.1067/mpd.2003.190Get rights and content

Abstract

Objective To evaluate symptoms and neurocognitive recovery patterns after sports-related concussion in high school and college athletes. Study design College athletes (n = 371) and high school athletes (n = 183) underwent baseline neuropsychological evaluation between 1997 and 2000. Individuals who received a concussion during athletic competition (n = 54) underwent serial neuropsychologic evaluation after injury and were compared with a noninjured within-sample control group (n = 38). Main outcome measures included structured interview, four memory measures, and Concussion Symptom Scale ratings. Baseline to postinjury change scores and multiple analyses of variance were used to compare recovery curves within and between groups. Results High school athletes with concussion had prolonged memory dysfunction compared with college athletes with concussion. High school athletes performed significantly worse than age-matched control subjects at 7 days after injury (F = 2.90; P <.005). College athletes, despite having more severe in-season concussions, displayed commensurate performance with matched control subjects by day 3 after concussion. Self-report of postconcussion symptoms by student athletes was not predictive of poor performance on neuropsychologic testing. Conclusions Caution and systematic evaluation should be undertaken before returning athletes with concussion to competition. Sole reliance on the self-report of the athlete may be inadequate. Preliminary data may suggest a more protracted recovery from concussion in high school athletes. (J Pediatr 2003;142:546-53)

Section snippets

Subjects

Study subjects were college and high school athletes. The college sample consisted of 370 male football and 23 female soccer players from four Division 1A programs: Michigan State University, East Lansing; the University of Utah, Salt Lake City; the University of California, Berkeley; and Arizona State University, Tempe. The high school sample consisted of 161 varsity male football players and 22 varsity male soccer players from 5 high schools in Shiawassee County, Michigan.

Program Protocol and Outcome Measures

All athletes in the

Demographic Data

Of the high school sample, 95% was white (n = 37) and 5% was nonwhite (1 black and 1 Asian). At the college level, 66% were white (n = 35), 25% were black (n = 13), and 9% were of either Hispanic, Asian, or Polynesian ancestry (n = 5). In the high school sample, 90% (n = 35) of the athletes were football players and approximately 10% (n = 4) were soccer players. At the college level, 96% (n = 51) of the athletes were male football players and 2 (4% of sample) were female soccer players.

The mean

Discussion

No area of sports medicine involves more clinical uncertainty and controversy than the treatment of concussion. Reasons for concern include an overall difficulty in measuring the phenomenon (CT scan and MRI are insensitive to injury), the enigmatic and complex pathophysiologic processes underlying concussion, and a failure to create evidence-based standards for return-to-play. On the basis of prevailing standards of care (ie, existing guidelines), it is assumed that the speed of recovery from

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      There is significant debate if age at time of concussion diagnosis is associated with long-term effects and time to recovery. Several studies have been completed evaluating the connection between age and recovery with preliminary, non-conclusive data showing a longer average recovery time after concussion in younger athletes when compared to their older counterparts. [27–28] On the contrary, the NCAA-DOD Care Consortium data has demonstrated that repetitive head injury during early adolescence is unrelated to brain health later in life as measured by specific outcome measures.

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    Reprint requests: Melvin Field, MD, Department of Neurological Surgery, University of Pittsburgh School of Medicine, PUH Suite B-400, 200 Lothrop St, Pittsburgh, PA 15213. E-mail: [email protected].

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