Objective: A 6-year study was conducted to determine the signs, symptoms, and outcome of concussions with 7 or more (7+) days out from play or extended postconcussion recovery in the National Football League (NFL).
Methods: From 1996 to 2001, reporting of concussion was performed by NFL teams using a special standardized reporting form filled out by team physicians. Signs and symptoms were grouped by general symptoms, somatic complaints, cranial nerve effects, cognition problems, memory problems, and unconsciousness. Medical action taken and management were recorded. In all, 887 concussions were reported in practices and games.
Results: There were 72 concussions (8.1%) involving 7+ days out from play. The highest frequency occurred in quarterbacks (14.8%), the return unit on special teams (11.8%), and secondary (10.8%). Quarterbacks had the highest odds ratio (OR) of 7+ days out with concussion (OR = 2.10, P = 0.049), whereas running backs had the lowest relative risk (OR = 0.13, P = 0.021). The greatest fraction of 7+ days out occurred in passing plays (36.1%) and kickoffs (22.2%). Many signs and symptoms occurred at a greater frequency on initial examination in players 7+ days out; the average number per player was 4.64 with 7+ days out versus 2.58 with fewer days out (t = 6.02, df = 77.1). The signs and symptoms with the highest incidence for 7+ days out were disorientation to time (chi(2) = 51.2, P = 001), retrograde amnesia (chi(2) = 33.2, P = 0.001), fatigue (chi(2) = 28.1, P = 0.001), and the general category of cognition problems (chi(2) = 21.7, P = 0.001). Loss of consciousness for more than 1 minute was a predictor of 7+ days out (chi(2) = 33.5, P = 0.001), although it occurred in only 7.9% of cases. Of players with 7+ days out, 72.2% were removed from the game and 12.5% were hospitalized. These frequencies were significantly greater than for players with fewer than 7 days out (chi(2) = 68.03, df = 3, P < 0.0001). Approximately 90% of players were managed by rest, irrespective of days out, but a greater fraction were given drug or medical therapies with prolonged days out.
Conclusion: The most vulnerable players for 7+ days out with concussion were quarterbacks and the secondary in professional football. Although 8.1% of concussions involved 7+ days out, only 1.6% involved a prolonged postconcussion syndrome. They recovered from symptoms and had a consistent return to play in the NFL.