Clinical recovery of amateur athletes who present to the emergency department within one-week following sport-related concussion: a one-year prospective, matched-cohort study

Abstract

Sport-related concussion is a major public health burden due to its concerning prevalence and possible negative, long-term consequences on brain health. However, approximately 85% of athletes recover within two weeks following sport-related concussion when assessed using self-reported symptoms, computerised neurocognitive testing, and clinician-administered static balance performance. This is a relatively consistent finding across existing studies, and across the spectrum of sex, age, sport, and level of play. Despite the acute clinical recovery experienced by most athletes following sport-related concussion, a notable minority experience a prolonged recovery that is characterised by persistent symptoms, adverse health related quality-of-life, and delayed return-to-sporting activity. Sport-related concussion typically induces a variety of impairments that involve many body systems. The complex array of somatic, cognitive, vestibular, oculomotor, autonomic, sensorimotor, and psychological impairments that can manifest following sport-related concussion underscores the need for many outcome measures to longitudinally identify concussion-associated impairments. In the absence of a comprehensive and longitudinal assessment incorporating many outcome measures, concussion-associated impairments may go unidentified. The clinical time-course of concussion recovery beyond three months and up to one-year after injury remains relatively under-investigated in the concussion literature. Consequently, it is unclear whether athletes experience impaired, or fluctuating, outcomes in the year following sport-related concussion that may contribute towards adverse brain health in later-life. Patient-, clinician-, and laboratory-based outcome measures assess different constructs with varying granularity and, when assessed simultaneously, enable a more holistic understanding of the wide spectrum of patient health and disability that a patient may experience after injury. To this end, we assessed patient-, clinician-, and laboratory-based outcomes within a clinical outcomes assessment framework to prospectively investigate the one-year recovery of athletes who presented to a university-affiliated hospital emergency department within one-week following sport-related concussion.