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Wednesday, January 17, 2018

Study Spotlight: Predictors of Clinical Recovery from Concussion

By: Joel Luedke

Concussions have become one of the, if not the, biggest topics when it comes to sports related injury. Research continues to advance and look at many possible factors for how to predict them, diagnose them, predict recovery length and also predict recovery outcomes.  While things have come a long way when it comes to evaluation and management of a concussion there is still a lot of work to be done.

This study tries to take a look at what has been previously done and get a sense of the broad strokes of where we are with concessions and what factors specifically predict clinical recovery from concussion.

What They Did:
Researchers identified 7617 articles utilizing their search strategy.  After review, 101 articles were included in the review based on the established criteria.  The researchers identified 'clinical recovery' as the functional return to normal actives, including school and sport, following injury.

What They Found: 
The researchers did a very good job in this review stating how difficult it was to compare studies due to wide ranging variables in methodologies and how the statistics were run.  They also did a good job looking at the broadest strokes they could while making it very clear that they were not finding direct relationships but general trends as they were going through the data.  A summary of those points follows: 

  • For the majority of predictors, the literature is mixed with positive and negative findings.
  • Pre injury mental health problems and prior concussions appear to be risk factors for persistent symptoms.
  • Greater acute and subacute symptoms are a consistent predictor of worse clinical outcomes.
  • The teenage years might be a particularly vulnerable time for having persistent symptoms-with great risk for girls and boys.


What It All Means:
From the bullet points above it may not seem like much ground breaking information came out of this study.  While there wasn't a specific list of factors that seemed to directly predict concussion the information they did provide can help reinforce what we might be already doing as well give a reminder that we might need to adapt what we are looking at.

It was interesting that researchers noted that ADHD and other (non-specified) mental health problems can play a role in pre concussion symptoms but have not seem across the board to influence the recovery from a concussion.

The main finding of the review is that greater acute and subacute symptoms are a consistent predictor of worse clinical outcomes.  This does not seem like a surprising finding but it reinforces the importance of quick and accurate diagnosis and immediate management of concussion symptoms.  This is something that is within the control of athletic trainers, physicians, coaches and parents and must be taken seriously as it can have a profound effect not only on the athletes return to play but also their long term health.

Resource: Iverson, G. Predictors of clinical recovery from concussion: a systematic review. British Journal of Sports Medicine.
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