Recovery from mild concussion in high school athletes

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Object. A computerized neuropsychological test battery was conducted to evaluate memory dysfunction and self-reporting of symptoms in a group of high school athletes who had suffered concussion.

Methods. Neuropsychological performance prior to and following concussion was compared with the test performance of an age-matched control group. Potentially important diagnostic markers of concussion severity are discussed and linked to recovery within the 1st week of injury.

Conclusions. High school athletes who had suffered mild concussion demonstrated significant declines in memory processes relative to a noninjured control group. Statistically significant differences between preseason and postinjury memory test results were still evident in the concussion group at 4 and 7 days postinjury. Self-reported neurological symptoms such as headache, dizziness, and nausea resolved by Day 4. Duration of on-field mental status changes such as retrograde amnesia and posttraumatic confusion was related to the presence of memory impairment at 36 hours and 4 and 7 days post-injury and was also related to slower resolution of self-reported symptoms. The results of this study suggest that caution should be exercised in returning high school athletes to the playing field following concussion. On-field mental status changes appear to have prognostic utility and should be taken into account when making return-to-play decisions following concussion. Athletes who exhibit on-field mental status changes for more than 5 minutes have longer-lasting postconcussion symptoms and memory decline.

Article Information

Address reprint requests to: Mark R. Lovell, Ph.D., University of Pittsburgh Medical Center Sports Medicine Concussion Program, 3200 South Water Street, Pittsburgh, Pennsylvania 15203. email: lovellmr@msx.upmc.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Graph showing IMPACT memory composite score for concussion and control groups. Scores represent mean performance on the memory composite index of IMPACT. The performance of the control group did not differ significantly across the evaluation periods. Athletes in the concussion group differed across the evaluation periods.

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    Graph showing IMPACT symptom score for the concussion and control groups. Scores represent total symptom scores for the groups. The control group demonstrated lower symptom scores at follow up than at baseline; however, the concussion group displayed significantly higher symptom scores at follow up.

  • View in gallery

    Graph showing IMPACT memory composite scores stratified by concussion severity. Scores represent mean performance on the memory composite index of IMPACT. Athletes in the concussion group performed more poorly across time. Athletes with more severe injuries (as defined by on-field markers lasting longer than 5 minutes) displayed poorer performance compared with those with brief on-field difficulties.

  • View in gallery

    Graph showing IMPACT symptom total score stratified by concussion severity. Scores represent total symptom scores for the two severity groups. Athletes in the concussion group performed significantly more poorly across time. A comparison between athletes in the subgroups of the concussion group with more severe and mild injuries (as defined by on-field markers of concussion lasting longer than 5 minutes) did not reach statistical significance, although there was a trend toward more symptom reporting in the more severe group.

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