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Immediate removal from play linked to faster concussion recovery

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Athletes who remain on the field after sustaining a head injury take longer to recover, new research has shown.

In a study involving 130 athletes aged between 11 and 19 years, researchers at the University of Pittsburgh investigated the dose-response relationship between continuing to play following a sport related concussion (SRC) and overall outcome.

The study compared symptoms, neurocognitive performance and recovery time between 52 athletes who were immediately removed from play after sustaining a concussion (‘removed’), 24 who continued to play for 15 minutes or less (‘short-play’), and 32 who continued to play for more than 15 minutes (‘long-play’).

Recovery was measured by the number of days from injury to clearance to return to sport. The researchers used Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) to measure neurocognitive outcomes and the Post-Concussion Symptom Scale (PCSS) to measure symptom severity.

Results published in the Journal of Head Trauma Rehabilitation show that athletes classed as long-play (44.09 ± 27.01 days) took longer to recover than short-play (28.42 ± 12.74 days) and removed (18.98 ± 13.76 days). Continued play was also associated with protracted recovery (21 days or more), with short-play 5.43 times more likely, and long-play 11.76 times more likely, to experience protracted recovery relative to those who were removed from play.

The researchers also found that both groups who were not immediately removed from play had worse neurocognitive performance and higher symptom scores than those who were removed at days 1 to 7, with long-play demonstrating worse reaction time than short-play. At days 8 to 30, both ‘play’ groups performed worse than ‘removed’ on visual memory and visual motor speed, while only long-play performed worse on verbal memory and reaction time.

The findings of the study “demonstrate the implications of continuing to play following SRC and highlight the importance of identifying and removing athletes from play,” the authors said.

“Removal from play represents a modifiable risk factor for prolonged recovery that should be emphasised in education and awareness programmes for sport medicine professionals, coaches, officials, parents and athletes,” they concluded.