Continuing Play, Symptom Severity, and Symptom Duration After Concussion in Youth Athletes

To determine whether continuing to play after a concussion is associated with higher symptom burden or prolonged symptom duration.

Patients who presented for care at a sport concussion clinic within the first 3 weeks of injury were asked whether they continued to play immediately after their injury.

Sport concussion clinic within a regional tertiary care hospital.

Clinical outcomes including symptom severity, symptom duration, age, time from injury-clinical presentation, sex, sport type, previous concussion history, and whether or not they experienced loss of consciousness or amnesia at the time of injury were recorded. Univariable comparisons between those who did and did not report continuing play were conducted. Multivariable linear regression models were constructed to identify the independent association of continuing to play postinjury with symptom burden and symptom recovery time, while controlling for the effect of potential confounding variables.

A total of 516 patients were included in the study, assessed a mean of 12.1 ± 5.2 days postinjury (35% female, mean age = 14.5 ± 2.3 years). A total of 227 (44%) continued play after sustaining a concussion. Continuing to play postconcussion was independently associated with higher symptom severity during the initial clinical evaluation [β-coefficient = 6.144, 95% confidence interval (CI), 1.357-10.93], but not with symptom duration evaluation (β-coefficient = 1.794, 95% CI, -15.66 to 19.25).

Those who continued to play postconcussion presented with more severe symptoms after injury. Recognition of suspected concussion and removal from play on diagnosis confirmation may lead to better initial clinical outcomes after concussion among child and adolescent athletes.