Resting Metabolic Rate and Recovery From Sport-Related Concussion: A Critically Appraised Topic

Critical appraisal of whole-body metabolism as a measure of concussion recovery is lacking in the available evidence. There has been extensive exploration of options for a gold standard assessment for concussion, including blood biomarkers, electroencephalogram, and neuroimaging, but none have yet to demonstrate good empirical evidence of efficacy.

In patients with sport-related concussion (SRC), can resting metabolic rate (RMR), as measured through indirect calorimetry, be used as a physiologic assessment of recovery?

Three studies demonstrated relevance to the clinical question. Of the selected studies, 2 studies were case-control, and 1 was a case series. All studies observed reduced total energy expenditure and increased energy balance when initially assessed between 24 and 72 hours after injury.

Evidence exists to suggest that RMR as measured with indirect calorimetry is a poor indicator of SRC recovery. All 3 articles found that RMR was not affected by SRC, even when compared with healthy controls. One article did observe a between sex difference in RMR, but a very small sample size was included in the case series.

The findings of this critically appraised topic suggest a strength of recommendation of grade B, demonstrating that RMR is a poor indicator of recovery from SRC.