Symptom Resolution Characteristics: Initial Symptom Trajectories of Collegiate Students with and without Persisting...

The aim of this study was to describe and compare symptom characteristics using individual symptom items and symptom clusters over time between collegiate athletes with and without persisting symptoms after concussion (PSaC).

This was a retrospective cohort study. Data from the National Collegiate Athletic Association and US Department of Defense Concussion Assessment, Research, and Education Consortium were analyzed. PSaC was defined as symptoms lasting longer than 28 days post-concussion, while NoPSaC included individuals who became asymptomatic within 28 days. We analyzed 323 PSaC cases and 3973 cases without PSaC. Symptoms were assessed through the Sport Concussion Assessment Tool-3rd edition symptom checklist during the initial 14 days after concussion. Individual symptom scores and symptom cluster scores were collected as outcomes. We conducted separate generalized linear mixed models for each symptom and symptom cluster using ordinal distribution. Effects included group main effect, time main effect, and its interaction (group × time).

There were significant interactions for all individual symptoms and symptom clusters (p < 0.001). Post-hoc analysis revealed that the PSaC group experienced significantly more severe symptoms across 14 days post-concussion for all individual symptoms and symptom clusters, relative to the NoPSaC group. The highest symptom score reported was headaches followed by 'pressure in head' during the first week of the injury.

Our findings highlighted the significant differences in symptom recovery patterns between individuals with and without PSaC. The PSaC group reported significantly higher symptom scores and showed less consistent, slower, and less pronounced symptom improvement across concussion recovery. In contrast, the NoPSaC group showed consistent symptom improvement.