Predicting time to clearance of sport-related concussions using machine learning

To evaluate whether integrating longitudinal clinical data improves machine learning (ML)-based prediction of time to medical clearance following sport-related concussion (SRC) and to identify clinical features most strongly associated with classification of either 'prolonged' recovery (≥ 30 days) or 'normal' recovery (< 30 days).

A retrospective cohort of 217 athletes (mean age 26.94 years) from the USF Concussion Center (2021-2025) was analyzed. Six ML classifiers were trained on Visit 1 features (n = 48) and combined Visit 1 + Visit 2 features (n = 95). Internal validation was performed using Leave-One-Out Cross-Validation (LOOCV).

Prolonged recovery occurred in 81.1% of the cohort. Adding Visit 2 features improved accuracy in 66% of models, with XGBoost achieving the highest accuracy (0.84, +5% gain over Visit 1). Specificity remained low (0.00-0.34) due to class imbalance. VOR Vertical Headache and its change score were the most frequent predictors of prolonged recovery, present in 81% and 100% of models, respectively. Treatment presence between visits emerged as the strongest predictor of normal recovery.

Longitudinal clinical data modestly improves ML-based SRC recovery predictions. Vestibulo-oculomotor symptoms - particularly headache provoked during vertical VOR testing - are robust prognostic indicators. These findings support the utility of granular VOMS subscores for early risk stratification and targeted rehabilitation. External validation is required before clinical deployment. Code: https://github.com/MeganTran6023/Sport-Related-Concussions_Machine-Learning. IRB: USF STUDY003514.