Age Differences in Recovery Following Concussions Addressed at Youth Sports Safety Summit

Source: National Athletic Trainers' Association

New Research Published Online Today

ALEXANDRIA, Va., March 15, 2016 – At the seventh Youth Sports Safety Summit this morning, leading health care experts released a new study – “Age Differences in Recovery After Sport-Related Concussion: A Comparison of High School and Collegiate Athletes.” The event was convened by the National Athletic Trainers’ Association and the Youth Sport Safety Alliance, comprising nearly 260 sports and health organizations committed to sport safety. Advance released online today in the Journal of Athletic Training, NATA’s scientific publication, the research sheds new light on traditionally held beliefs regarding return-to-play considerations. It has been hypothesized that younger age may be a risk factor for prolonged recovery following concussion yet few studies have directly evaluated age differences:  https://natajournals.org/doi/full/10.4085/1062-6050-51.4.04.  

More than 7.8 million students participate in organized secondary school athletics in the United States, and more than 460,000 student athletes across 23 sports represent their colleges in athletic participation. It is estimated that 2 million injuries occur annually to secondary school athletes and approximately 209,000 yearly at the collegiate level. Among children, those ages 12-15 experience the highest rate of emergency room visits for concussion (47 percent). 

“There have been significant strides in recent years to document the natural course of clinical recovery following sport-related concussion (SRC), with most athletes demonstrating full recovery within five to seven days,” says lead author Lindsay Nelson, PhD, assistant professor of neurosurgery and neurology, Medical College of Wisconsin, Milwaukee. “This includes recovery of symptoms, cognitive and balance measures. However, the majority of this work has been done in the collegiate setting and researchers have questioned whether these findings generalize to younger athletes.”

In an effort to answer that question, the authors of this multicenter prospective study analyzed concussed athletes (a total of 621: 545 males and 76 females) and a control group of 150 non-injured athletes participating in high school and collegiate contact and collision sports. Seventy-nine percent participated in football; 15.7 percent in soccer and the remainder in lacrosse or ice hockey.

Their findings suggest that there is no clinically significant age difference in recovery following SRC, and therefore, separate injury management protocols for high school and collegiate athletes are not needed.

There are numerous biomechanical and neurologic factors why children and adolescents may manifest differences in response to head trauma and recovery following SRC than adults. Prior research has revealed poorer outcomes after moderate to severe traumatic brain injuries in children as compared to adults and has suggested that children are particularly sensitive to rare cerebral edema after mild head injuries. 

Due to concern that immature brains may demonstrate more prolonged or incomplete recovery, current consensus guidelines regarding SRC encourage caution in managing youth. The authors studied multiple measures commonly used in clinical practice, including components of the Sport Concussion Assessment Tool and traditional paper and pencil neuropsychological measures. They expected to observe minimal to no differences between the two age groups in the rate of symptom recovery, with slightly longer (roughly two days) cognitive recovery for high school athletes.

Data collection was from 1999-2003 and aggregated from the NCAA Concussion Study, composed of Division I, II and III football players at 15 universities across the United States; Project Sideline, which followed high school football, hockey and soccer players in the Milwaukee, Wisconsin, area; and the Concussion Prevention Initiative, a study of male and female high school and college athletes mostly in the southeastern U.S. Athletes were evaluated by an athletic trainer or team physician at baseline, immediately following injury and at intervals from day one to 90 post-injury.

“From a historic perspective, it is interesting to note that these findings were determined well before the rapid increase in concussion education and awareness and advances regarding diagnoses of concussion. Importantly, we continue to see the same findings in more recent studies of concussed athletes.”

Comparisons of concussed high school and collegiate athletes to each other and to non-injured controls revealed equivalent rates of recovery in symptom and balance measures. Cognitive recovery appeared equivalent or 1-2 days longer in high school athletes, depending on the type of comparison performed. Group level recovery occurred at or before 7 days post injury on all assessments metrics.

“Our findings differ from current consensus guidelines suggesting that more conservative injury management practices may be needed for child and adolescent athletes versus adults,” says Nelson. “Our finding of high overlap in the rate of clinical recovery implies that protocols need not differ, at least not due to assumptions of differences in clinical recovery rates. Further study will be needed to understand whether neurobiological recovery occurs at equivalent rates for athletes of different ages or developmental levels.”

Nelson also notes that guidelines to allow concussed athletes to rest after injury need to be weighed against practical demands such as attending school, particularly for younger athletes. “Participating in cognitively demanding activity soon after concussive injury can exacerbate symptoms, but in general concussed athletes are encouraged to re-engage in school as soon as they are able and to prioritize return-to-school over return-to-sport participation.” The authors also observe that validating assessment for protocols younger than the high school level remains another area for continued research.

For additional resource information please visit:

National Athletic Trainers’ Association Position Statement: Management of Sport Concussion:

https://natajournals.org/doi/pdf/10.4085/1062-6050-49.1.07

About NATA: National Athletic Trainers’ Association (NATA) – Health Care for Life & Sport

Athletic trainers are health care professionals who specialize in the prevention, diagnosis, treatment and rehabilitation of injuries and sport-related illnesses. They prevent and treat chronic musculoskeletal injuries from sports, physical and occupational activity, and provide immediate care for acute injuries. Athletic trainers offer a continuum of care that is unparalleled in health care. The National Athletic Trainers' Association represents and supports 43,000 members of the athletic training profession. Visit www.nata.org.

About the Youth Sports Safety Alliance:

Since 2010, the Youth Sports Safety Alliance has worked to raise awareness, advance legislation and improve medical care for young athletes across the country. High school athletes suffer 2 million injuries; 200,000 doctor visits and 30,000 hospitalizations every year. The alliance is committed to reducing those numbers and improving the health and safety of young athletes. The YSSA was founded by the National Athletic Trainers’ Association and now includes nearly 260 member organizations. Visit: www.youthsportssafetyalliance.org