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The Interval Between Concussions Does Not Influence Time to Asymptomatic or Return to Play: A CARE Consortium Study

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Abstract

Introduction

The purpose of this study was to determine if the time interval between two concussive events influences the number of days to asymptomatic status, days to return to play, or performance on common post-concussion assessments following the second concussion.

Methods

Data from 448 collegiate athletes and service academy cadets with two concussions (time between concussions: median 295.0 days [interquartile range: 125.0–438.2]), 40.0% female) were analyzed from Concussion Assessment Research and Education (CARE) Consortium institutions between 2014 and 2020. Days between concussions was the primary predictor variable. Primary outcome measures included time to asymptomatic and time to return to play following the second concussion. Secondary outcome measures included total number of symptoms, total symptom severity, Balance Error Scoring System total score, and Standardized Assessment of Concussion total score within 48 h of their second concussion.

Results

Time between concussions did not significantly contribute to the multivariate time to asymptomatic (p = 0.390), time to return to play (p = 0.859), or the secondary outcomes (p-range = 0.165–0.477) models. Time to asymptomatic (p = 0.619) or return to play (p = 0.524) did not differ between same-season and different-season concussions. Sex significantly contributed to the return to play (p = 0.005) multivariate model. Delayed symptom onset and immediate removal from play/competition significantly contributed to the total number of symptoms (p = 0.001, p = 0.014) and symptom severity (p = 0.011, p = 0.022) multivariate models.

Conclusion

These results suggest that in a population with a large period between injuries, the time between concussions may not be relevant to clinical recovery.

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Acknowledgements

This project was supported, in part, by the Grand Alliance Concussion Assessment, Research, and Education (CARE) Consortium, funded, in part by the National Collegiate Athletic Association (NCAA) and the Department of Defense (DOD). The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702-5014 is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under Award NO W81XWH-14-2-0151. Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Department of Defense (DHP funds). CARE Consortium Investigators: Stefan M. Duma, PhD (Director, Institute for Critical Technology and Applied Science (ICTAS) Virginia Tech), Paul F. Pasquina, MD (Walter Reed National Military Medical Center, Defense Health Agency, Uniformed Services University of the Health Sciences), Alison Brooks, MD MPH (Department of Orthopedics, University of Wisconsin-Madison), Louise A. Kelly, PhD (California Lutheran University), Holly J. Benjamin, MD, FAAP, FACSM, FAMSSM (Director of Primary Care Sports Medicine, University of Chicago), James T. Eckner, MD, MS (Department of PM&R, Director of Clinical Research, Michigan NeuroSport, PM&R Concussion Program), Joseph B. Hazzard, Jr., ATC, NBCC TM (Clinical Director, Health & Human Performance Institute, University of Houston-Clear Lake), Adam Susmarski, DO, FACSM (Department Head Brigade Orthopaedics and Sports Medicine, United States Naval Academy Team Physician), Christina L. Master, MD, FAAP, CAQSM, FACSM, FAMSSM (University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia), April Hoy MS, ATC, CSCS (Department of Athletics, School of Behavioral and Applied Sciences, Azusa Pacific University), Justus Ortega, PhD (California State Polytechnic University, Humboldt) , Thomas Buckley, EdD, ATC (Department of Kinesiology & Applied Physiology, University of Delaware), Megan H. Roach, PhD, ATC (Musculoskeletal Health Specialist, Womack Army Medical Center), Thomas W. Kaminski, PhD, ATC, FNAK, FNATA, FACSM, RFSA (Director of the Athletic Training Research Laboratory, University of Delaware), Luis A. Feigenbaum, PT, DPT, ATC/L (Clinical Associate Professor—Leonard A Miller School of Medicine at the University of Miami, Senior Associate Athletics Director—Performance, Health and Wellness).

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Authors and Affiliations

  1. UGA Concussion Research Laboratory, Department of Kinesiology, Ramsey Student Center, University of Georgia, 330 River Rd., Athens, GA, 30602, USA

    Eric J. Shumski, Robert C. Lynall & Julianne D. Schmidt

  2. Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    Shawn R. Eagle

  3. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    Anthony P. Kontos

  4. Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    Jeffrey J. Bazarian

  5. The Ohio State University Chronic Brain Injury Program, The Ohio State University College of Medicine, Columbus, OH, USA

    Jaclyn B. Caccese

  6. Division of Adolescent Medicine, University of Washington, Seattle, USA

    Sara P. D. Chrisman

  7. Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA

    James R. Clugston

  8. Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA

    Thomas W. McAllister

  9. Medical College of Wisconsin, Milwaukee, WI, USA

    Michael McCrea

  10. Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA

    Steven P. Broglio

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  1. Eric J. Shumski
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Consortia

CARE Consortium Investigators

  • Stefan M. Duma
  • , Paul F. Pasquina
  • , Alison Brooks
  • , Louise A. Kelly
  • , Holly J. Benjamin
  • , James T. Eckner
  • , Joseph B. Hazzard Jr.
  • , Adam Susmarski
  • , Christina L. Master
  • , April Hoy
  • , Justus Ortega
  • , Thomas Buckley
  • , Megan H. Roach
  • , Thomas W. Kaminski
  •  & Luis A. Feigenbaum

Corresponding author

Correspondence to Eric J. Shumski.

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Author Contributions

All authors contributed to the study conception, study design, critical review, and interpretation of findings, and drafting and/or critique of the manuscript. All authors read and approved the final manuscript. The CARE Consortium Investigators contributed to critique and review of methodology, data analysis, and original manuscript review.

Funding

This project was supported, in part, by the Grand Alliance Concussion Assessment, Research, and Education (CARE) Consortium, funded, in part, by the National Collegiate Athletic Association (NCAA) and the Department of Defense (DOD). The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702–5014 is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under Award NO W81XWH-14–2-0151. Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Department of Defense (DHP funds).

Conflicts of Interest

Bazarian: Abbott (research support, speaking fees), BrainBox (research support), BrainScope (research support); All authors received funding from the National Collegiate Athletic Association and/or the Department of Defense to complete this investigation and cover travel costs related to the study.

Availability of Data and Material

The CARE Consortium datasets generated and analyzed during the current study are available in the FITBIR repository (https://fitbir.nih.gov/).

Ethics Approval

All study procedures were reviewed and approved by the University of Michigan IRB, the US Army Medical Research and Materiel Command Human Research Protection Office (HRPO), as well the local IRB at each of the performance sites. The study was performed in accordance with the standards of ethics outlined in the Declaration of Helsinki.

Consent to Participate

Participants provided written informed consent prior to participation.

Additional information

The Members of the CARE Consortium Investigators are Mentioned in Acknowledgments section.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 234 KB)

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Shumski, E.J., Eagle, S.R., Kontos, A.P. et al. The Interval Between Concussions Does Not Influence Time to Asymptomatic or Return to Play: A CARE Consortium Study. Sports Med (2024). https://doi.org/10.1007/s40279-024-02015-2

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