Sport-related concussion: factors associated with prolonged return to play

Clin J Sport Med. 2004 Nov;14(6):339-43. doi: 10.1097/00042752-200411000-00003.


Objective: To assess predictive value of concussion signs and symptoms based on return-to-play timelines.

Design: Physician practice study without diagnosis that includes presentation, initial and subsequent treatment, and management of concussion.

Setting: National multisite primary care sports medicine provider locations.

Participants: Twenty-two providers at 18 sites; 101 athletes (91 men, 10 women in the following sports: 73 football, 8 basketball, 8 soccer, 3 wrestling, 2 lacrosse, 2 skiing, 5 others; 51 college, 44 high school, 4 professional, and 2 recreational).

Main outcome measurements: Duration of symptoms, presence of clinical signs, and time to return to play following concussion.

Results: One hundred one concussions were analyzed. Pearson chi2 analysis of common early and late concussion symptoms revealed statistical significance (P < 0.05) of headache >3 hours, difficulty concentrating >3 hours, any retrograde amnesia or loss of consciousness, and return to play >7 days. There appeared to be a trend in patients with posttraumatic amnesia toward poor outcome, but this was not statistically significant.

Conclusions: When evaluating concussion, symptoms of headache >3 hours, difficulty concentrating >3 hours, retrograde amnesia, or loss of consciousness may indicate a more severe injury or prolonged recovery; great caution should be exercised before returning these athletes to play.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Athletic Injuries / diagnosis*
  • Athletic Injuries / epidemiology
  • Brain Concussion / epidemiology
  • Brain Concussion / etiology*
  • Brain Concussion / physiopathology*
  • Cohort Studies
  • Female
  • Humans
  • Incidence
  • Injury Severity Score
  • Male
  • Post-Concussion Syndrome / epidemiology
  • Post-Concussion Syndrome / physiopathology*
  • Predictive Value of Tests
  • Probability
  • Prognosis
  • Recovery of Function
  • Risk Factors
  • Sex Distribution
  • Sports*
  • Surveys and Questionnaires
  • Time Factors