Trends in concussion return-to-play timelines among high school athletes from 2007 through 2009

J Athl Train. 2013 Nov-Dec;48(6):836-43. doi: 10.4085/1062-6050-48.6.17. Epub 2013 Oct 23.


Context: Whereas guidelines about return-to-play (RTP) after concussion have been published, actual prognoses remain elusive.

Objective: To develop probability estimates for time until RTP after sport-related concussion.

Design: Descriptive epidemiology study.

Setting: High school.

Patients or other participants: Injured high school varsity, junior varsity, or freshman athletes who participated in 1 of 13 interscholastic sports at 7 area high schools during the 2007-2009 academic years.

Intervention(s): Athletic trainers employed at each school collected concussion data. The athletic trainer or physician on site determined the presence of a concussion. Athlete-exposures for practices and games also were captured.

Main outcome measure(s): Documented concussions were categorized by time missed from participation using severity outcome intervals (same-day return, 1- to 2-day return, 3- to 6-day return, 7- to 9-day return, 10- to 21-day return, >21-day return, no return [censored data]). We calculated Kaplan-Meier time-to-event probabilities that included censored data to determine the probability of RTP at each of these time intervals.

Results: A total of 81 new concussions were documented in 478 775 athlete-exposures during the study period. After a new concussion, the probability of RTP (95% confidence interval) was 2.5% (95% confidence interval = 0.3, 6.9) for a 1- to 2-day return, 71.3% (95% confidence interval = 59.0, 82.9) for a 7- to 9-day return, and 88.8% (95% confidence interval = 72.0, 97.2) for a 10- to 21-day return.

Conclusions: For high school athletes, RTP within the first 2 days after concussion was unlikely. After 1 week, the probability of return rose substantially (approximately 71%). Prognostic indicators are used to educate patients about the likely course of disease. Whereas individual symptoms and recovery times vary, prognostic time-to-event probabilities allow clinicians to provide coaches, parents, and athletes with a prediction of the likelihood of RTP within certain timeframes after a concussion.

MeSH terms

  • Adolescent
  • Athletes
  • Athletic Injuries / epidemiology*
  • Athletic Injuries / rehabilitation*
  • Brain Concussion / diagnosis*
  • Brain Concussion / epidemiology*
  • Female
  • Humans
  • Male
  • Return to Work / statistics & numerical data*
  • Schools
  • Sports
  • Students