Age Differences in Recovery After Sport-Related Concussion: A Comparison of High School and Collegiate Athletes

Abstract

Context: Younger age has been hypothesized to be a risk factor for prolonged recovery after sport-related concussion, yet few studies have directly evaluated age differences in acute recovery.

Objective: To compare clinical recovery patterns for high school and collegiate athletes.

Design: Prospective cohort study.

Setting: Large, multicenter prospective sample collected from 1999-2003 in a sports medicine setting.

Subjects: Concussed athletes (n = 621; 545 males and 76 females) and uninjured controls (n = 150) participating in high school and collegiate contact and collision sports (79% in football, 15.7% in soccer, and the remainder in lacrosse or ice hockey).

Main outcome measure(s): Participants underwent evaluation of symptoms (Graded Symptom Checklist), cognition (Standardized Assessment of Concussion, paper-and-pencil neuropsychological tests), and postural stability (Balance Error Scoring System). Athletes were evaluated preinjury and followed serially at several time points after concussive injury: immediately, 3 hours postinjury, and at days 1, 2, 3, 5, 7, and 45 or 90 (with neuropsychological measures administered at baseline and 3 postinjury time points).

Results: Comparisons of concussed high school and collegiate athletes with uninjured controls suggested that high school athletes took 1 to 2 days longer to recover on a cognitive (Standardized Assessment of Concussion) measure. Comparisons with the control group on other measures (symptoms, balance) as well as direct comparisons between concussed high school and collegiate samples revealed no differences in the recovery courses between the high school and collegiate groups on any measure. Group-level recovery occurred at or before 7 days postinjury on all assessment metrics.

Conclusions: The findings suggest no clinically significant age differences exist in recovery after sport-related concussion, and therefore, separate injury-management protocols are not needed for high school and collegiate athletes.

Keywords: adolescents; adults; mild traumatic brain injury.

Figure 1.

Baseline and postinjury performance on the Graded Symptom Checklist. Higher scores reflect more severe symptoms. Error bars indicate 95% confidence intervals.

Figure 2.

Baseline and postinjury performance on the Standardized Assessment of Concussion. Lower scores reflect poorer cognitive performance. Error bars indicate 95% confidence intervals.

Figure 3.

Baseline and postinjury performance on the Balance Error Scoring System. Higher scores reflect more severe postural instability. Error bars indicate 95% confidence intervals.