Frequency and Outcomes of a Symptom-Free Waiting Period After Sport-Related Concussion

Am J Sports Med. 2016 Nov;44(11):2941-2946. doi: 10.1177/0363546516651821. Epub 2016 Jul 1.


Background: Guidelines and practices for the management of sport-related concussion (SRC) have evolved swiftly over the past 2 decades. Despite common recommendations for a symptom-free waiting period (SFWP) before returning to sport, past reports have suggested poor utilization rates for this intervention.

Purpose: To obtain current estimates of the utilization and characterization of SFWPs with high school and collegiate athletes.

Study design: Descriptive epidemiology study.

Methods: Data were extracted from a larger prospective study that followed athletes with SRC across 13 institutions in southeastern Wisconsin from 2012 to 2014. Participants included 143 contact and collision sport athletes who were followed serially through their recoveries after SRCs.

Results: In the current study sample, 99.3% of athletes used an SFWP. The mean self-reported symptom duration was 6.35 days (median, 5 days), with 72.7% reporting symptom recovery within 1 week of injury, 93.7% within 2 weeks, and 99.3% within 30 days. Rate of same-season repeat concussion was low (3.8%) and was similar to or lower than the overall rate of concussion (4.3%). Five same-season repeat concussions occurred at a range of 8 to 42 days after initial injuries.

Conclusion: In comparison with prior published data collected from 1999 to 2004, utilization and duration of SFWPs were higher in the current study samples (99.3% vs 60.3% of athletes reported an SFWP; mean duration, 6.1 vs 3.2 days), and athletes were withheld from sports for more days than previously reported (12.3 vs 7.4 days). Rate of same-season repeat concussion was equivalent to that of prior published data. The findings support improved adherence to clinical management guidelines through increased utilization of SFWPs after SRC.

Keywords: clinical management; concussion; head injury; mild traumatic brain injury; sports; symptom-free waiting period.

MeSH terms

  • Adolescent
  • Athletic Injuries / etiology
  • Athletic Injuries / therapy*
  • Brain Concussion / etiology
  • Brain Concussion / therapy*
  • Female
  • Humans
  • Male
  • Prospective Studies
  • Return to Sport* / statistics & numerical data
  • Watchful Waiting / statistics & numerical data*
  • Wisconsin
  • Young Adult