Removal From Play After Concussion and Recovery Time

Pediatrics. 2016 Sep;138(3):e20160910. doi: 10.1542/peds.2016-0910.


Objective: Despite increases in education and awareness, many athletes continue to play with signs and symptoms of a sport-related concussion (SRC). The impact that continuing to play has on recovery is unknown. This study compared recovery time and related outcomes between athletes who were immediately removed from play and athletes who continued to play with an SRC.

Methods: A prospective, repeated measures design was used to compare neurocognitive performance, symptoms, and recovery time between 35 athletes (mean ± SD age, 15.61 ± 1.65 years) immediately removed after an SRC (REMOVED group) compared with 34 athletes (mean ± SD age, 15.35 ± 1.73 years) who continued to play (PLAYED group) with SRC. Neurocognitive and symptom data were obtained at baseline and at 1 to 7 days and 8 to 30 days after an SRC.

Results: The PLAYED group took longer to recover than the REMOVED group (44.4 ± 36.0 vs 22.0 ± 18.7 days; P = .003) and were 8.80 times more likely to demonstrate protracted recovery (≥21 days) (P < .001). Removal from play status was associated with the greatest risk of protracted recovery (adjusted odds ratio, 14.27; P = .001) compared with other predictors (eg, sex). The PLAYED group exhibited significantly worse neurocognitive and greater symptoms than the REMOVED group.

Conclusions: SRC recovery time may be reduced if athletes are removed from participation. Immediate removal from play is the first step in mitigating prolonged SRC recovery, and these data support current consensus statements and management guidelines.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Athletic Injuries / complications*
  • Brain Concussion / complications*
  • Child
  • Cognition Disorders / etiology
  • Female
  • Humans
  • Male
  • Memory Disorders / etiology
  • Neuropsychological Tests
  • Prospective Studies
  • Reaction Time
  • Recovery of Function*
  • Rest*
  • Young Adult