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Acute Effects and Recovery Time Following Concussion in Collegiate Football Players
The NCAA Concussion Study
Michael McCrea, PhD;
Kevin M. Guskiewicz, PhD, ATC;
Stephen W. Marshall, PhD;
William Barr, PhD;
Christopher Randolph, PhD;
Robert C. Cantu, MD;
James A. Onate, PhD, ATC;
Jingzhen Yang, MPH;
James P. Kelly, MD
JAMA. 2003;290:2556-2563.
Context Lack of empirical data on recovery time following sport-related concussion hampers clinical decision making about return to play after injury.
Objective To prospectively measure immediate effects and natural recovery course relating to symptoms, cognitive functioning, and postural stability following sport-related concussion.
Design, Setting, and Participants Prospective cohort study of 1631 football players from 15 US colleges. All players underwent preseason baseline testing on concussion assessment measures in 1999, 2000, and 2001. Ninety-four players with concussion (based on American Academy of Neurology criteria) and 56 noninjured controls underwent assessment of symptoms, cognitive functioning, and postural stability immediately, 3 hours, and 1, 2, 3, 5, 7, and 90 days after injury.
Main Outcome Measures Scores on the Graded Symptom Checklist (GSC), Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), and a neuropsychological test battery.
Results No player with concussion was excluded from participation; 79 players with concussion (84%) completed the protocol through day 90. Players with concussion exhibited more severe symptoms (mean GSC score 20.93 [95% confidence interval {CI}, 15.65-26.21] points higher than that of controls), cognitive impairment (mean SAC score 2.94 [95% CI, 1.50-4.38] points lower than that of controls), and balance problems (mean BESS score 5.81 [95% CI, –0.67 to 12.30] points higher than that of controls) immediately after concussion. On average, symptoms gradually resolved by day 7 (GSC mean difference, 0.33; 95% CI, -1.41 to 2.06), cognitive functioning improved to baseline levels within 5 to 7 days (day 7 SAC mean difference, -0.03; 95% CI, -1.33 to 1.26), and balance deficits dissipated within 3 to 5 days after injury (day 5 BESS mean difference, -0.31; 95% CI, -3.02 to 2.40). Mild impairments in cognitive processing and verbal memory evident on neuropsychological testing 2 days after concussion resolved by day 7. There were no significant differences in symptoms or functional impairments in the concussion and control groups 90 days after concussion.
Conclusions Collegiate football players may require several days for recovery of symptoms, cognitive dysfunction, and postural instability after concussion. Further research is required to determine factors that predict variability in recovery time after concussion. Standardized measurement of postconcussive symptoms, cognitive functioning, and postural stability may enhance clinical management of athletes recovering from concussion.
Author Affiliations: Neuroscience Center, Waukesha Memorial Hospital, Waukesha, Wis (Dr McCrea); Department of Neurology, Medical College of Wisconsin, Milwaukee, (Dr McCrea); Departments of Exercise and Sport Science (Drs Guskiewicz and Cantu), Orthopedics (Drs Guskiewicz and Marshall), and Epidemiology (Dr Marshall), and Injury Prevention Research Center (Drs Guskiewicz and Marshall and Ms Yang), University of North Carolina at Chapel Hill; Department of Neurology, New York University School of Medicine, New York (Dr Barr); Chicago Neurological Institute (Drs Randolph and Kelly) and Department of Neurology, Northwestern University Feinberg School of Medicine (Dr Kelly), Chicago, Ill; Department of Neurology, Loyola University Medical School, Maywood, Ill (Dr Randolph); Neurosurgery Service, Emerson Hospital, Concord, Mass (Dr Cantu); and Department of Rehabilitation Sciences Athletic Training Program, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Mass (Dr Onate).
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