Optimizing Concussion Care Seeking: A Longitudinal Analysis of Recovery.


Journal

The American journal of sports medicine
ISSN: 1552-3365
Titre abrégé: Am J Sports Med
Pays: United States
ID NLM: 7609541

Informations de publication

Date de publication:
01 2023
Historique:
pubmed: 23 11 2022
medline: 4 1 2023
entrez: 22 11 2022
Statut: ppublish

Résumé

Approximately half of concussions go undisclosed and therefore undiagnosed. Among diagnosed concussions, 51% to 64% receive delayed medical care. Understanding the influence of undiagnosed concussions and delayed medical care would inform medical and education practices. To compare postconcussion longitudinal clinical outcomes among (1) individuals with no concussion history, all previous concussions diagnosed, and ≥1 previous concussion undiagnosed, as well as (2) those who have delayed versus immediate symptom onset, symptom reporting, and removal from activity after concussion. Cohort study; Level of evidence, 2. Participants included 2758 military academy cadets and intercollegiate athletes diagnosed with concussion in the CARE Consortium. We determined (1) each participant's previous concussion diagnosis status self-reported at baseline (no history, all diagnosed, ≥1 undiagnosed) and (2) whether the participant had delayed or immediate symptom onset, symptom reporting, and removal from activity. We compared symptom severities, cognition, balance, and recovery duration at baseline, 24 to 48 hours, date of asymptomatic status, and date of unrestricted return to activity using tests of parallel profiles. The ≥1 undiagnosed concussion group had higher baseline symptom burdens ( Clinicians should expect that cadets/athletes who delay reporting concussion symptoms will have acutely higher symptom burdens and take 2 days longer to become asymptomatic. Educational messaging should emphasize the clinical benefits of seeking immediate care for concussion-like symptoms.

Sections du résumé

BACKGROUND
Approximately half of concussions go undisclosed and therefore undiagnosed. Among diagnosed concussions, 51% to 64% receive delayed medical care. Understanding the influence of undiagnosed concussions and delayed medical care would inform medical and education practices.
PURPOSE
To compare postconcussion longitudinal clinical outcomes among (1) individuals with no concussion history, all previous concussions diagnosed, and ≥1 previous concussion undiagnosed, as well as (2) those who have delayed versus immediate symptom onset, symptom reporting, and removal from activity after concussion.
STUDY DESIGN
Cohort study; Level of evidence, 2.
METHODS
Participants included 2758 military academy cadets and intercollegiate athletes diagnosed with concussion in the CARE Consortium. We determined (1) each participant's previous concussion diagnosis status self-reported at baseline (no history, all diagnosed, ≥1 undiagnosed) and (2) whether the participant had delayed or immediate symptom onset, symptom reporting, and removal from activity. We compared symptom severities, cognition, balance, and recovery duration at baseline, 24 to 48 hours, date of asymptomatic status, and date of unrestricted return to activity using tests of parallel profiles.
RESULTS
The ≥1 undiagnosed concussion group had higher baseline symptom burdens (
CONCLUSION
Clinicians should expect that cadets/athletes who delay reporting concussion symptoms will have acutely higher symptom burdens and take 2 days longer to become asymptomatic. Educational messaging should emphasize the clinical benefits of seeking immediate care for concussion-like symptoms.

Identifiants

pubmed: 36412549
doi: 10.1177/03635465221135771
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S.

Langues

eng

Sous-ensembles de citation

IM

Pagination

214-224

Auteurs

Julianne D Schmidt (JD)

UGA Concussion Research Laboratory and Department of Kinesiology, University of Georgia, Athens, Georgia, USA.

Steven P Broglio (SP)

Michigan Concussion Center and School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA.

Kristen Knight (K)

Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.

Daniel Leeds (D)

Computer and Information Sciences, Fordham University, New York, New York, USA.

Robert C Lynall (RC)

UGA Concussion Research Laboratory and Department of Kinesiology, University of Georgia, Athens, Georgia, USA.

Christopher D'Lauro (C)

Department of Behavioral Sciences and Leadership, United States Air Force Academy, Colorado Springs, Colorado, USA.

Johna Register-Mihalik (J)

Matthew Gfeller Research Center and STAR Heel Performance Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Emily Kroshus (E)

Department of Pediatrics, University of Washington, and Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA.

Michael McCrea (M)

Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

Tom W McAllister (TW)

Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA.

Zachary Y Kerr (ZY)

Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

April Hoy (A)

School of Behavioral and Applied Sciences, Azusa Pacific University, Azusa, California, USA.

Louise Kelly (L)

Department of Exercise Science, California Lutheran University, Thousand Oaks, California, USA.

Christina Master (C)

Division of Orthopedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

Justus Ortega (J)

Department of Kinesiology and Recreation Administration, Humboldt State University, Humbolt, California, USA.

Nicholas Port (N)

School of Optometry, Indiana University, Bloomington, Indiana, USA.

Col Darren Campbell (CD)

Intermountain Sports Medicine, Ogden, Utah, USA.

Col Steven J Svoboda (CSJ)

MedStar Orthopaedic Institute, Alexandria, Virginia, USA.

Margot Putukian (M)

Athletic Medicine, Princeton University, Princeton, New Jersey, USA.

Sara P D Chrisman (SPD)

Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA.

Dianne Langford (D)

Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA.

Gerald McGinty (G)

United States Air Force Academy, Air Force Academy, Colorado, USA.

Jonathan C Jackson (JC)

United States Air Force Academy, Air Force Academy, Colorado, USA.

Kenneth L Cameron (KL)

Keller Army Hospital, United States Military Academy, West Point, New York, USA.

Adam James Susmarski (A)

Department Head Brigade Orthopaedics and Sports Medicine, United States Naval Academy, Annapolis, Maryland, USA.

John DiFiori (J)

University of California, Los Angeles, Los Angeles, California, USA.

Joshua T Goldman (JT)

Departments of Family Medicine and Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA.

Holly Benjamin (H)

Department of Rehabilitation Medicine and Pediatrics, University of Chicago, Chicago, Illinois, USA.

Thomas Buckley (T)

Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA.

Thomas Kaminski (T)

Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA.

James R Clugston (JR)

Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA.

Patrick G O'Donnell (PG)

UMass Memorial Health, Worcester, Massachusetts, USA.

Luis Feigenbaum (L)

Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, Florida, USA.

James T Eckner (JT)

Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA.

Jason P Mihalik (JP)

Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Scott Anderson (S)

University of Oklahoma, Norman, Oklahoma, USA.

Anthony Kontos (A)

Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

M Alison Brooks (MA)

Department of Orthopedics, University of Wisconsin, Madison, Wisconsin, USA.

Christopher Miles (C)

Department of Family and Community Medicine, Wake Forest University, Winston-Salem, North Carolina, USA.

Laura Lintner (L)

Winston-Salem State University, Winston-Salem, North Carolina, USA.
Investigation performed at the University of Georgia, Athens, Georgia, USA.

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