A systematic review of criteria used to define recovery from sport-related concussion in youth athletes. Issue 18 (22nd July 2017)

• Record Type: Journal Article
• Authors: Haider, Mohammad Nadir; Leddy, John J; Pavlesen, Sonja; Kluczynski, Melissa; Baker, John G; Miecznikowski, Jeffrey C; Willer, Barry S
• Is Part Of: British journal of sports medicine. Volume 52:Issue 18(2018)
• Page Start: 1179
• Page End: 1190
• Publication Date: 2017-07-22
• Subjects: sport-related concussion -- recovery -- mild traumatic brain injury -- student athlete -- return to play; Sports medicine -- Periodicals; 617.1027
• DOI: 10.1136/bjsports-2016-096551
• Languages: English
• ISSNs: 0306-3674

Abstract

Abstract : Objective: The Concussion in Sport Group guidelines recommend a multifaceted approach to help clinicians make return to sport decisions. The purpose of this study was to identify the most common multifaceted measures used to define clinical recovery from sport-related concussion in young athletes (high school and/or college level) and to summarise existing knowledge of criteria used to make return to sport decisions. Design: Systematic review. Data sources: The PubMed (MEDLINE), SPORTDiscus and Embase electronic databases were searched from 1 January 2000 to 1 March 2017 by three independent reviewers. Eligibility criteria: Inclusion criteria: elementary, high school and college age groups, and a specific definition of clinical recovery that required two or more measures. Exclusion criteria: review articles, articles using the same sample population, case studies, non-English language and those that used one measure only or did not specify the recovery measures used. Study quality: Study quality was assessed using the Downs and Black Criteria. Results: Of 2023 publications, 43 met inclusion criteria. Included articles reported the following measures of recovery: somatic symptom resolution or return to baseline (100%), cognitive recovery or return to baseline (86%), no exacerbation of symptoms on physical exertion (49%), normalisation of balance (30%), normal special physical examination (12%), successful return to school (5%), no exacerbation of symptoms with cognitive exertion (2%) and normalisation of cerebral blood flow (2%). Follow-up to validate the return to sport decision was reported in eight (19%) articles. Most studies were case–control or cohort (level of evidence 4) and had significant risk of bias. Conclusion: All studies of sport-related concussion use symptom reports to define recovery. A minority of studies used multiple measures of outcome or had clearly defined recovery criteria, the most common being a combination of a self-reported symptom checklist and a computerised neurocognitive test. Future studies ideally should define recovery a priori using objective physiological measures in addition to symptom reports.