Gender-specific predictors of long-term recovery from concussion
Early psychological symptoms predict concussion recovery time in middle and high school athletes.
[ PMC gratis artikel ][ PubMed ]Wilmoth K, Tan A, Tarkenton T, Rossetti HC, Hynan LS, Didehbani N, Miller SM, Bell KR, Cullum CM. J Clin Exp Neuropsychol. 2022 May;44(4):251-257. doi: 10.1080/13803395.2022.2118676. Epub 8 Sep 2022. PMID:36073744.
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Take home message
Middle and high school athletes who reported more concussion symptoms and sleep problems, as well as post-traumatic memory loss, were more likely to have long-term recovery than peers without these concerns. Additionally, depressive symptoms can help identify men at risk for a prolonged recovery.
Background
Recovery from a concussion is quite variable. Therefore, determining risk factors for long-term recovery is essential to provide appropriate patient care to reduce this risk. Several risk factors for prolonged post-injury recovery have been identified (e.g., emotional symptoms, sleep disturbances). However, these factors have not been well established in college athletes.
Study aim
The authors analyzed clinical data from middle and high school athletes to investigate whether post-concussion psychological factors and sleep symptoms predict long-term recovery.
Methods
The authors recruited 393 high school students (~15 years old; 45% female) to complete 3 surveys within 14 days of injury (~6 days of injury), which is part of a larger study through Con Tex. completed the 3 questionnaires during their clinical evaluation: 1. 7-item Generalized Anxiety Disorder Scale (GAD-7), which screened for anxiety; 2. The eight-item patient questionnaire (PHQ-8) to assess whether depression is present; and 3. The Pittsburg Sleep Quality Index (PSQI) to evaluate sleep quality. The authors located the provider’s documented date of symptom resolution through a medical record review.
Results
A total of 17% (n=66) needed more than 30 days to recover. The authors found that post-traumatic memory loss, worse concussion scores, and poorer sleep quality predicted longer concussion recovery. In women, only more severe concussion symptoms predicted longer recovery. In men, on the other hand, greater depression and post-traumatic memory loss are related to long-term recovery.
Viewpoints
Someone with more severe symptoms or poor sleep quality within the first two weeks after a concussion may have a greater chance of long-term recovery from the concussion. However, the authors found that there were different predictors when they looked at sex. Women with greater symptom severity were more likely to have a long recovery. At the same time, men were more likely to have a long recovery if they had worse depression symptoms or post-traumatic memory loss. It is worth noting that although sleep, anxiety and depressive symptoms were predictive factors, the overall scores were low, indicating that they were unlikely to experience high levels of anxiety, depression or sleep disturbance.
Clinical implications
Medical professionals should screen patients after a concussion for signs of anxiety, depression, or sleep disturbance, because even subtle signs can increase the likelihood of long-term recovery. These assessments can help identify problems early and lead to a more targeted concussion plan.
Questions for discussion
Have you noticed any specific predictors associated with your athlete’s recovery? How do you incorporate concussion risk into your concussion education/management/basic protocol?
related posts
- Wake-up call for collegiate athletes’ sleep: narrative review and consensus recommendations from the NCAA Interassociation Task Force on Sleep and Wellness
- A few more hours of sleep, my baseline for your athletes
- Typical versus prolonged recovery time and predictors after concussion in high school and college athletes
- In patients who report persistent symptoms after a concussion, groups of symptoms occur together
Written by: Jane McDevitt
Review by: Jeffrey Driban
