Tested positive for COVID? Be careful out there

Higher concussion rates following COVID-19 infection in high school athletes.

Bullock GS, Emery CA, Nelson VR, etc. al, Br J Sports Med2023; [epub ahead of print]. two: 10.1136/brjsports-2022-106436.

Full text freely available

Take home message

Athletes who tested positive for a COVID-19 infection were more likely to suffer a concussion within 60 days of recovering from the infection than athletes who did not contract COVID-19.

Background

COVID-19 affects the respiratory, cardiovascular and nervous systems. In some cases, COVID-19 can lead to long-term consequences (e.g. impaired cognition). It is currently unknown whether COVID-19 infection affects the risk of sports-related concussions.

Study aim

Bullock and colleagues completed a prospective cohort study to compare concussion rates between high school athletes who recently tested positive for COVID-19 and those who did not.

Methods

The authors recruited athletes from high schools in six states. A certified athletic trainer recorded all cases of COVID-19 infection or concussion. If an athlete reported COVID-like symptoms or had an elevated temperature during a daily screening, the athletic trainer administered a COVID test. The research team also recorded when an athlete participated in a training or competition. The authors focused on the number of concussions within 60 days after an athlete returned to play following a COVID-19 infection. All data was recorded in the Players Health Rehab system, including demographic information, sports and illness data for all athletes.

Results

A total of 72,522 athletes participated in high school sports at the affected school during the 2020-2021 school year. Of these athletes, 430 had COVID-19 infections. Of the athletes with a COVID-19 infection, 32 had a concussion, and 1,241 athletes without COVID-19 had a concussion. An athlete with a history of COVID-19 was approximately 3 times more likely to suffer a concussion within 60 days of returning to play than an athlete without COVID-19.

Viewpoints

Overall, the authors found that prior COVID-19 infection increased the risk of concussion during the first 60 days after recovery from COVID-19. Therefore, the effects of a COVID-19 infection may linger after returning to play. Knowing whether this applies to other sports-related injuries would be interesting. Additionally, learning why these athletes are at greater risk for concussion (e.g., deconditioning, persistent symptoms) can help us develop prevention strategies and make informed decisions about when and how to release an athlete to play following a COVID-19 infection.

Clinical implications

Doctors should explain to patients with COVID-19 that they may experience lingering effects that predispose them to concussion. We need to help the patient make an informed decision about when to return to play after COVID-19 infection. Once an athlete returns, doctors should monitor these patients for concussions.

Questions for discussion

What other measures have you implemented in your clinical practice to monitor athletes after COVID-19 infection? Is a COVID-19 infection something you are currently documenting?

Written by Kyle Harris
Reviewed by Jeffrey Driban

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