Early concussion treatment tied to faster recovery

By Lisa Rapaport

By Lisa Rapaport

(Reuters Health) - Young athletes who get concussions may recover faster when they're treated within the first week than when they wait longer to get care, a new study suggests.

Researchers examined data on 162 athletes ages 12 to 22who were diagnosed with concussions. Recovery time averaged 57 days, and ranged from 9 to 299 days.

Compared with athletes who started treatment within a week, those who didn't receive care that quickly were over four times more likely to have a recovery that took more than 30 days, the study found.

"There was an assumption that only patients with more severe symptoms and impairment following concussion would benefit from early care, which typically involved prescribed rest and restricted activities," said lead author Anthony Kontos, research director of the Sports Medicine Concussion Program at the University of Pittsburgh Medical Center.

"However, our research shows that regardless of symptoms and impairments, patients who seek specialty care earlier have better outcomes and recover sooner than those who seek care later."

A concussion is a traumatic brain injury caused by a jolt to the head or body that disrupts the function of the brain. This injury can result in physical, cognitive, emotional or sleep-related symptoms that may or may not involve a loss of consciousness. The symptoms can last from several minutes to days, weeks, months or longer.

More than half of athletes who sustain concussions don't receive care beyond an initial evaluation or diagnosis around the time of injury, researchers note in JAMA Neurology.

In the current study, recovery times from when athletes started follow-up concussion care were similar, suggesting that differences in recovery trajectories were due to the number of days they waited to begin treatment.

At their first follow-up checkups, athletes who received care within a week and those who took longer to start treatment had similar symptom severity as well as similar levels of impairment in areas like cognitive ability, vision, sleep and balance.

Later initiation of treatment as well as more severe vision and motion-related symptoms at diagnosis were both associated with much longer recovery times.

One limitation of the study is that researchers lacked data on how closely athletes followed any prescribed treatments or rehabilitation programs, how soon athletes returned to practice or competition, and how quickly they resumed regular academic work. All these factors could influence concussion recovery time.

Athletes may be advised on when to resume exercise or school work based on the severity of their injuries and their progress in treatment, said Jingzhen Yang of the Center for Injury at Nationwide Children's Hospital in Columbus, Ohio.

"Specifically, athletes may be advised on things they should avoid, such as strict rest or excessive physical activity, as these could result in increased symptoms or delayed recovery," Yang, who wasn't involved in the study, said by email. "Athletes may also be encouraged to engage in the symptom-limited, light physical activity as these could help mitigate symptoms and hasten concussion recovery."

Earlier treatment may help athletes receive therapy targeted to their specific combination of symptoms, which might include some mix of anxiety, mood swings, sleep difficulties, balance problems, dizziness, vision impairment, attention deficits and cognitive problems.

Although the study didn't explain why some athletes waited longer than others for care, it's possible many either were unaware of the need for rapid follow-up treatment or were unable to find or afford specialists, Yang said.

"It is imperative that student-athletes and parents understand that delayed presentation for clinical care after concussion may result in prolonged symptom duration, whereas early presentation for clinical care after concussion may lead to a shorter symptom duration and recovery time," Yang said.


SOURCE: https://bit.ly/30a5Nb9 JAMA Neurology, online January 6, 2020.