According to the Centers for Disease Control, a concussion is a “type of traumatic brain injury — or TBI — caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, stretching and damaging the brain cells and creating chemical changes in the brain.” The CDC also estimates 1.6-3.8 million concussions occur in the United States each year.
On average, a person takes seven to 14 days to recover from a concussion, and researchers recently questioned if recovery takes longer in college students who might find it difficult to give themselves time to recover.
“Recovering from a concussion requires active rest and refraining from excessive physical and cognitive stimuli, such as contact sports, reading, writing and even the need for limitation of watching television and online activities, says Prakash Jayabalan, MD, PhD who is lead investigator on the study and is an attending physician at the Rehabilitation Institute of Chicago (RIC) and assistant professor at Northwestern University Feinberg School of Medicine. “These are all things that the average college student encounters on a daily basis and will find challenging to limit. Therefore, our research team wanted to determine if recovery time for patients in a college setting is different from those people outside of that setting.”
To assess this, Dr. Jayabalan and the research team at Northwestern University Student Health Center in Evanston, Ill., reviewed the medical charts of 128 students who were seen for concussion during the 2014-2015 academic year. On average, the students were 20 years old and predominately female (53.1 percent). Forty-four students were varsity athletes, 33 played club sports, 34 played recreational sports, and 17 did not engage in regular physical activity or did not report their activity level when seen.
Dr. Jayabalan’s team found that varsity athletes experienced a shorter duration of concussion symptoms (11.5 days, on average) when compared to club (nearly 19 days) and recreational athletes (nearly 23 days). This, according to Dr. Jayabalan, could be due to the higher amount of medical support student athletes receive.
Female students took longer to recover in comparison to men (nearly 21 days vs. nearly 15 days). People with seizure disorders or prior concussions were more likely to have symptoms that last longer than 28 days. Finally, graduate students took two weeks longer to recover when compared to undergraduates (31 days vs. 16), although the number of graduate students who sustained a concussion was relatively small in this study.
“This is the first cross-sectional study reporting the outcome of concussions at a collegiate institution,” says Dr. Jayabalan, who also notes the need for improved resources for university students who suffer a concussion. “The findings in our study highlight the difficulty in treating collegiate students with concussions, due to both the academic rigors of institutions and the differing needs of student populations. The study also provides insight into at-risk subsets of the student population. Factors such as level of sport, year in school, athlete vs. non-athlete, pre-morbid conditions and gender may affect outcome, and this needs to be an important consideration for the physician managing concussed college students.” As a next step, the research team plans to implement resources for students with concussion and assess the effect of them on the concussion recovery. ###
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An Investigation into the Outcome of Concussions in Students Enrolled at a Collegiate Institution
Prakash Jayabalan, MD, PHD; Natalie Kramer, MED, ATC; Kelly Iwanaga Becker, MS; Brian Vesci, MA, ATC; Rajat Jain, MD; Kristin Abbott, MD
Objectives: The Center for Disease Control and Prevention estimate that 3.8 million concussions occur in the United States annually with average length of time for full resolution of symptoms being 7-14 days. This duration is in the pediatric and sports specific populations, however no prior study has evaluated the outcome of concussions in a collegiate student population. This population is unique in that it is heterogeneous in individual sporting activity (varsity vs. club sports vs. recreational activity) and students can have relatively high academic demands placed on them. The pivotal consensus statement on concussion in sport from the 4th International Conference on Concussions advocates for cognitive rest. Yet maintaining a period of cognitive rest in collegiate students is particularly challenging due to the academic rigors of their schooling.
Investigating the outcome of concussions in a collegiate student population allows us to outline issues that remain unresolved in general concussion management. For example, there are no research studies that have compared the outcome between concussions that occur during ‘sports’ and ‘non-sports’ related activity and the relationship between levels of sports participation at baseline (i.e. varsity vs. club vs. recreational vs. no regular participation) and outcome. It is not known whether in a collegiate student population, there are certain patient-specific factors based on their history and/or clusters of presenting symptoms that may contribute to symptom prolongation. Improved ability to predict prognosis would be beneficial in outlining ‘at risk’ subjects for symptom prolongation, help in academic planning and estimating how long an individual may need to be removed from play or class.
The primary objective of this study, which is the first of its kind, was to investigate the days to symptom resolution in students with a concussion, enrolled at a collegiate institution. Our hypothesis was that students who present to our clinic (a student health center within an academic university) with symptoms of a concussion will have prolonged symptoms compared to the average reported duration nationally (7-14 days).
Design:
Type/Location: Retrospective chart review for the academic year of 2014-2015 of students who presented to our university student health service.
Subject identification: Medical charts from our clinical database of subjects with diagnoses of “concussion,” “post-concussion syndrome,” or “head injury.”
Inclusion/exclusion criteria: We included subjects aged ≥18 years at evaluation and enrolled as a full-time student. Subjects were diagnosed with a concussion using the consensus statement on ‘Concussion in Sport' from the Zurich Guidelines. We excluded subjects not examined within the first 7 days after injury, who did not complain of concussion related symptoms on initial examination, did not complete the Standardized Concussion Assessment Tool (SCAT), and did not provide a specific date of injury or date of symptom resolution.
Symptom clusters: On initial and subsequent evaluations subjects rated their concussion-related symptoms on a scale of 0-6 for 22 symptoms (max. score of 132) using the SCAT. Presenting symptoms from the SCAT were further split into 4 clusters: cognitive, somatic, sleep and emotional components.
Statistical Analyses: Descriptive statistics, independent samples t-tests and a multiple linear regression were utilized.
Results: Of 213 cases identified, 128 subjects fulfilled our inclusion criteria. Average duration of symptoms of a concussion for all subjects was 17.89 days (SD 17.05) the mean age was 20.86 years (SD 3.23) with 46.9% male and 53.1% female. There were 34.4% (n=44) varsity level athletes, 25.8% (n=33) club sports level and 26.6% (n=34) recreational level athletes with 13.3% (n=17) not engaging in regular physical activity or unknown. Subjects who were playing varsity-level sports had significantly less duration of concussion-related symptoms (mean 11.5 days) compared to club (18.61 days, p < 0.001) and recreational level (22.59 days, p < 0.001) athletes. Concussions that were related to sports were shorter in duration (mean 14.96 days) compared to those that were sustained during non-sporting activity (mean 21.75 days). Female students had a longer duration of symptoms compared to male students (20.79 vs. 14.60 days, p < 0.001) and graduate students had more than two weeks longer duration of symptoms compared to undergraduates (16.12 vs. 31.20 days). Statistical analyses showed symptom resolution in subjects with a history of seizure disorder takes approximately 32 days longer than those without and those with a prior concussion were twice as likely to have symptoms for longer than 28 days than those without. The cluster of subject presenting symptoms was not associated with symptom duration.
Conclusions: This is the first cross-sectional study reporting the outcome of concussions at a collegiate institution. The duration of concussion related symptoms appear to be prolonged in our population at approximately 18 days, compared to that reported nationally of 7-14 days. This suggests the need for further support for the general student population. Varsity athletes had significantly less duration of concussion-related symptoms compared to participants who engage in club or recreational sports. This could be due to the higher amount of medical support these athletes receive at our institution or their goal to return to play sooner. In addition, graduate students had a prolonged duration of symptoms compared to undergraduates, as do females students compared to males. Factors which appear to put athletes at increased risk of prolonged symptoms appear to be history of a prior seizure disorder or prior concussions.
The findings in our study highlight the difficulty in treating subjects with concussions at a collegiate institution, due to both the academic rigors and the differing needs of the student population. It also provides insight into at risk subsets of the student population, which needs to be an important consideration for the physician managing the patient. Our study also suggests the potential need for improved resources for the general population of university students who suffer a concussion, similar to those that varsity athletes receive.
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