Age May Play Role in Recovery from Sports-Related Concussions, Pitt Researchers Find—Study may have serious implications for return-to-play guidelines for high school athletes

By Susan Manko

In the first published study to examine age as a factor, University of Pittsburgh researchers found that high school athletes demonstrated prolonged memory dysfunction requiring longer recovery, compared with college athletes.

The study’s results, published in the May 19 issue of the Journal of Pediatrics, supports more conservative management and comprehensive assessment of the concussed high school athlete and may have serious implications for return-to-play guidelines and decisions involving high school athletes.

In the study, postconcussion neuropsychological recovery of high school athletes was compared to that of college athletes at 24 hours, 3 days, 5 days, and 7 days postinjury. In tests of neurocognitive function and self-reported symptoms, high school athletes performed significantly worse than age-matched control subjects at 7 days postinjury.

Concussed college athletes, despite sustaining more severe injuries, displayed commensurate performance with age-matched control subjects by day 3 postinjury. Specifically, following mild concussion, high school athletes showed significant memory impairment at day 7; conversely, college athletes revealed significant memory deficits only within the first 24 hours postinjury.

“Our finding that high school athletes did not recover from concussion as quickly as college athletes is a cause for concern because the largest majority of at-risk athletes are at the high school level or below,” said principal investigator Melvin Field, chief resident in Pitt’s Department of Neurological Surgery. “Furthermore, existing return-to-play guidelines assume a standard use for all age groups and levels of play, from school-age to professional. Our study is the first to suggest that there may be differing vulnerabilities to concussion at different ages and that current guidelines may not be appropriate for all age groups,” said Field.

At least 1.5 million high school and college athletes compete in contact sports. Recent studies show that more than 62,000 concussions occur each year in high school sports, with football accounting for about 63 percent of them. At the college level, 34 percent of football players have had at least one concussion and 20 percent have had more than one.

Concussion is a trauma-induced alteration of mental status, which may or may not result in unconsciousness. Other symptoms may include dizziness, disorientation, headache, nausea, amnesia, and poor hand-eye coordination. Concussion occurs when the brain is violently rocked back-and-forth inside the skull, due to a blow to the head, neck, or upper body.

“The problem with concussion in sports is that symptoms are not always straightforward, not always reported by the athlete, and usually difficult to objectively measure,” said study coinvestigator Joseph Maroon, professor and vice chair of the Department of Neurological Surgery at Pitt.

“Meanwhile, the typically competitive high school athlete is usually quite anxious to return to the game despite any minor symptoms. The concern is that previous studies have proven that before an athlete is fully recovered from an initial concussion, he or she is more susceptible to a second concussion and is at higher risk for further, more serious damage. Thus, keeping an athlete out of contact play until he or she is fully recovered from initial concussion is absolutely crucial to preventing further injury,” said Maroon. “No concussed athlete should ever return to contact sports before it is determined that their recovery is complete.”

Field added, “Unfortunately, too many high schools lack qualified full-time sports medicine staff, which increases the risk of concussions going unidentified and inadequately evaluated through the recovery period, thus predisposing the athlete to more serious injury and poor outcome.”

“This study suggests that further studies are needed in children of all ages before current adult-based return-to-play management guidelines are maintained or implemented in high schools and other adolescent-related sports,” said study coinvestigator Mark Lovell, assistant professor in Pitt’s Department of Orthopaedics and director of UPMC’s Sports Medicine Concussion Program. Michael Collins, a clinical instructor in Pitt’s Department of Orthopaedic Surgery and assistant director of the concussion program, was also a study coinvestigator.

The study evaluated 39 high school athletes (19 who sustained concussions and 20 control subjects) and 53 college athletes (35 concussed, 18 control subjects) during the 2000-2001 scholastic sports season.

The average age of the high school athletes was 15.9 years. The average age of the college athletes was 19.9 years. All of the athletes had undergone preinjury baseline testing methods identical to postinjury methods.

For more information on this and previously published sports concussion research studies, visit www.upmc.com.