A systematic review of criteria used to define recovery from sport-related concussion in youth athletes

Abstract

Objective: The Concussion in Sport Group guidelines recommend a multifaceted approach to help clinicians make return to sport decisions. The purpose of this study was to identify the most common multifaceted measures used to define clinical recovery from sport-related concussion in young athletes (high school and/or college level) and to summarise existing knowledge of criteria used to make return to sport decisions.

Design: Systematic review.

Data sources: The PubMed (MEDLINE), SPORTDiscus and Embase electronic databases were searched from 1 January 2000 to 1 March 2017 by three independent reviewers.

Eligibility criteria: Inclusion criteria: elementary, high school and college age groups, and a specific definition of clinical recovery that required two or more measures.

Exclusion criteria: review articles, articles using the same sample population, case studies, non-English language and those that used one measure only or did not specify the recovery measures used.

Study quality: Study quality was assessed using the Downs and Black Criteria.

Results: Of 2023 publications, 43 met inclusion criteria. Included articles reported the following measures of recovery: somatic symptom resolution or return to baseline (100%), cognitive recovery or return to baseline (86%), no exacerbation of symptoms on physical exertion (49%), normalisation of balance (30%), normal special physical examination (12%), successful return to school (5%), no exacerbation of symptoms with cognitive exertion (2%) and normalisation of cerebral blood flow (2%). Follow-up to validate the return to sport decision was reported in eight (19%) articles. Most studies were case-control or cohort (level of evidence 4) and had significant risk of bias.

Conclusion: All studies of sport-related concussion use symptom reports to define recovery. A minority of studies used multiple measures of outcome or had clearly defined recovery criteria, the most common being a combination of a self-reported symptom checklist and a computerised neurocognitive test. Future studies ideally should define recovery a priori using objective physiological measures in addition to symptom reports.

Keywords: mild traumatic brain injury; recovery; return to play; sport-related concussion; student athlete.