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Study Finds No Difference in Concussion-Recovery Rate for H.S., College Athletes

High school athletes do not take significantly longer to recover from concussions than their collegiate counterparts, negating the need for separate injury-management protocols for the two groups, according to a study published online last week in the Journal of Athletic Training.

The study authors set out to determine whether age differences between high school and collegiate athletes affected the length of concussion recovery, as had previously been surmised. To do so, they analyzed data from 621 concussed athletes—405 high school, 216 college—most of whom played football. To assess when each athlete had recovered from his or her concussion, the authors compared preseason baseline results to post-concussion testing. Each concussed athlete was evaluated immediately after the injury, two to three hours after, and one, two, three, five, seven, and 45 or 90 days after.

Overall, the study authors found "little evidence" of differences between high school and collegiate athletes when it came to their rates of concussion recovery. Both groups showed "significantly elevated symptoms" versus uninjured athletes through the fifth day after the injury, although their symptom ratings sank to the control level by the seventh day. High school and collegiate athletes had equivalent symptom ratings each time they were measured, which implied "similar subjective responses to concussion and courses of symptom recovery in the injured groups."

In one of the post-concussion tests, the Standardized Assessment of Concussion, both high school and collegiate athletes performed significantly worse than the control group through the second day after the injury, but only high schoolers performed worse than the control group through the third day. The authors noted this could suggest high schoolers took an extra day or two to cognitively recover in comparison to their college counterparts, although both groups "demonstrated a relatively rapid cognitive recovery within a few days of injury," the authors noted. Additionally, the high school athletes' concussions tended to be more severe (based on loss of consciousness and post-injury amnesia), lending further credence to the idea that their recovery was not significantly longer than those of collegiate athletes.

"Our findings differ from current consensus guidelines suggesting that more conservative injury management practices may be needed for child and adolescent athletes versus adults," said lead author Lindsay Nelson, an assistant professor of neurosurgery and neurology at the Medical College of Wisconsin, Milwaukee, in a statement. "Our finding of high overlap in the rate of clinical recovery implies that protocols need not differ, at least not due to assumptions of differences in clinical recovery rates."

The authors did stress the need for further research into this subject, particularly focusing on athletes below high school. They also noted, "Emerging research suggests that neurophysiologic recovery may extend beyond what is apparent on standard clinical measures," so as science evolves to better track concussion recovery, those tasked with return-to-school and return-to-play decisions for youth-athletes must be aware of the newest methodology.

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