Trending Clinical Topic: Concussion

Ryan Syrek


August 21, 2020

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Although COVID-19 remains a primary focus for most in medicine, several recent studies and new guidance regarding concussion resulted in this week's top trending clinical topic.

Results of a retrospective, population-based cohort study found that concussion is associated with a significantly increased risk for certain mental health and neurologic diseases (see Infographic below). Unlike previous studies that found similar results, this investigation focused only on individuals who were actually diagnosed with concussion, not those who self-reported concussion. It also included as much as 25 years of follow-up data, making it one of the longer-term reviews on the subject.

A separate study of more than 300 high-school athletes found that return to play after concussion took 1 month on average, highlighting the need for prolonged rest after a head impact. The findings revealed that females and those with a previous history of similar injury took even longer to return to play. Data showed that around a third of high-school athletes  who had a concussion had a previous concussion. Lead author Toufic Jildeh, MD, stressed that coaches and clinicians should be aware that female athletes may be more susceptible and that possible concussion-related complaints in this group should not be ignored.

Increased awareness of sports-related concussion has led to new recommendations for team physicians. An updated consensus statement was presented at the virtual American College of Sports Medicine 2020 Annual Meeting. Among the important takeaways is that diagnosis remains a challenge due to nonspecific symptoms and a lack of objective biomarkers. Thus, the guidance suggests that diagnosis should lean heavily on thorough exams that take into account such factors as history of depression and anxiety, migraines, family history of mood disorders, and social stressors, all of which have been associated with slower recovery. Another major recommendation is to eliminate "cocooning," a practice in which a person with a concussion sits in a dark room, sometimes for several days.

Even athletes who don't experience concussion but suffer repeated jolts or falls inherent in contact sports can experience brain changes, according to new findings. A group of female college rugby players who had not experienced a concussion for at least 6 months prior to or during the study, and who showed no outward symptoms of brain injury or brain changes up to 2 years later, were found to have changes in brain structure and connectivity. No such changes were observed in the brains of female athletes who participated in noncontact sports.

A separate, small study of college students (not yet  published or peer reviewed) found that those who had recently resolved concussion symptoms had slower driving reaction times on three different tests compared with peers who did not have a concussion. Although there was a large magnitude of difference in all three tests between the concussion group and the control group, the difference did not reach statistical significance, said lead author Landon Lempke, MEd. Experts reacting to the findings say that although this is a small pilot trial, the implications are significant enough to warrant a larger investigation into potential dangers in resumption of driving after a concussion.

From an association with other serious conditions to concerns about recovery, new findings and guidance related to concussion made the injury the week's top trending clinical topic.

Read more about concussion.


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