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The Influence of Timing of Reporting and Clinic Presentation on Concussion Recovery Outcomes: A Systematic Review and Meta-Analysis

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A Letter to the Editor to this article was published on 05 October 2021

A Letter to the Editor to this article was published on 05 October 2021

Abstract

Background

Identifying risk factors for prolonged recovery following concussion can assist clinicians with appropriate management strategies. It is thought that athletes who continue to participate following a hit to the head or body may take longer to recover following a concussion diagnosis.

Objective

To systematically review the body of literature regarding the effect of delayed reporting and delayed presentation to medical providers on concussion recovery times.

Design

Systematic review with meta-analysis.

Data Sources

PubMed, Ovid Medline, SPORTDiscus, Cochrane Central Register of Controlled Trials and hand searches of reference lists. All the searches were performed in April 2020.

Eligibility criteria for selected studies

Studies included an investigation of immediate versus delayed reporting or early versus late presentation following a concussion, were published in the past ten years, and were level 4 evidence or higher.

Results

12 studies were included. Patients who continued play or delayed reporting their concussion had significantly longer recovery times (standardized mean difference = 0.36 days (95%CI 0.066, 0.662) than those who immediately reported or were removed from play (p = 0.017). Expressed in raw scores, those who immediately reported recovered in 5.4 days (95% CI − 10.14, − 0.75) fewer than delayed reporters. Comparable results were found for post-concussion symptom scores (p = 0.034) with immediate reporters demonstrating lower symptom severity scores. Our qualitative synthesis found patients who presented earlier to a concussion specialist tended to recover faster than those who presented later.

Conclusions

Patients who delayed reporting or continued play had longer recovery times compared to their immediately-reporting peers. Providers should ask concussion patients approximately how long they waited to report their injury, and also focus educational efforts on encouraging immediate reporting of concussion.

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Availability of data and material

The data that support the findings of this study are available on request from the corresponding author [TVM].

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Author information

Authors and Affiliations

  1. Athletic Training Programs, A.T. Still University, 5850 E Still Circle, Mesa, AZ, 85206, USA

    Mitchell Barnhart & Tamara C. Valovich McLeod

  2. Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa, AZ, USA

    R. Curtis Bay & Tamara C. Valovich McLeod

  3. School of Osteopathic Medicine in Arizona, A.T. Still University, 5850 E. Still Circle, Mesa, AZ, 85206, USA

    Tamara C. Valovich McLeod

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Contributions

MB and TVM contributed to the conception and design, search strategy and data extraction, and wrote the first draft of the manuscript. CB analyzed and interpreted the meta-analyses. CB and TVM revised the original manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tamara C. Valovich McLeod.

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Funding

No sources of funding were used to assist in the preparation of this article.

Conflict of interest

Mitchell Barnhart, R. Curtis Bay and Tamara C. Valovich McLeod declare that they have no conflicts of interest relevant to the content of this review.

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Not applicable.

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Not applicable.

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Not applicable.

Availability of data and material

The data that support the findings of this study are available on request from the corresponding author [TVM].

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Barnhart, M., Bay, R.C. & Valovich McLeod, T.C. The Influence of Timing of Reporting and Clinic Presentation on Concussion Recovery Outcomes: A Systematic Review and Meta-Analysis. Sports Med 51, 1491–1508 (2021). https://doi.org/10.1007/s40279-021-01444-7

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