Comparison of Concussion Management Programs on Return to Participation Outcomes of Concussed High School Student-Athletes During 2010-11

Journal of Athletic Training. -


Kanaoka, T., R. S. Oshiro, T. M. Furutani, L. M. Goeckeritz, T. P. Wahl, M. H. Kocher, M. A. Cleary, N. M. Murata and R. K. Uyeno.



Context: A multifaceted approach for the management of sport related concussion that includes a clinical examination, graded symptom check list, postural stability testing, neurocognitive testing, and Gradual Return to Play Protocol (GRPP) has been recommended by several concussion consensus statements and position papers. Health care professionals caring for concussed student-athletes across the United States may be not be following these guidelines and may be allowing student-athletes to return to participation (RTP) prematurely. Objective: To investigate how the duration of RTP and GRPP for concussed high school student-athletes was influenced by the type of Concussion Management Program (CMP) which incorporated two different neuropsychological testing batteries for RTP decision-making. Design: Retrospective cross-sectional investigation. Setting: Two different neurocognitive tests were utilized within a CMP in 42 public high schools in the State of Hawaii. Patients or Other Participants: Concussed student-athletes (n=426, between age 13 to 18) received baseline and postconcussion neurocognitive testing during school year (SY) 2010-11. Interventions: Two different neurocognitive tests used in a CMP were compared: 18 schools utilized the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and 24 schools utilized Standard Assessment of Concussion (SAC). Main Outcome Measures: Complete data sets for days of restricted participation post-concussion (ImPACT n=239, SAC n=129), duration of the GRPP until return to unrestricted participation (ImPACT n=231, SAC n=125), and 95% confidence interval (CI). The duration of the GRPP was defined as the number of days of the rehabilitation period starting from light aerobic exercise to full-contact practice. The GRPP consisted of five steps, each separated by a minimum of 24 hr. Results: No significant (F1=.277, p=.599) difference was found between restricted participation post-concussion for ImPACT=17.71±11.91 (CI=16.19-19.23) days compared to SAC=18.33±7.91 (CI=16.95-19.70) days. No significant (F1=.104, p=.748) difference was found for average duration of GRPP that incorporated ImPACT=8.95±5.61 (CI=8.22-9.68) days compared to SAC=9.14±4.53 (CI=8.33-9.94) days. Conclusions: We found that the days of restricted participation post-concussion and the duration of GRPP for concussed student-athletes was not significantly different when using the two different neurocognitive testing batteries in the CMPs. The two neurocognitive testing batteries used in this study are just one part of the multifaceted nature of the RTP decision-making as part of a comprehensive CMP. Furthermore, a CMP incorporating a neurocognitive test in addition to clinical examination, graded symptom check list, postural stability testing, and GRPP is vital to determining appropriate duration of RTP and prevent the premature release of concussed student-athletes. Injury surveillance is an important aspect of future recommendations and modification of CMPs.

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