Collision Of Contagion: Exploring The Effects Of Prior Covid-19 Diagnosis On Concussion Outcomes

While the clinical presentations of COVID-19 and concussion are not identical, there is a significant overlap in symptomology (e.g., fatigue, headache) and neurological deficits (e.g., cognitive, vestibular). Emerging evidence has also demonstrated that these symptoms and deficits may persist past 90 days in prolonged COVID-19 cases. However, limited research has examined the effect of prior COVID-19 diagnosis on concussion outcomes. PURPOSE: To determine if prior diagnosis of COVID-19 influences concussion outcomes, including concussion assessment scores and recovery time, in college-aged individuals. METHODS: A prospective study of college-aged individuals diagnosed with concussion was conducted in a university laboratory setting. Participants completed demographics, injury details, Sport Concussion Assessment Tool-5 (SCAT5), and the Vestibular/Ocular-Motor Screening (VOMS) at initial (within 5 days of concussion) and return-to-play (RTP) visits. Participants were grouped based on self-reported prior diagnosis of COVID-19 or no prior diagnosis (NO-COVID-19). Independent samples t-tests, chi-square tests, and Fisher’s exact tests determined differences in demographic variables between groups. Mann Whitney U Tests determined differences in concussion outcomes between groups. RESULTS: No significant differences were found between groups for demographic variables, VOMS, and SCAT5 scores (Table 1). Significant differences were found between COVID-19 and NO-COVID-19 groups in days to symptom resolution (12 days vs. 8 days; p=0.019) but not in days to clearance for RTP (14 days vs. 17 days; p=0.088). CONCLUSION: Our results suggest that a prior COVID-19 diagnosis does not influence concussion assessment outcomes. While days to RTP were similar between groups, those with a prior COVID-19 diagnosis experienced a longer time to symptom resolution, urging further investigation into the intersection of COVID-19 and concussion symptoms. Table 1. - Comparison of Demographic Variables, VOMS Total Scores, and SCAT-5 Composite Scores for COVID-19 and NO-COVID-19 Participants Variable Prior Diagnosis of COVID-19 (n=32) No Prior Diagnosis of COVID-19 (n=38) Total(n=70) P value Age (years) 21.5 (2.8) 21.1 (2.5) 21.3 (2.6) 0.48b Time to Assessment (days) 3.7 (1.7) 3.8 (1.4) 3.8 (1.5) 0.74b Gender Woman 17 (53.1%) 20 (52.6%) 37 (52.9%) 0.97c Man 15 (46.9%) 18 (47.4%) 33 (47.1%) Race White/Caucasian 22 (68.8%) 25 (65.8%) 47 (67.1%) 0.94d Black or African American 7 (21.9%) 8 (21.1%) 15 (21.4%) Other, unknown, or not reported 3 (9.3%) 5 (13.2%) 8 (10.7%) Sport Participation Yes 30 (93.8%) 31 (81.6%) 61 (87.1%) 0.17d No 2 (6.2%) 7 (18.4%) 9 (12.9%) Medical History Depression/Anxiety 11 (34.4%) 7 (18.4%) 20 (26.7%) 0.15c ADD/ADHD/Learning Disorder/Dyslexia 9 (28.1%) 7 (18.4%) 18 (24.5%) Headache or Migraine Disorder 4 (12.5%) 2 (5.3%) 7 (9.3%) Motion Sickness 3 (9.4%) 3 (7.9%) 7 (9.3%) No pertinent medical history 5 (15.6%) 25 (65.8%) 40 (57.1%)e History of Concussion Yes 19 (59.4%) 20 (52.6%) 39 (55.7%) 0.63c No 13 (40.6%) 18 (47.4%) 31 (44.3%) Median (IQR [25,75]) Median (IQR [25,75]) Median(IQR [25,75]) P value VOMS Scores Baseline VOMS Total 6 (2, 14) 4 (1, 7) 4 (1, 10) 0.08 Smooth Pursuits Total 5.5 (1, 15) 5 (1, 7) 5 (1, 9) 0.26 Horizontal Saccades Total 6 (1, 15) 5 (1, 8) 5 (1, 11) 0.17 Vertical Saccades Total 7 (1, 16) 5 (2, 8) 6 (2, 10) 0.24 Near Point of Convergence Symptoms 7 (2, 16) 6 (2, 10) 6 (2, 13) 0.16 Horizontal Vestibulo-Ocular Reflex 8 (3, 17) 5 (2, 10) 6 (2, 14) 0.08 Vertical Vestibulo-Ocular Reflex 8 (2, 17) 6 (1, 10) 6 (2, 14) 0.11 Visual Motion Sensitivity 9 (3, 18) 6 (2, 11) 8 (2, 14) 0.12 VOMS Total 54 (18, 125) 40 (12, 69) 45 (14, 96) 0.14 SCAT-5 Composite Scores Total Number of Symptoms 13 (9, 17) 9 (3, 16) 10 (5, 17) 0.09 Symptom Severity Score 21 (10, 40) 13 (, 37) 20 (6, 38) 0.21 Immediate Memory 23 (17, 25) 20 (19, 22) 20 (17, 24) 0.41 Concentration 4 (3.25, 5) 4 (4, 5) 4 (4, 5) 0.55 Delayed Recall 7 (5, 8) 5.5 (5, 7) 6 (5, 8) 0.20 mBESS Total Score 9 (4, 13) 6 (2, 10) 8 (3, 11) 0.17 BESS Total Score 18 (22, 12) 17 (13, 20) 17 (13, 20) 0.41