Factors Associated With Persistent Post-concussive Symptoms: Findings From The Ncaa Injury Surveillance Program

Persisting Post-Concussive Symptoms (PPCS) can cause distress and disability in National Collegiate Athletic Association (NCAA) athletes with sport-related concussion (SRC). Furthermore, it has been suggested that PPCS may be associated with SRC- and biopsychosocial-factors. While symptoms usually resolve within 28 days, SRCs with symptoms that persist for more than 28 days could be classified with PPCS. By elucidating factors associated with PPCS, clinicians will be better positioned to inform individualized treatment strategies and estimate their patient’s recovery. PURPOSE: To examine factors associated with odds of PPCS following SRC. METHODS: SRCs reported to the NCAA Injury Surveillance Program during 2014/15-2018/19 were examined. SRCs with a symptom resolution time of >28 days/did not resolve were defined as PPCS. Summary statistics (counts, %s) were used to describe PPCS across sex, SRC history, event type, class year, injury mechanism, and symptomatology. A multivariable binary logistic regression model was used to identify predictors of PPCS across sex (men’s [referent], women’s), SRC history (new [referent], recurrent), event type (practice [referent], competition), class year (freshman [referent], sophomore, junior, senior), injury mechanism (other-[referent], player-contact), and symptoms endorsed (≤3 [referent], ≥4). Odds Ratio (ORAdj.) estimates with 95% Confidence Intervals (95% CI) excluding 1.0 were deemed statistically significant. RESULTS: Among reported SRCs (n = 1353) with complete symptom and covariate data, 7.7% could be classified with PPCS. Prevalence of SRCs with PPCS was higher in women’s- than in men’s sports (11.0% vs. 6.3%), and more recurrent SRCs compared to new SRCs (17.2% vs. 7.0%) could be classified with PPCS. Odds of PPCS were higher among SRCs in women’s- compared with men’s sports (ORAdj. = 1.90; 95% CI = 1.21-2.97), and in recurrent SRCs compared to new SRCs (ORAdj. = 3.04; 95% CI = 1.65-5.59), adjusting for covariate effects. CONCLUSIONS: Identifying factors associated with PPCS can alert clinicians early in the recovery process, of individuals at risk for prolonged recovery and therefore guide a tailored and safe return to sport protocol. Accordingly, SRCs in women’s sports and student-athletes with a history of SRCs may warrant particular attention. The NCAA Injury Surveillance Program was funded by the NCAA. The Datalys Center is an independent nonprofit organization that manages the operations of the NCAA ISP.