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Systematic Review of Prognosis and Return to Play After Sport Concussion: Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis

  • Carol Cancelliere
    Correspondence
    Corresponding author Carol Cancelliere, DC, MPH, Toronto Western Research Institute, University Health Network, University of Toronto, LuCliff Place, 700 Bay St, Ste 200, Toronto, Ontario, Canada M5G 1Z6.
    Affiliations
    Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada

    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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  • Cesar A. Hincapié
    Affiliations
    Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada

    Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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  • Michelle Keightley
    Affiliations
    Departments of Occupational Science and Occupational Therapy, Psychology and Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Ontario, Canada

    Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
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  • Alison K. Godbolt
    Affiliations
    Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
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  • Pierre Côté
    Affiliations
    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada

    UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
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  • Vicki L. Kristman
    Affiliations
    Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada

    Institute for Work and Health, Toronto, Ontario, Canada
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  • Britt-Marie Stålnacke
    Affiliations
    Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
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  • Linda J. Carroll
    Affiliations
    School of Public Health and Alberta Centre for Injury Control and Research, University of Alberta, Edmonton, Alberta, Canada
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  • Ryan Hung
    Affiliations
    Department of Rehabilitation and Complex Continuing Care, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada

    Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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  • Jörgen Borg
    Affiliations
    Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
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  • Catharina Nygren-de Boussard
    Affiliations
    Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
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  • Victor G. Coronado
    Affiliations
    National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
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  • James Donovan
    Affiliations
    Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
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  • J. David Cassidy
    Affiliations
    Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada

    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    Institute of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark
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      Abstract

      Objective

      To synthesize the best available evidence on prognosis after sport concussion.

      Data Sources

      MEDLINE and other databases were searched (2001–2012) with terms including “craniocerebral trauma” and “sports.” Reference lists of eligible articles were also searched.

      Study Selection

      Randomized controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to have a minimum of 30 concussion cases.

      Data Extraction

      Eligible studies were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Two reviewers independently reviewed and extracted data from accepted studies into evidence tables.

      Data Synthesis

      Evidence was synthesized qualitatively according to modified SIGN criteria, and studies were categorized as exploratory or confirmatory based on the strength of their design and evidence. After 77,914 records were screened, 52 articles were eligible for this review, and 24 articles (representing 19 studies) with a low risk of bias were accepted. Our findings are based on exploratory studies of predominantly male football players at the high school, collegiate, and professional levels. Most athletes recover within days to a few weeks, and American and Australian professional football players return to play quickly after mild traumatic brain injury. Delayed recovery appears more likely in high school athletes, in those with a history of previous concussion, and in those with a higher number and duration of postconcussion symptoms.

      Conclusions

      The evidence concerning sports concussion course and prognosis is very preliminary, and there is no evidence on the effect of return-to-play guidelines on prognosis. Our findings have implications for further research. Well-designed, confirmatory studies are urgently needed to understand the consequences of sport concussion, including recurrent concussion, across different athletic populations and sports.

      Keywords

      List of abbreviations:

      CDC (Centers for Disease Control and Prevention), CI (confidence interval), LOC (loss of consciousness), MCI (mild cognitive impairment), MTBI (mild traumatic brain injury), RTP (return to play), WHO (World Health Organization)
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