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Take kids with concussion out of the game

October 13, 2016

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You’re out!
The group of athletes immediately removed from play after concussion took 22 days to recover, whereas the group not immediately removed took 44 days.  The delay group also had greater neurocognitive symptoms and more severe symptoms.  I explain it to families like it’s a sprained ankle.  “If you try to run on it too soon, it feels worse and swells more.  You have a sprained brain, and the only way to heal it is to rest your body and rest your brain.”

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Concussed athletes need to come out of play immediately.  Delays lead to worsening symptoms and doubling of recovery time.  The NYT covered this article.

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Pediatrics. 2016 Aug 29. pii: e20160910. [Epub ahead of print]

Removal From Play After Concussion and Recovery Time.

Elbin RJ1, Sufrinko A2, Schatz P3, French J2, Henry L2, Burkhart S4, Collins MW2, Kontos AP2.

Author information:

1Department of Health, Human Performance and Recreation/Office for Sport Concussion Research, University of Arkansas, Fayetteville, Arkansas; rjelbin@uark.edu.

2Department of Orthopaedic Surgery/UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania;

3Department of Psychology, Saint Joseph’s University, Philadelphia, Pennsylvania; and.

4Department of Human Sciences/Tallahassee Orthopedic Clinic, Florida State University, Tallahassee, Florida.



Despite increases in education and awareness, many athletes continue to play with signs and symptoms of a sport-related concussion (SRC). The impact that continuing to play has on recovery is unknown. This study compared recovery time and related outcomes between athletes who were immediately removed from play and athletes who continued to play with an SRC.


A prospective, repeated measures design was used to compare neurocognitive performance, symptoms, and recovery time between 35 athletes (mean ± SD age, 15.61 ± 1.65 years) immediately removed after an SRC (REMOVED group) compared with 34 athletes (mean ± SD age, 15.35 ± 1.73 years) who continued to play (PLAYED group) with SRC. Neurocognitive and symptom data were obtained at baseline and at 1 to 7 days and 8 to 30 days after an SRC.


The PLAYED group took longer to recover than the REMOVED group (44.4 ± 36.0 vs 22.0 ± 18.7 days; P = .003) and were 8.80 times more likely to demonstrate protracted recovery (≥21 days) (P < .001). Removal from play status was associated with the greatest risk of protracted recovery (adjusted odds ratio, 14.27; P = .001) compared with other predictors (eg, sex). The PLAYED group exhibited significantly worse neurocognitive and greater symptoms than the REMOVED group.


SRC recovery time may be reduced if athletes are removed from participation. Immediate removal from play is the first step in mitigating prolonged SRC recovery, and these data support current consensus statements and management guidelines.

Copyright © 2016 by the American Academy of Pediatrics.

PMID: 27573089 [PubMed – as supplied by publisher]

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