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The reporting of concussions among high school adolescents has increased markedly.1 Although historically literature has reported a concussion prevalence of 4% to 5%, more recent findings have found that nearly 20% of adolescents (patients 14 to 18 years old) have experienced at least 1 diagnosed concussion in their lifetime.2,3 Due to the fact that the developing brain has greater neural plasticity, it was previously thought that young age was protective against concussion and allowed faster postconcussion recovery.4 These thoughts have been disproven in recent years because studies have found that concussions in the immature brain result in a prolonged period of pathogenesis, leading to progressive neurodegeneration, hyperactivity, sustained cognitive impairments, and ultimately longer recovery.5,6
Team physicians must be particularly mindful when evaluating an athlete in this age group due to the short- and long-term neurocognitive implications, particularly as it pertains to return to sport (RTS). To assist in the management of concussions, neuropsychological testing is routinely implemented. Many institutions use the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) score as their primary neuropsychological exam. ImPACT uses 6 neuropsychometric tests to generate 4 separate composite scores. These scores serve as surrogate markers for memory, attention, processing speed, and reaction time. Data from the concussed athlete are then compared with the athlete's previously obtained baseline scores or normative data matching the patient's demographics.7
Although the rates and long-term effects of concussion are extensively evaluated in the adult population, previous studies have not characterized concussions in the youth athlete or evaluated factors influencing time to RTS. The purpose of this study was to elucidate the epidemiological and RTS data of a large consecutive cohort of high school athletes presenting to sports medicine clinics who sustained 1 or more concussions, using the ImPACT scoring to quantify athlete readiness. The authors hypothesized that as patients experienced recurrent concussions, all ImPACT domains would show a predictable decline and athletes would require a longer time period prior to RTS.
Materials and Methods
After receiving institutional review board approval, the clinical records of 357 consecutive patients (14 to 18 years old) who presented to a single health care system between September 2013 and December 2016 with concussions were retrospectively reviewed. Four independent reviewers collected all data and performed extensive chart reviews. Patients with...