David K. Brennan1, Mark Means2, Thomas Kern1, Jam J. Khojasteh3,

1University of Oklahoma Center for Concussion, Tulsa, Oklahoma, 2OU/TU School of Community Medicine, Tulsa, Oklahoma, 3Oklahoma State University, Tulsa, Oklahoma

The US Center for Disease Control and Prevention reported that between 1.6 and 3.8 million participants in sports and recreational activities sustain a concussion each year. PURPOSE: Physiological changes within the brain following a Sports Related Concussion (SRC) involve axonal shearing, an associated neuro-metabolic cascade, decreased glucose metabolism and cerebral blood-flow. Cerebral metabolic changes can persist for 7-10 days or more. Delayed evaluation could negatively influence SRC outcomes. This study investigated the relationship between Time-Till Treatment (TTT), post-concussion symptoms (PCSS), balance (mBESS), reaction time (RT) and return to play (RTPt). METHODS: A retrospective analysis of the relationship between PCSS, mBESS, RT, RTPt and TTT after a SRC. Medical records of 98 athletes (43 males, 55 females, age: M = 14.4 ± 2.5 years) diagnosed with a SRC on presentation at The University of Oklahoma Center for Concussion (January 1, 2017-December 31, 2019. The TTT (M = 20.6 days) was determined by the number of days between date of injury and date of clinical presentation. The RTPt was equal to the number of days between clinical presentation and full, unrestricted RTP. Two groups, TTT <14 days (M = 6.6 ± 5.5) and a TTT > 14 days (M = 37.6 ± 3.2) were compared. Independent t-test assessed group differences (α <.05, 2-tailed) for PCSS, mBESS and RT and RTPt. Correlates (Pearson’s r), for PCSS, mBESS, RT and TTT were calculated. RESULTS: There were no statistically significant differences between groups for Age, M = -.827, SE ±.50,CI -1.81,0.16, t(96) = -1.666, p = .099, g= 0.369, PCSS, M = 4.0, SE ±4.0, CI -4.1,12.1, t(96) = 0.979, p = .330, g = 0.199 or mBESS M = 3.12 SE ±, CI -2.02,8.27, t(96) = 1.21, p = .625, g = 0.502. Mean group differences were statistically significant for both RT, M = 39.7 SE ±15.1, CI 9.8,69, t(85.1) = 2.639, p = .010, g = 0.502 and RTPt , M = -13.1 days SE ±9.6, CI-32,6.0, t(67) = -1.374, p = <.001, g = 0.333. Correlates for TTT were very small for PCSS (r = 0.03), mBESS (r = 0.12) and RT (r = 0.17). CONCLUSION: A delay in TTT for a SRC > 14 days was associated with a significant increased RT and RTPt. Study limitations included, exclusion of PCSS, mBESS and RT “pre-season” baseline data and small sample size. Analysis did not include patients who failed to present to the clinic due to early resolution of symptoms.

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