Outcome of Concussions in Students Enrolled at a Collegiate Institution

Background: Prior studies have shown the duration of concussion related symptoms may be related to pre-morbid patient specific factors and initial symptom burden. However, there is a paucity of data regarding the presence of such factors and their relationship to the outcome of concussions specifically in a collegiate student population consisting of athletes and non-athletes. Objectives: The objectives of this study, the first of its kind, was to investigate the time to symptom resolution in college students and identify ‘at risk’ subsets of the student population to aid in academic planning and better estimate how long an individual may need to be removed from class or play. Methods: The study was a retrospective chart review for the academic year of 2014-2015 for students who presented to the Northwestern University Student Health Center, Sports Medicine Service. We included subjects aged ≥18 years and enrolled as a full-time student. Subjects were diagnosed with a concussion using the consensus statement on ‘Concussion in Sport from the Zurich Guidelines’. We excluded subjects not examined within the first 7 days after injury, and who did not complete the Standardized Concussion Assessment Tool (SCAT). If the patient record did not provide a specific date of injury or symptom resolution, they were also excluded. For analyses, descriptive statistics, independent samples t-tests, linear and binary regressions were utilized. Results: Of the 213 cases identified, 128 fulfilled our inclusion criteria. The average duration of concussion related symptoms for all subjects was 17.89 days (SD 17.05). Subjects who were playing varsity-level sports had a significantly shorter duration of concussion-related symptoms (mean 11.5 days) compared to club (18.61 days, p<0.001) and recreational (22.59 days, p<0.001) athletes. Female students had a longer duration of symptoms compared to male (20.79 days vs. 14.60 days, p<0.001) and graduate students had more than two weeks longer duration of symptoms compared to undergraduates (31.20 vs. 16.12). Linear regression analyses showed that a history of prior seizures was associated with a significantly longer time to symptom resolution and binary regression analysis showed those with a prior history of concussion were twice as likely to have symptoms for longer than 28 days than those without. Conclusion: Our study highlights the difficulty in treating subjects with concussions at a collegiate institution, due to both the academic rigors of the institution and the differing needs of the student. We also provide insight into at-risk subsets of the student population. Level of sport, year in school, athlete vs non-athlete, pre-morbid conditions and gender may affect outcome and these need to be an important consideration for the physician managing the concussed collegiate student. Our study also suggests the need for improved resources for the general population of university students who sustain a concussion.