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Post-concussion symptoms in sports-related mild traumatic brain injury compared to non-sports-related mild traumatic brain injury

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Abstract

Objectives

To compare post-concussion symptoms in patients who sustained a sports-related mild traumatic brain injury (TBI) to those with non-sports-related mild TBI at 7 and 90 days post-injury.

Methods

This prospective multicentre cohort study took place in seven Canadian Emergency Departments (ED). Non-hospitalized patients aged ≥ 14 years with a documented mild TBI that occurred ≤ 24 h of ED visit and a Glasgow Coma Scale score ≥ 13 were included. Main outcome measure was the presence of ≥ 3 symptoms on the Rivermead Post-concussion Questionnaire at 90 days post-injury. Secondary outcomes were the prevalence of (1) individual Rivermead Post-concussion Questionnaire symptom, (2) total Rivermead Post-concussion Questionnaire score ≥ 21 and (3) return to normal daily activities. Adjusted risk ratios (RR) were calculated.

Results

1727 patients were included, 363 (21.0%) sustained a sports-related mild TBI. Similar proportions of patients with ≥ 3 symptoms, a Rivermead Post-concussion Questionnaire score ≥ 21 and those who returned to their normal daily activities were observed at 7 and 90 days post-injury. Sports-related mild TBI patients were at higher risk of poor concentration [RR: 1.3 (95% CI 1.05–1.54)] and non-return to sports activities [RR: 2.2 (95% CI 1.69–2.94)] at 7 days post-injury. At 90 days, sports-relate -mild TBI patients reported less fatigue [RR: 0.7 (95% CI 0.51–0.98)] and feeling of dizziness [RR: 0.6 (95% CI 0.35–0.99)].

Conclusion

Patients who sustained sports-related mild TBI could be at lower risk of experiencing symptoms such as fatigue and dizziness 90 days post-injury. Clinicians should be mindful that non-sports-related mild TBI patients may experience more post-concussion symptoms and that the level of physical activity may influence the patient’s rehabilitation.

Résumé

Objectifs

Comparer les symptômes post-commotionnels chez les patients ayant subi un traumatisme cranio-cérébral léger (TCCL) lié au sport à ceux qui ont un TCCL non lié au sport à 7 et 90 jours post-traumatisme.

Méthodes

Cette étude prospective de cohorte multicentrique s'est déroulée dans sept Départements d’urgence (DU) du Canada. Les patients non hospitalisés âgés de ≥ 14 ans ayant subi un TCCL ≤ 24 heures avant leur visite au DU et présentant un score de Glasgow de ≥ 13 ont été inclus. Le critère principal de jugement était la présence d’au moins 3 symptômes au Rivermead Post-concussion Questionnaire 90 jours après le traumatisme. Les critères de jugement secondaires étaient la prévalence de 1) chacun des symptômes du Rivermead Post-concussion Questionnaire 2) score total du Rivermead Post-concussion Questionnaire ≥ 21 et 3) retour aux activités habituelles. Des risques relatifs ajustés (RR) ont été calculés.

Résultats

Un total de 1727 patients a été inclu, dont 363 (21,0 %) ont subi un TCCL lié au sport. Des proportions similaires de patients présentant ≥ 3 symptômes, un score ≥ 21 au Rivermead Post-concussion Questionnaire et de participants ayant repris leurs activités habituelles ont été observés à 7 et 90 jours après la blessure. Les patients avec TCCL lié au sport présentaient un risque plus élevé de manque de concentration (RR: 1,3 [IC à 95 % = 1,05-1,54]) et de non-retour aux activités sportives (RR: 2,2 [IC à 95 % = 1,69-2,94]) à 7 jours après la blessure. À 90 jours, les patients avec TCCL lié au sport ont signalé moins de fatigue (RR: 0,7 [IC à 95 % = 0,51-0,98]) et de sensation de vertige (RR: 0,6 [IC à 95 % = 0,35-0,99]).

Conclusion

Les patients qui ont subi un TCCL lié au sport seraient moins à risque de présenter des symptômes tels que de la fatigue et des étourdissements 90 jours après la blessure. Les cliniciens doivent être conscients que les patients avec TCCL non lié au sport peuvent présenter davantage de symptômes post-commotionnels et que le niveau d’activité physique peut influencer la réadaptation du patient.

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Acknowledgements

We are deeply indebted to all the patients who participated in this study and gratefully acknowledge the emergency physicians at the study sites who recruited the patients and the emergency medicine residents who helped in this process. We acknowledge the following members of our research team: Quebec site—Marilyne Dufresne, Martin Roy, Catherine Bédard and Suzy Lavoie; Lévis site—Lise Lavoie and Josée Jolicoeur; Trois-Rivières site—Émilie Gouin and Annie Cossette; Montreal site—Chantal Lanthier, Tanya Leduc and Catherine Perreault-Légaré; Ottawa site—Connor Sheehan.

Funding

This study was funded by the Canadian Institutes of Health Research. FB was recipient of a scholarship from the Faculté de Médecine de l’Université Laval.

Author information

Authors and Affiliations

  1. Population Health and Optimal Health Practices Research Unit, Trauma, Emergency, Critical Care Medicine, CHU de Québec-Université Laval Research Centre, Hôpital de l’Enfant-Jésus, 1401, 18e rue, H-610, Québec, QC, G1J 1Z4, Canada

    Frédérique Beauchamp, Valérie Boucher, Xavier Neveu, Vincent Ouellet, Simon Berthelot, Marcel Émond, Éric Mercier & Natalie Le Sage

  2. Centre de Recherche sur les Soins et les Services de Première Ligne de l’Université Laval (CERSSPL-UL), Quebec City, Canada

    Frédérique Beauchamp, Valérie Boucher, Xavier Neveu, Vincent Ouellet, Simon Berthelot, Marcel Émond, Jérôme Frenette, Éric Mercier, Lynne Moore & Natalie Le Sage

  3. Faculté de Médecine, Université Laval, Quebec City, Canada

    Frédérique Beauchamp, Vincent Ouellet, Patrick Archambault, Simon Berthelot, Marcel Émond, Éric Mercier, Lynne Moore, Marie-Christine Ouellet & Natalie Le Sage

  4. Centre Intégré de Santé et de Services Sociaux de Chaudière‐Appalaches, Centre Hospitalier Affilié Universitaire Hôtel‐Dieu de Lévis, Lévis, Canada

    Patrick Archambault

  5. Université de Montréal, Montreal, Canada

    Jean-Marc Chauny & Elaine de Guise

  6. Research-Institute, McGill University Health Centre, Montreal, Canada

    Elaine de Guise

  7. Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain (CRIR), Montreal, Canada

    Elaine de Guise

  8. University of Calgary, Calgary, Canada

    Eddy Lang

  9. Schwartz/Reisman Emergency Medicine Institute, Toronto, Canada

    Jacques Lee

  10. Department of Social and Preventative Medicine, Université Laval, Québec, QC, Canada

    Lynne Moore

  11. Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (Cirris), Québec, QC, Canada

    Marie-Christine Ouellet

  12. Ottawa Hospital Research Institute and Department of Emergency Medicine, University of Ottawa, Ottawa, Canada

    Jeffrey Perry

Authors
  1. Frédérique Beauchamp
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  2. Valérie Boucher
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  3. Xavier Neveu
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  4. Vincent Ouellet
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  7. Jean-Marc Chauny
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  8. Elaine de Guise
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  9. Marcel Émond
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  10. Jérôme Frenette
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  11. Eddy Lang
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  12. Jacques Lee
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  13. Éric Mercier
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  14. Lynne Moore
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  15. Marie-Christine Ouellet
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  16. Jeffrey Perry
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  17. Natalie Le Sage
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Corresponding author

Correspondence to Natalie Le Sage.

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Beauchamp, F., Boucher, V., Neveu, X. et al. Post-concussion symptoms in sports-related mild traumatic brain injury compared to non-sports-related mild traumatic brain injury. Can J Emerg Med 23, 223–231 (2021). https://doi.org/10.1007/s43678-020-00060-0

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