Effects of Repetitive Head Trauma on Symptomatology of Future Sport Related Concussion in Adolescent Student-athletes

Introduction: Adolescent participation in athletics continues to grow due to the recognized social and physical benefits. However, this has led to an increasing incidence of sports-related concussion. Current literature makes the generalization that a history of more prior concussions increases total symptoms after future head injury but does not investigate which symptoms are impacted. The current study investigates the effects of prior recurrent head injury on symptom profiles of student-athletes following another suspected concussion.

Methods: A multi-center database consisting of 25,815 Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) tests was filtered for student-athletes aged 12-22 years old. Patients were separated into two cohorts: athletes reporting a single prior concussion(SRC1) and athletes reporting two or more prior concussions(SRC2+). Comparisons assessed for differences in 22 symptoms and 4 symptom clusters (Migraine, Cognitive, Sleep, and Neuropsychiatric) before suspected concussion at baseline and after suspected concussion at first post-injury test (PI1), and second post-injury test (PI2) using t-test and multivariate analyses.

Results: No differences were seen between SRC1 (n=2253) and SRC2+ (n=976) at baseline testing. On univariate analysis at PI1, the SRC2+ group (n=286) had a lower severity of headaches (p=0.04), and increased nervousness (p=0.042), irritability (p=0.028), sadness (p=0.028), visual problems (p=0.04), and neuropsychiatric symptoms (p=0.009) compared with SRC1 (n=529). Multivariate analysis revealed decreased headache severity with increased prior concussions (β=-0.26,p=0.004). Multivariate analysis at PI2 demonstrated the SRC2+ cohort (n=130) had increased cognitive (β=1.22,p=0.011), sleep (β=0.59,p=0.011), and neuropsychiatric (β=0.69,0.009) symptoms compared with SRC1 (n=292).

Conclusion : Patients with history of recurrent concussions report greater symptom burden in cognitive, sleep, and neuropsychiatric symptom clusters but not migraine symptoms. This is an important distinction as migraine symptoms are comparably more noticeable to patients and physicians. Careful assessment of these cognitive, sleep, and neuropsychiatric symptoms should be considered in patients with a history of recurrent head injury prior to return to play.