Symptom clusters and cognitive changes: predictors of recovery timelines following concussion in college athletes

Objective: Further research is warranted to identify factors that may place an individual at greater risk for prolonged recovery, especially those present 24–48 hours post-concussion. Methods: Using data available through FITBIR and the CARE Consortium, this study included 786 athletes. All athletes had available return-to-play (RTP) data which was examined continuously and categorically (>28 days vs ≤28 days). Reliable change index methods were used to examine reliable changes in cognitive performance (ImPACT) and total symptom severity (PCSS) from baseline to post-concussion. We also examined five symptom cluster scores from SCAT-3 as predictors. Results: Linear regression revealed that, when examining cognitive performance, reliable decreases in performance on ImPACT Verbal Memory and Visual Memory composites were associated with longer RTP. When evaluating symptomatology, reliable increase in total PCSS score and higher SCAT-3 Physical Symptom cluster scores were associated with longer RTP. Combining cognitive performance and symptomatology, only the SCAT-3 Physical Symptom Cluster predicted longer RTP. Logistic regression results showed that, when examining cognitive performance, a reliable decrease in ImPACT Visual Memory performance was associated with 62% increased risk for prolonged recovery. When examining symptomatology, increases in SCAT-3 Physical Symptom Cluster scores and a reliable increase in PCSS Total Symptoms resulted in an increased risk for prolonged recovery by 33% and 76%, respectively. When examining cognitive performance and symptomatology, only the SCAT-3 Physical Symptom Cluster was associated with increased risk for prolonged recovery. Conclusions: Overall, these results demonstrate the unique effects of individual factors on recovery from concussion, particularly physical symptomatology. Further, these findings provide support for targeted, multidomain treatments for concussion based on presenting symptomatology. Future work should continue to explore the effectiveness of early intervention based on symptom profiles.