Do Sport-Related Concussions Later in the Season Take Longer to Recover From?

Objective:In a cohort of high-school football athletes with sport-related concussion (SRC), we sought to investigate the role of seasonality, defined as time of injury during a season, on recovery.Design:Retrospective cohort study.Setting:Regional sport concussion center.Participants:High-school football athletes ages 14 to 19 -years old who sustained an SRC from 11, 2017 to 04, 2022.Intervention:Athletes were divided into 3 groups based on seasonality: early, middle, and late season.Main Outcome Measures:The primary outcomes were initial Post-Concussion Symptom Scale score and recovery, as defined by time to return-to-learn (RTL), symptom resolution, and return-to-play (RTP). Descriptive statistics, analysis-of-variance, t tests, and multivariable regressions were performed.Results:Of our cohort of 273 high-school football players who sustained an SRC, 97 (35.5%) sustained an SRC during early season, 107 (39.2%) during middle season, and 69 (25.3%) during late season. Compared with late-season concussions, early-season concussions took less days to symptom resolution (early = 11.5 +/- 12.9 vs late = 25.5 +/- 27.0, P = 0.03), but no differences were found in days to RTL (early = 5.3 +/- 4.8 vs late = 7.2 +/- 15.8, P = 0.51) and RTP (early = 13.5 +/- 11.8 vs late = 23.0 +/- 22.8, P = 0.08). Seasonality was not a significant predictor for any recovery metric in multivariable regressions.Conclusion:Sport-related concussions occurring in the early third of the season took significantly less time to symptom resolution than those occurring in the later third of the season; however, this was not statistically significant in multivariable analyses. No association was observed between seasonality and time to RTL and RTP. A trend of worse recovery with concussions later in the season may be present.