Neurocognitive Deficits of Concussed Adolescent Athletes at Self-reported Symptom Resolution in the Zurich Guidelines Era

Background: Previous studies have evaluated high school and collegiate athletes in the pre-Zurich guidelines era; whether adolescent athletes demonstrate similar neurocognitive decrements in the current concussion management era remains unclear. Purpose: To assess for the presence of neurocognitive deficits in adolescents with a sport-related concussion at the time of self-reported symptom resolution. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We conducted a prospective cohort study of 32 patients, aged 13 to 18 years, who sustained concussions during ice hockey and who were referred to 3 sports medicine clinics between September 1, 2012, and March 31, 2015. Demographic, anthropometric, and injury data were collected at the time of the initial postconcussion evaluation. To document symptoms, patients completed the Post-Concussion Symptom Scale (PCSS) at initial and follow-up visits. Baseline and postinjury neurocognitive function were assessed using computerized neurocognitive testing (Immediate Post-Concussion Assessment and Cognitive Test [ImPACT]), and a reliable change index was used to determine significant changes in composite scores. Statistical comparisons were conducted using the Student t test and Mann-Whitney U test. Results: A total of 9 of 32 athletes (28.1%; 95% CI, 14.8%-46.9%) demonstrated continued neurocognitive impairment on 1 composite score when no longer reporting concussion-related symptoms, while only 2 of 32 athletes (6.3%; 95% CI, 1.4%-23.2%) demonstrated continued neurocognitive impairment on 2 composite scores. Conclusion: Neurocognitive deficits persist in adolescent athletes who no longer report concussion-related symptoms, at rates similar to those of collegiate athletes but at longer time intervals. This finding provides further evidence that adolescent athletes with a sport-related concussion demonstrate a protracted recovery and resolution of neurocognitive deficits compared with collegiate and professional athletes. Computer-based neurocognitive testing as part of a multifaceted approach continues to play an important role in return-to-play decision making after a sport-related concussion in adolescent athletes. Test-taking strategies may erroneously identify asymptomatic athletes as exhibiting neurocognitive impairment.