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Am Fam Physician. 2004;69(1):171-172

Mild traumatic brain injuries are common in high school and collegiate sports. Neuropsychologic impairment has been noted in players who have had multiple concussions. Field and associates compared preconcussion and postconcussion neuropsychologic evaluations to determine neurocognitive recovery patterns in high school and college athletes.

Athletes at several colleges and high schools participated in the study. Concussions were defined and graded according to the American Academy of Neurology Practice Parameter. Concussions were graded according to associated loss of consciousness and the amount of time required for mental status changes to resolve. A battery of neuropsychologic tests and the Post-Concussion Symptom Scale, defining 20 symptoms associated with concussion, were administered at baseline. Postconcussion evaluation assessed symptoms and markers of injury and included serial neuropsychologic testing at 24 hours after injury and again on days 3, 5, and 7. Matched control subjects who did not have a concussion during the study also were followed.

Most concussions were mild. College athletes had a higher rate of loss of consciousness than high school athletes. At 24 hours after injury, memory differences between athletes with concussions and control subjects were significant. Longer memory impairment was noted in injured high school athletes than in injured college athletes. Postconcussion symptoms lasted longer in high school athletes.

The authors conclude that high school athletes showed slower neuropsychologic recovery from sports-related concussions compared with college athletes. Hypotheses to explain this difference include more prolonged cerebral swelling with greater risk of ischemia in younger athletes and increased sensitivity to glutamate-mediated excitotoxic brain injury in less mature brains. More conservative treatment and thorough evaluation are recommended before injured high school athletes are allowed to return to sports participation.

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