Concurrent symptom domains and associations with recovery timelines among collegiate athletes with sport-related concussion

Objective Concussion symptoms can be clustered into domains and understanding how multiple symptom domains present clinically may guide more accurate interventions. We investigate the associations between concurrent symptom domains and clinical recovery outcomes, as well as the role of sex in these relationships.Methods We analysed data from the Ivy League-Big Ten Epidemiology of Concussion Study and included sport-related concussions (SRC) across five academic years 2015-2016/2019-2020 with complete data (n=1160). We used symptoms from the Sport Concussion Assessment Tool 22-symptom evaluation, previously categorised into symptom domains. Symptom profiles characterise how athletes endorse concurrent symptom domains. Outcomes are time (in days) from SRC to symptom resolution, return to academics, and full play.Results Females more commonly endorsed headache, sensory, and affective symptom domains. Four classes/symptom profiles emerged: (1) 'low' on all domains, (2) 'high' on headache and sensory domains, (3) 'high' on vestibulo-ocular, cognitive, and sleep domains, and (4) 'high' on all domains. Time to symptom resolution, return to academics, and return to play were consistently shorter among class/symptom profile 1 compared with other classes/profiles. Compared with class/profile 1, the chance of having symptoms resolve was lower among classes/profiles 2, 3, and 4 (HR 0.74, 95% CI 0.63 to 0.88; HR 0.74, 95% CI 0.60 to 0.92; HR 0.50, 95% CI 0.43 to 0.57, respectively). Results were similar for return to academics and full play outcomes. Interactions with sex were not statistically significant.Conclusions Four symptom profiles characterised how concussion symptom domains co-occur. We found differences in recovery timelines among these groups, but not by sex. Findings inform and support targeted, symptom domain-specific interventions in concussion management.