Traumatic brain injury; concussion; epidemiology; head injuries; sports injuries
Abstract :
[en] [en] OBJECTIVES: To examine self-reported sport-related concussion (SRC) symptom duration and return to sport (RTS) timelines across countries and sport demographics in a large international cohort.
METHODS: An anonymous survey collected sociodemographic data and concussion history from French-speaking athletes affiliated with the ReFORM IOC Research Center. SRC symptoms and RTS durations were analyzed by geographic origin (Canada, Europe) and a multivariate analysis examined the combined impact of geographic origin, sex, age group (minor, adult), professional status (amateur, professional) and SRC risk (low, moderate, high).
RESULTS: Of 998 participants (Canada: 635; Europe: 363), 409 (41%) reported a history of SRC. Median [IQR] symptom duration was longer in Canada (30 [14, 91] days) than Europe (7 [2, 21] days; p < 0.001). RTS was also longer in Canada (28 [14, 61] vs. 10 [7, 21] days; p < 0.001).The binary logistic regression identified geographic origin (Canada) and sex (female) as significant predictors of prolonged symptom duration (i.e. >14 days) and return to sport (i.e. >20 days), while age group, professional status and SRC risk did not significantly influence these durations.
CONCLUSION: SRC recovery times differ significantly by geography and sex in French-speaking athletes. European athletes and males report shorter symptom and RTS durations.
Disciplines :
Orthopedics, rehabilitation & sports medicine
Author, co-author :
Martens, Géraldine ; Université de Liège - ULiège > Département des Sciences de l'activité physique et de la réadaptation ; Réseau Francophone Olympique de la Recherche en Médecine du Sport (ReFORM), IOC Research Centre for Injury Prevention and Protection of Athlete Health, Liège, Belgium
Thibaut, Aurore ; Université de Liège - ULiège > GIGA > GIGA Neurosciences - Coma Science Group
de Beaumont, Louis; Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal, CIUSSS du nord-de-l'Île-de-Montréal, Montréal, QC, Canada
Beaudart, Charlotte; Public Health Aging Research & Epidemiology (PHARE) Group Research Unit in Clinical Pharmacology and Toxicology (URPC) NAmur Research Institute for LIfe Sciences (NARILIS), University of Namur, Namur, Belgium
Bodet, Colin; Department of Physical Medicine and Sports Traumatology, University and University Hospital of Liège, Liège, Belgium
Urhausen, Axel; Réseau Francophone Olympique de la Recherche en Médecine du Sport (ReFORM), IOC Research Centre for Injury Prevention and Protection of Athlete Health, Liège, Belgium ; Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science (LIROMS), Eich, Luxembourg ; Clinique du Sport, Centre Hospitalier de Luxembourg, Eich, Luxembourg
Tscholl, Philippe M; Réseau Francophone Olympique de la Recherche en Médecine du Sport (ReFORM), IOC Research Centre for Injury Prevention and Protection of Athlete Health, Liège, Belgium ; Department of Orthopaedic Surgery and Traumatology, Geneva University Hospitals, Geneva, Switzerland
Romeas, Thomas; Réseau Francophone Olympique de la Recherche en Médecine du Sport (ReFORM), IOC Research Centre for Injury Prevention and Protection of Athlete Health, Liège, Belgium ; Département Recherche et innovation, Institut National du Sport du Québec (INS Québec), Montréal, QC, Canada ; École de kinésiologie et des sciences de l'activité physique, Montréal, QC, Canada
Le Garrec, Sébastien; Réseau Francophone Olympique de la Recherche en Médecine du Sport (ReFORM), IOC Research Centre for Injury Prevention and Protection of Athlete Health, Liège, Belgium ; Pôle Médical, Institut National du Sport, de l'Expertise Et de la Performance (INSEP), Paris, France
Hannouche, Didier; Réseau Francophone Olympique de la Recherche en Médecine du Sport (ReFORM), IOC Research Centre for Injury Prevention and Protection of Athlete Health, Liège, Belgium ; Department of Orthopaedic Surgery and Traumatology, Geneva University Hospitals, Geneva, Switzerland
Seil, Romain; Réseau Francophone Olympique de la Recherche en Médecine du Sport (ReFORM), IOC Research Centre for Injury Prevention and Protection of Athlete Health, Liège, Belgium ; Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science (LIROMS), Eich, Luxembourg ; Clinique du Sport, Centre Hospitalier de Luxembourg, Eich, Luxembourg
Kaux, Jean-François ; Université de Liège - ULiège > Département des Sciences de l'activité physique et de la réadaptation > Médecine physique, réadaptation et traumatologie du sport ; Réseau Francophone Olympique de la Recherche en Médecine du Sport (ReFORM), IOC Research Centre for Injury Prevention and Protection of Athlete Health, Liège, Belgium
Leclerc, Suzanne; Réseau Francophone Olympique de la Recherche en Médecine du Sport (ReFORM), IOC Research Centre for Injury Prevention and Protection of Athlete Health, Liège, Belgium ; Département Recherche et innovation, Institut National du Sport du Québec (INS Québec), Montréal, QC, Canada
Patricios JS, Schneider KJ, Dvorak J, Ahmed OH, Blauwet C, Cantu RC, Davis GA, Echemendia RJ, Makdissi M, McNamee M, et al. Consensus statement on concussion in sport: The 6th international conference on concussion in sport–Amsterdam, October 2022. Br J Sports Med. 2023juin1;57(11):695–711. doi:10.1136/bjsports-2023-106898.
Hon KL, Leung AKC, Torres AR., Concussion: a global perspective. Semin Pediatr Neurol. 2019juill1;30:117–27.
Theadom A, Mahon S, Hume P, Starkey N, Barker-Collo S, Jones K, Majdan M, Feigin V. Incidence of sports-related traumatic brain injury of all severities: a systematic review. Neuroepidemiology. 2020jan14;54(2):192–99. doi:10.1159/000505424.
Waldén M, Hägglund M, Orchard J, Kristenson K, Ekstrand J. Regional differences in injury incidence in European professional football. Scand J Med Sci Sports. 2013;23(4):424–30.
Ramkumar PN, Navarro SM, Haeberle HS, Luu BC, Jang A, Frangiamore SJ, Farrow LD, Schickendantz MS, Williams RJ. Concussion in American versus European professional soccer: a decade-long comparative analysis of incidence, return to play, performance, and longevity. Am J Sports Med. 2019août1;47(10):2287–93. doi:10.1177/0363546519859542.
Hallock H, Mantwill M, Vajkoczy P, Wolfarth B, Reinsberger C, Lampit A, Finke C, Sport-related concussion. Neurol Clin Pract. 2023;13(2):e200123.
Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. 2007;42(2):311–19.
Zuckerman SL, Kerr ZY, Yengo-Kahn A, Wasserman E, Covassin T, Solomon GS. Epidemiology of sports-related concussion in NCAA athletes from 2009-2010 to 2013-2014: incidence, recurrence, and mechanisms. Am J Sports Med. 2015nov1;43(11):2654–62. doi:10.1177/0363546515599634.
Nathanson JT, Connolly JG, Yuk F, Gometz A, Rasouli J, Lovell M, Choudhri T. Concussion incidence in professional football: position-specific analysis with use of a novel metric. Orthop J Sports Med. 2016jan1;4(1):2325967115622621. doi:10.1177/2325967115622621.
Salmon DM, Mcgowan J, Sullivan SJ, Murphy I, Walters S, Whatman C, Keung S, Clacy A, Romanchuk J. What they know and who they are telling: concussion knowledge and disclosure behaviour in New Zealand adolescent rugby union players. J Sports Sci. 2020juill;38(14):1585–94. doi:10.1080/02640414.2020.1749409.
Pierpoint LA, Collins C. Epidemiology of sport-related concussion. Clin Sports Med. 2021jan1;40(1):1–18.
Ferdinand Pennock K, McKenzie B, McClemont Steacy L, Mainwaring L. Under-reporting of sport-related concussions by adolescent athletes: a systematic review. Int Rev Sport Exerc Psychol. 2023déc31;16(1):66–92.
Putukian M, Purcell L, Schneider KJ, Black AM, Burma JS, Chandran A, Boltz A, Master CL, Register-Mihalik JK, Anderson V, et al. Clinical recovery from concussion–return to school and sport: a systematic review and meta-analysis. Br J Sports Med. 2023juin1;57(12):798–809. doi:10.1136/bjsports-2022-106682.
McNamee M, Anderson LC, Borry P, Camporesi S, Derman W, Holm S, Knox TR, Leuridan B, Loland S, Lopez Frias FJ, et al. Sport-related concussion research agenda beyond medical science: culture, ethics, science, policy. J Med Ethics. 2025jan1;51(1):68–76. doi:10.1136/jme-2022-108812.
Zech A, Hollander K, Junge A, Steib S, Groll A, Heiner J, Nowak F, Pfeiffer D, Rahlf AL. Sex differences in injury rates in team-sport athletes: a systematic review and meta-regression analysis. J Sport Health Sci. 2022janv;11(1):104–14. doi:10.1016/j.jshs.2021.04.003.
Hannah TC, Li AY, Spiera Z, Kuohn L, Dai J, McAuley F, Ali M, Durbin JR, Dreher N, Marayati NF, et al. Sex-related differences in the incidence, severity, and recovery of concussion in adolescent student-athletes between 2009 and 2019. Am J Sports Med. 2021juin1;49(7):1929–37. doi:10.1177/03635465211008596.
Cook NE, Kissinger-Knox A, Iverson IA, Stephenson K, Norman MA, Hunter AA, Saadi A, Iverson GL. Social determinants of health and health equity in the treatment and rehabilitation of sport-related concussion: a content analysis of intervention research and call-to-action. J Neurotrauma. 2024oct;41(19‑20):2201–18. doi:10.1089/neu.2023.0550.
Martens G, Patricios JS, Schneider KJ, Davis GA, Blauwet C, Feddermann-Demont N, Tooth C, Thibaut A, Kaux J-F, Leclerc S. Reform synthesis of the 6th International Consensus Statement on Concussion in Sport. Br J Sports Med. 2025avr1;59(7):444–47. doi:10.1136/bjsports-2024-109188.
Thibaut A, Kaux JF, Martens G, Urhausen A, Tscholl P, Hannouche D, Le Garrec S, Crema M, Winkler L, Cabri J, et al. Way for improvement: Primary survey on concussion knowledge of sports stakeholders in three European countries. Sci Sports. 2022avr1;37(2):94–100. doi:10.1016/j.scispo.2021.08.001.
Martens G, Edouard P, Tscholl P, Bieuzen F, Winkler L, Cabri J, Urhausen A, Guilhem G, Croisier J-L, Thoreux P, et al. Document, create and translate knowledge: the mission of ReFORM, the Francophone IOC Research Centre for Prevention of Injury and Protection of Athlete Health. Br J Sports Med. 2021févr;55(4):187–88. doi:10.1136/bjsports-2020-103087.
Martens G, Thibaut A, Urhausen A, Tscholl PM, Beaudart C, Romeas T, de Beaumont L, Caron JG, Le Garrec S, Hannouche D, et al. Sport-related concussion knowledge in French-speaking athletes, coaches, and health care professionals: results from an international survey on 2073 participants. Clin J Sport Med. 2025mar17. doi:10.1097/JSM.0000000000001388.
Van Pelt KL, Puetz T, Swallow J, Lapointe AP, Broglio SP. Data-driven risk classification of concussion rates: a systematic review and meta-analysis. Sports Med. 2021juin1;51(6):1227–44. doi:10.1007/s40279-021-01428-7.
Clay MB, Glover KL, Lowe DT. Epidemiology of concussion in sport: a literature review. J Chiropr Med. 2013déc1;12(4):230–51.
Gordon KE, Kuhle S. Canadians reporting sport-related concussions: increasing and now stabilizing. Clin J Sport Med. mai2022;32(3):313. doi:10.1097/JSM.0000000000000888.
Romeas T, Croteau F, Leclerc S. Where is the research on sport-related concussion in Olympic athletes? A descriptive report and assessment of the impact of access to multidisciplinary care on recovery. Br J Sports Med. 2024sep1;58(17):993–1000. doi:10.1136/bjsports-2024-108211.
Kontos AP, Jorgensen-Wagers K, Trbovich AM, Ernst N, Emami K, Gillie B, French J and Holland C and Elbin R. J. and Collins M. Association of time since injury to the first clinic visit with recovery following concussion. JAMA Neurol. 2020avr1;77(4):435–40. doi:10.1001/jamaneurol.2019.4552.
Parachute C. Concussion professional ressources[Internet]. Available at: https://parachute.ca/en/professional-resource/concussion-collection/.
Cook DJ, Cusimano MD, Tator CH, Chipman ML. Evaluation of the ThinkFirst Canada, Smart Hockey, brain and spinal cord injury prevention video. Inj Prev. 2003déc1;9(4):361–66. doi:10.1136/ip.9.4.361.
Fremont P, Schneider K, Laroche A, Emery C, Yeates K. Could a massive open online course be part of the solution to sport-related concussion? Participation and impact among 8368 registrants. BMJ Open Sport Exerc Med [Internet]. 2020 [cité 10 avr 2025];févr27;6(1). Disponible sur: https://bmjopensem.bmj.com/content/6/1/e000700.
FIFA. Inside FIFA[Internet]. Available at: https://inside.fifa.com/social-impact/campaigns/concussion/return-to-play-guidelines.
Zuckerman SL, Apple RP, Odom MJ, Lee YM, Solomon GS, Sills AK. Effect of sex on symptoms and return to baseline in sport-related concussion: clinical article. J Neurosurg Pediatr. 2014jan1;13(1):72–81. doi:10.3171/2013.9.PEDS13257.
Baker JG, Leddy JJ, Darling SR, Shucard J, Makdissi M, Willer BS. Gender differences in recovery from sports-related concussion in adolescents. Clin Pediatr (Phila). 2016juill1;55(8):771–75. doi:10.1177/0009922815606417.
Brown DA, Elsass JA, Miller AJ, Reed LE, Reneker JC. Differences in symptom reporting between males and females at baseline and after a sports-related concussion: a systematic review and meta-analysis. Sports Med. 2015juill1;45(7):1027–40. doi:10.1007/s40279-015-0335-6.
Stone S, Lee B, Garrison JC, Blueitt D, Creed K. Sex differences in time to return-to-play progression after sport-related concussion. Sports Health. 2017jan1;9(1):41–44.
Berz K, Divine J, Foss KB, Heyl R, Ford KR, Myer GD. Sex-specific differences in the severity of symptoms and recovery rate following sports-related concussion in young athletes. Phys Sportsmed. 2013mai1;41(2):58–63.
Desai N, Wiebe DJ, Corwin DJ, Lockyer JE, Grady MF, Master CL. Factors affecting recovery trajectories in pediatric female concussion. Clin J Sport Med. 2019sept;29(5):361. doi:10.1097/JSM.0000000000000646.
D’Lauro C, Johnson BR, McGinty G, Allred CD, Campbell DE, Jackson JC. Reconsidering return-to-play times: a broader perspective on concussion recovery. Orthop J Sports Med. 2018mar1;6(3):2325967118760854. doi:10.1177/2325967118760854.
Gallagher V, Kramer N, Abbott K, Alexander J, Breiter H, Herrold A, Lindley T, Mjaanes J, Reilly J. The effects of sex differences and hormonal contraception on outcomes after collegiate sports-related concussion. J Neurotrauma. 2018juin;35(11):1242–47. doi:10.1089/neu.2017.5453.
Bazarian JJ, Blyth B, Mookerjee S, He H, McDermott MP. Sex differences in outcome after mild traumatic brain injury. J Neurotrauma. 2010mars;27(3):527–39.
Kerr ZY, Register-Mihalik JK, Kroshus E, Baugh CM, Marshall SW. Motivations associated with nondisclosure of self-reported concussions in former collegiate athletes. Am J Sports Med. 2016jan1;44(1):220–25. doi:10.1177/0363546515612082.
Torres DM, Galetta KM, Phillips HW, Dziemianowicz EMS, Wilson JA, Dorman ES, Laudano E, Galetta SL, Balcer LJ. Sports-related concussion: Anonymous survey of a collegiate cohort. Neurol Clin Pract. 2013août;3(4):279–87. doi:10.1212/CPJ.0b013e3182a1ba22.
Ono KE, Burns TG, Bearden DJ, McManus SM, King H, Reisner A. Sex-based differences as a predictor of recovery trajectories in young athletes after a sports-related concussion. Am J Sports Med. 2016mar1;44(3):748–52. doi:10.1177/0363546515617746.
