Sidney Crosby and postconcussion syndrome

One of the biggest stories heading into the start of the NHL season: When will Sydney Crosby play again? Unfortunately, it seems that not even Crosby knows at this point. A growing number of people are starting to wonder if that day will ever happen...

The topic that I'll look at here will revolve around postconcussion syndrome (PCS) and general information about the prognosis of it.

• Symptoms and disability are usually greatest between 7-10 days after the concussion.
• Most recover from PCS by three months, with 10-15% still experiencing symptoms after one year (the article quotes possible biased reporting in the study which means the prevalence may actually be lower).
• In a small study of 79 patients who presented with concussions to the Emergency Department, 28% had one or more complaints after 6 months.
  

In the quick review I did of some studies, the risk factors for a prolonged recovery time usually included...

• older age
• increased number of symptoms immediately after the concussion (i.e. headache, dizziness, nausea, decreased level of consciousness) - one study these symptoms doubled the risk of PCS
• longer post-traumatic amnesia
• abnormalities seen on MRI or CT immediately after the concussion
• more disability when admitted to rehabilitation
  
• preinjury unemployment, substance abuse (you'd like to think that these last two aren't relevant to Crosby's case)

In a nutshell, it looks like the majority of factors that are correlated with long-term disability lie more in the acute injury itself rather than the length of recovery time itself. (Does that make sense?)

One stat that made me think of Marc Savard: In a prospective cohort (I know, not the best evidence) of 2995 people, disability 1 year after a traumatic head injury was also often associated with disability 5-7 years after the injury. However, this was also highly dependent on the severity (i.e. initial level of consciousness) of the injury.

Interestingly, some of what I was reading started to go into complications of repeated traumatic head injuries. Lo and behold, common complications of the repeated injuries include increased risk for depression and chronic pain. Ring a bell?

Here's hoping the NHL takes these head injuries as seriously as trying to keep the Coyotes in Phoenix...


Sources: UpToDate and DynaMed