Factors influencing delayed removal from middle school, high school, and collegiate competition following sport-related concussion.

Authors

Clayton R Baker, Keen Zoller, Jonathan Bao, Kristen Williams, Anna Peterson, Robert Fitch, Scott L Zuckerman, Douglas P Terry

Published in

JSAMS plus. Volume 8. Pages 100147. Epub Jul 04, 2026.

Abstract

While delayed removal from play has been associated with worse outcomes following sport-related concussions (SRC), factors that predict delayed removal (vs. immediate) remain poorly understood. This study aimed to identify predictors of delayed removal following an SRC.
A retrospective analysis included athletes aged 12-23 who presented to a regional sports concussion center within one day of injury. Patient demographics, injury characteristics, and clinical recovery metrics were extracted from medical records. Removal timeline was categorized as immediate (removed from play at time of injury) or delayed (continued participation). Comparisons across groups and a multivariable logistic regression model were conducted to identify predictors of delayed removal.
In 291 athletes (29.6% female, median age = 15.6 [IQR = 14.5-16.8]), 109 (37.5%) had delayed removal (29.4% female; median age 15.7 [IQR 14.5-16.9]). Sex, race, sport, school, and competition type did not differ significantly between immediate and delayed removal groups. Athletes with loss of consciousness (LOC) had over 81% lower odds of delayed removal (OR = 0.19, 95%CI: 0.08-0.44; p < 0.01), and those evaluated on the field had 70% lower odds of delayed removal (OR = 0.30, 95%CI: 0.17-0.54; p < 0.01). Initial symptom scores were lower among those immediately removed (19.0 [IQR = 6.0-38.2]) compared to the delayed removal group (24.0 [IQR = 11.0-44.0]; p = 0.05). Return-to-learn, symptom resolution, and return-to-play timelines did not differ significantly between groups.
On-field evaluations and observable clinical signs such as LOC strongly reduced risk of delayed removal from play after SRC. These findings emphasize the critical role of athletic trainers and prompt sideline recognition in reducing delayed removal and acute symptom burden.

PMID:
42437190
Bibliographic data and abstract were imported from PubMed on 12 Jul 2026.

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