Does Timing of Concussion in Season Affect Incidence and Recovery in Division I Collegiate Football Players? A CARE Consortium Study

Objective: – To investigate whether seasonality is associated with (1) concussion incidence and (2) recovery outcomes, including the time to symptom resolution (SR) and return-to-play (RTP) in Division I college football players. Setting: – Multi-institution study using the CARE Consortium database composed of 30 universities investigating the natural history of concussions between 2014 and 2020. Participants: – 682 Division I football athletes across 21 institutions who sustained a concussion during practice or competition. Design: – Prospective cohort study of NCAA Division I football players with concussion. Main Measures: – Concussion incidence rates across 4 season periods (preseason, early, middle, and late-season) were analyzed using chi-square tests. Time to SR and RTP were analyzed using Kaplan-Meier curves, and Cox proportional hazards regression. Results: – Concussion incidence rates were highest during preseason (4.73 per 100 players) compared to early (2.19), middle (2.31), and late-season (2.17). The temporal distribution showed 41.9% of concussions occurred during preseason, with 19.2%, 20.1%, and 18.8% occurring during early, middle, and late-season, respectively (χ² = 104.6, P < .001). Kaplan-Meier analysis revealed significant differences in time to SR (log-rank P = .012). Early (HR = 0.582, P < .001) and late-season (HR = 0.634, P = .002) concussions had delayed SR compared to preseason. No differences in time to RTP (log-rank P = .300) were found, although early-season concussions had a lower RTP hazard (HR = 0.703, P = .040). Conclusions: – In a multi-institution cohort of collegiate football players, preseason resulted in the highest incidence of concussions, while early and late-season concussions had significantly longer time to SR compared to preseason. These temporal patterns suggest that contextual factors may influence concussion outcomes and warrant mechanistic investigation to inform future management strategies.