Simulation-Optimization to Distinguish Optimal Symptom Free Waiting Period for Return-to-Play Decisions in Sport-Related Concussion

Gian Gabriel P. Garcia, Lauren L. Czerniak, Mariel S. Lavieri, Spencer W. Liebel, Michael A. McCrea, Thomas W. McAllister, Paul F. Pasquina, Steven P. Broglio

Research output: Chapter in Book/Report/Conference proceedingConference contributionpeer-review

2 Scopus citations


Approximately 1.6-3.8 million sport and recreation concussions occur annually. Yet, there is currently no universal agreement on when an athlete should be permitted to unrestricted play after being diagnosed with a concussion. Simulation-optimization provides a tractable method to optimize the length of the symptom-free waiting period (SFWP), i.e., the number of consecutive days after starting the return-to-play protocol that an athlete must be symptom-free before they are permitted to unrestricted play. We develop a two-part treatment initiation/cessation simulation model consisting of a (1) Controlled Hidden Markov Model [pre-return-to-play] and (2) Uncontrolled Markov Chain [post-return-to-play] and apply four simulation-optimization methods (Crude Monte Carlo, 2-Stage Decomposition, NSGS, KN) to optimize the SFWP. For collegiate men's football and women's soccer, we find an optimal SFWP of approximately 2 and 3.5 weeks, respectively. This research provides clinical decision-support for return-to-play decisions.

Original languageEnglish
Title of host publicationProceedings of the 2022 Winter Simulation Conference, WSC 2022
EditorsB. Feng, G. Pedrielli, Y. Peng, S. Shashaani, E. Song, C.G. Corlu, L.H. Lee, E.P. Chew, T. Roeder, P. Lendermann
PublisherInstitute of Electrical and Electronics Engineers Inc.
Number of pages12
ISBN (Electronic)9798350309713
StatePublished - 2022
Externally publishedYes
Event2022 Winter Simulation Conference, WSC 2022 - Guilin, China
Duration: 11 Dec 202214 Dec 2022

Publication series

NameProceedings - Winter Simulation Conference
ISSN (Print)0891-7736


Conference2022 Winter Simulation Conference, WSC 2022


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