Mapping the acute trajectory of sport-related concussion outcomes across symptoms, cognition, and blood biomarkers

Abstract

Sport-related concussion (SRC) and its potential neurological sequela represent an emerging global health concern, requiring improved recovery management and strategies for return-to-play (RTP) to enhance brain health in athletes. Given the dynamic and multifaceted nature of SRC recovery, the purpose of this review is to synthesize existing literature on post-SRC outcomes in adult athletes, and to outline the temporal trajectories of key recovery indicators (symptoms, cognitive function, blood biomarkers) across distinct recovery phases until resolution. In the acute phase of SRC (first 48 h), symptom scores and brain damage markers peaked immediately, while cognitive impairments and neuroinflammation emerged with a slight delay. Following the initial rise, brain damage marker concentrations rapidly dropped below baseline levels at approximately 48 h following SRC injury. During the early recovery phase, neuroinflammation and most cognitive alterations resolved after 3-5 days, though symptom burden and attention deficits persisted for up to 7 days. Despite prolonged alterations reported in some individuals, recovery markers typically returned to pre-injury levels in the transition phase (>2 weeks), though mild attention deficits were detected up to 3 weeks, and TNF-α concentrations remained elevated throughout late recovery (> 2 weeks). These results reveal distinct temporal discrepancies across recovery markers and emphasize that physiological disturbances can outlast symptom resolution, underscoring the need for both multimodal assessments and appropriately timed evaluations to accurately track recovery progression. Incorporating structured follow-ups at key time points, particularly beyond symptom resolution, may improve RTP decision-making and reduce the risk of premature return and long-term neurological consequences.

Keywords

Sport-related concussion / Recovery / Return-to-play / Symptoms / Cognitive function / Blood biomarkers / Narrative review

CRediT authorship contribution statement

SoYoung Ahn: Writing - original draft, Methodology, Writing -review & editing, Project administration, Conceptualization, Visualiza-tion, Data curation. Michael Prock: Visualization, Data curation, Writing - original draft, Methodology, Writing - review & editing, Project administration, Conceptualization. Ji-won Seo: Data curation, Writing - original draft, Writing - review & editing. Sanghyuk Han: Data curation, Writing - original draft, Writing - review & editing. David Michael O'Sullivan: Writing - review & editing, Conceptualization, Supervision, Validation. Wook Song: Validation, Writing - review & editing, Conceptualization, Supervision.

Declaration of Generative AI

During the preparation of this work the authors used ChatGPT in order to improve readability and language. After using this tool/service, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.

Funding details

The authors declare no specific funding for this research.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Appendix A. Supplementary data

Supplementary data to this article can be found online at https://doi.org/10.1016/j.smhs.2025.07.003.

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