Exercise intolerance and time to medical clearance to return to sport following sport-related concussion in adolescents
Bibliographic record
Abstract
Objective: Recovery duration following adolescent sport-related concussion (SRC) is variable. Previous research revealed exercise intolerance is associated with delayed recovery (predominantly male Australian cohort). Additional sport contexts and considerations of sex are necessary. This study investigated sex-specific associations between exercise intolerance and time-to-medical clearance to return-to-sport (RTS) following SRC in adolescents (ages 10-19). Methods: Adolescent athletes participating in the pan-Canadian SHRed Concussions cohort study were included within 14 days following a physician diagnosed SRC. Participants completed the Buffalo Concussion Treadmill Test (BCTT). Pre-BCTT Sport Concussion Assessment Tool 5 (SCAT5) Symptom Severity Score (SSS;/132) and concussion Overall Condition score (OC;/10) were recorded. Termination criteria for BCTT were participants who experienced ≥3/10 increase for OC (exercise intolerant) or reached volitional fatigue (≥180bpm, ≥18/20 rating of perceived exertion, exercise tolerant). Results: 281 adolescents (126 male and 155 female), of whom 204 (72.6%) (100 male (79.4%), 104 female (67.1%)) were exercise tolerant and 77 (27.4%) (26 male (20.6%), 51 female (32.9%)) were intolerant following SRC. Based on the point estimate, females had a 1.45 times higher risk of exercise intolerance compared with males (risk ratio=1.45, 95% CI 0.96 to 2.20). Exercise intolerance was associated with a 36% longer medical clearance time to RTS following SRC for females (time ratio=1.36, 95% CI 1.12 to 1.64), while for males, no association was observed (time ratio=1.13, 95% CI 0.90 to 1.42) (adjusted for age, BCTT duration, SCAT5 SSS and days from SRC to BCTT). Conclusion: Exertion testing may identify female adolescents at higher risk of delayed medical clearance recovery to RTS, informing the comprehensive clinical management of SRC.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".