Resting Metabolic Rate and Recovery From Sport-Related Concussion: A Critically Appraised Topic.

CLINICAL SCENARIO: Critical appraisal of whole-body metabolism as a measure of concussion recovery is lacking in the available evidence. There has been extensive exploration of options for a gold standard assessment for concussion, including blood biomarkers, electroencephalogram, and neuroimaging, but none have yet to demonstrate good empirical evidence of efficacy.

CLINICAL QUESTION: In patients with sport-related concussion (SRC), can resting metabolic rate (RMR), as measured through indirect calorimetry, be used as a physiologic assessment of recovery?

SUMMARY OF KEY FINDINGS: Three studies demonstrated relevance to the clinical question. Of the selected studies, 2 studies were case-control, and 1 was a case series. All studies observed reduced total energy expenditure and increased energy balance when initially assessed between 24 and 72 hours after injury.

CLINICAL BOTTOM LINE: Evidence exists to suggest that RMR as measured with indirect calorimetry is a poor indicator of SRC recovery. All 3 articles found that RMR was not affected by SRC, even when compared with healthy controls. One article did observe a between sex difference in RMR, but a very small sample size was included in the case series.

STRENGTH OF RECOMMENDATION: The findings of this critically appraised topic suggest a strength of recommendation of grade B, demonstrating that RMR is a poor indicator of recovery from SRC.