Return-to-Play Decision Making After Emergency Department Presentation: A Systematic Review from a Sports Medicine Perspective

Emergency department discharge initiates recovery after athletic injury, while decisions about unrestricted sport require assessment beyond clinical stability. This review examined comparative original studies about activity progression, discharge communication, and rehabilitation after emergency presentation. We aimed to distinguish treatment effects on recovery from evidence establishing readiness for competition. A structured search of bibliographic records and research reports identified ten original comparative studies for synthesis. Eligible studies recruited patients through emergency or mixed emergency and outpatient settings and evaluated concussion management or ankle rehabilitation and findings were grouped by injury and intervention. Nine randomized trials and one prospective cohort addressed seven concussion populations and three ankle sprain populations. Five days of strict rest increased concussion symptom burden, while pediatric and adult trials of early activity produced differing results. A recent trial found delayed symptom resolution with prescribed activity targets despite symptoms. Symptom-guided instructions improved perceived usefulness without establishing faster recovery. Early ankle exercise improved short-term function, supervised physiotherapy produced no clear additional benefit, and brief immobilization improved recovery after severe sprains. The data supports individualized activity progression, injury-specific rehabilitation, and clear follow-up arrangements. Symptom improvement and functional gains do not establish unrestricted sports clearance.