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We utilized a likelihood heuristic to assess the probability of observing a specific number of statistically significant and nonsignificant studies reporting an association between concussion history and clinical outcomes. We conducted a narrative synthesis of the study findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixteen studies met the inclusion criteria. Thirteen studies reported the number of participants with a history of prior concussions (\u2265\u20091), which totaled 1690 of 4573 total participants (on average 37.0% of study participants; median\u2009=\u200946.0%, range 5.6\u201363.8%). On the Newcastle\u2013Ottawa Quality Assessment Scale, the risk of bias ratings ranged from 3 to 9 (mean\u2009=\u20095.4, SD\u2009=\u20091.4). Across all studies, 43.8% (<jats:italic>k<\/jats:italic>\u2009=\u20097\/16) reported at least one statistically significant result among primary analyses showing an association between concussion history and worse clinical outcome. A minority of studies reporting on symptom duration (4\/13, 30.8%) and time to return to play (2\/7, 28.6%) found an association between concussion history and worse outcome. Studies included in the review reported limited information pertaining to the characteristics of prior concussions, such as presence or duration of loss of consciousness or posttraumatic amnesia, age at first lifetime concussion, time since most recent past concussion, or length of recovery from prior concussions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The question of whether college athletes with a prior history of concussion have worse clinical outcome from their next sport-related concussion remains unresolved. The published results are mixed and in aggregate show modest evidence for an association. Many studies have small samples, and only three studies were designed specifically to address this research question. Important outcomes, such as time to return to academics, have not been adequately studied. Larger hypothesis-driven studies considering the number of prior concussions (e.g., 3 or more) are needed.<\/jats:p><jats:p><jats:italic>Trial registration<\/jats:italic>: PROSPERO CRD42016041479, CRD42019128300.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s40798-022-00528-6","type":"journal-article","created":{"date-parts":[[2022,10,29]],"date-time":"2022-10-29T10:15:04Z","timestamp":1667038504000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Clinical Outcome Following Concussion Among College Athletes with a History of Prior Concussion: A Systematic Review"],"prefix":"10.1186","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1602-9652","authenticated-orcid":false,"given":"Charles E.","family":"Gaudet","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7348-9570","authenticated-orcid":false,"given":"Grant L.","family":"Iverson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"Kissinger-Knox","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Van Patten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan E.","family":"Cook","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,10,29]]},"reference":[{"key":"528_CR1","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1136\/bjsports-2017-097699","volume":"51","author":"P McCrory","year":"2017","unstructured":"McCrory P, Meeuwisse W, Dvo\u0159\u00e1k J, Aubry M, Bailes J, Broglio S, et al. 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Dr. Iverson serves as a scientific advisor for NanoDX\u00ae, Sway Operations, LLC, and Highmark, Inc. He has a clinical and consulting practice in forensic neuropsychology, including expert testimony, involving individuals who have sustained mild TBIs (including former athletes). He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He has received research funding as a principal investigator from the National Football League, and subcontract grant funding as a collaborator from the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association Members. Dr. Kissinger-Knox has no interests to disclose. Dr. Van Patten has no interests to disclose. Dr. Cook has no interests to disclose.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"134"}}