Abstract
Concussions are a common occurrence in young athletes. Hypobaric hypoxemia, such as that experienced during airplane travel, can potentially cause alterations to cerebral blood flow and increased neuroinflammatory response. It remains unknown whether flying early after a concussion may influence the clinical course of injury. To determine whether there is an association between concussion recovery and airplane travel in collegiate athletes and military cadets. This cohort study was conducted by the National Collegiate Athletic Association and US Department of Defense Concussion Assessment, Research, and Education Consortium from August 3, 2014, to September 13, 2018. Participant groups were categorized by those who flew within 72 hours of injury and those who did not fly. All participants included in the final analyses had complete data of interest and only 1 injury during the study. Data analysis was performed from September 2018 to March 2020. Recovery outcome measures were defined as time (in days) from injury to return to activity, school, and baseline symptoms. Symptom and headache severity scores were derived from the Sports Concussion Assessment Tool-Third Edition. Scores for both groups were taken at baseline and a median of 2 days after injury. A total of 92 participants who flew (mean [SD] age, 19.1 [1.2] years; 55 male [59.8%]) and 1383 participants who did not fly (mean [SD] age, 18.9 [1.3] years; 809 male [58.5%]) were included in the analysis of symptom recovery outcomes (analysis 1). Similarly, 100 participants who flew (mean [SD] age, 19.2 [1.2] years; 63 male [63.0%]) and 1577 participants who did not fly (mean [SD] age, 18.9 [1.3] years; 916 male [58.1%]) were included in the analysis of symptom severity outcomes (analysis 2). No significant group differences were found regarding recovery outcome measures. Likewise, there were no group differences in symptom (estimated mean difference, 0.029; 95% CI, -0.083 to 0.144; P = .67) or headache (estimated mean difference, -0.007; 95% CI, -0.094 to 0.081; P = .91) severity scores. Airplane travel early after concussion was not associated with recovery or severity of concussion symptoms. These findings may help guide future recommendations on flight travel after concussion in athletes.
Highlights
Concussion, a form of mild traumatic brain injury (TBI), is a neurological disturbance following a biomechanical force to the brain and is characterized by a constellation of symptoms including but not limited to headache, dizziness, fatigue, irritability, insomnia, and difficulty with concentration and memory.[1]
Airplane travel early after concussion was not associated with recovery or severity of concussion symptoms
Hypobaria and hypoxemia during air travel may aggravate moderate to severe disorders, it is currently unclear whether this can exacerbate symptoms after mild TBI
Summary
Concussion, a form of mild traumatic brain injury (TBI), is a neurological disturbance following a biomechanical force to the brain and is characterized by a constellation of symptoms including but not limited to headache, dizziness, fatigue, irritability, insomnia, and difficulty with concentration and memory.[1] Clinical outcome following concussion may be influenced by additional stressors that can affect brain function after initial injury Some of these stressors include sleep deprivation, pharmaceuticals, psychiatric disorders (eg, anxiety or depression), and dehydration.[2,3] Hypobaric hypoxemia, such as that encountered during air travel, could exacerbate concussion-related symptoms and prolong recovery. Hypobaria and hypoxemia during air travel may aggravate moderate to severe disorders, it is currently unclear whether this can exacerbate symptoms after mild TBI
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