Concussion In Athletes Research Articles

Initial Symptom Severity and Recovery of Sport-Related Concussion in Team Versus Individual Sport Athletes.

Recovery after sport-related concussion is variable, and potential differences between team vs individual sport athletes are not fully understood. In a cohort of athletes with concussions, we sought to compare these groups across (1) symptom severity score, (2) individual symptom cluster scores, and (3) recovery metrics. A retrospective, cohort study of 13 to 23-year-old athletes treated at a regional sport concussion center between November 2017 and April 2022 was conducted. Athletes were categorized into team vs individual sport athletes, with additional classification of individual sports based on strong vs minimal team elements (ie, the degree of interdependence displayed by athletes). The primary outcomes were symptom severity score, measured by either the Sport Concussion Assessment Tool-5th Edition or the Immediate Post-Concussion Assessment and Cognitive Testing, and physical, cognitive, emotional, and sleep symptom cluster scores. Secondary outcomes were recovery metrics, including time to return-to-learn, symptom resolution, and return-to-play. Of the 1051 athletes, 954 (90.8%) were in team sports and 97 (9.2%) in individual sports. In multivariable linear regression, individual sport athletes had higher emotional symptom severity compared with team sport athletes (β = 0.09 [0.01, 0.17], P = .034) when adjusting for sex, attention-deficit/hyperactivity disorder, psychological disorders, time to clinic, on-field evaluation, and Immediate Post-Concussion Assessment and Cognitive Testing vs Sport Concussion Assessment Tool-5th Edition scale. There were no significant differences in return-to-learn (P = .104), symptom resolution (P = .941), or return-to-play (P = .279) on univariate regressions. In the current single-center, pilot study of athletes with a sport-related concussion, individual sport athletes exhibited more emotional symptoms than team sport athletes. These preliminary data lend early support that individual sport athletes may be more at risk of emotional symptoms than team sport athletes after a sport-related concussion. Clinicians may use these findings to identify athletes who may be particularly vulnerable to emotional symptoms.

Concussion in Female Athletes of Contact Sports: A Scoping Review.

Recent studies have described higher incidences of concussion, with more severe symptoms and worse outcomes in female athletes compared with male athletes. To compile current knowledge about sex-specific differences in incidence, biomechanics, biomarkers, imaging, and outcomes of concussion in athletes participating in contact sports to better understand which fields should be explored in more detail. Scoping review; Level of evidence, 3. The PubMed database was searched for articles published between January 2000 and November 2020 using the Medical Subject Headings terms "craniocerebral trauma" and "brain concussion" combined with the contact sports "football,""soccer,""hockey," and "boxing." Eligibility criteria were based on the recommendations of the Scottish Intercollegiate Guidelines Network. It focused on sex-specific differences within 5 major topics: (1) epidemiology, (2) biomechanics, (3) biomarkers, (4) imaging, and (5) specific concussion outcome variables, including neurocognitive performance, injury severity, and behavioral and psychological symptoms. A total of 22 studies were included. Eight studies investigated the incidence of concussion, with 4 of the 8 finding a significantly higher incidence rate for female versus male athletes. Six studies that focused on biomechanics found that female athletes received fewer impacts with lower magnitudes. One study addressed biomarkers, showing that S100 calcium-binding protein B and neuron-specific enolase were increased after a game in female athletes, and the level of increase was similar to the changes found in male athletes. Based on the 3 imaging studies, affected brain tissue was greatest in areas associated with tau pathology in chronic traumatic encephalopathy. One study showed a lower hypointensity burden index after a season of ice hockey for female athletes, while another study showed more regions with white matter alterations. Seven studies examined concussion outcomes, with 4 studies showing more severe neuropsychological deficits; in addition, female athletes reported more and worse symptoms than male athletes. The results of this review indicated that female athletes had a higher risk of sustaining a concussion, although they received fewer impacts with lower magnitudes than male athletes. Biomarkers were able to be used equally for both sexes. Female athletes also had a higher neuropsychological deficit and increasingly worse symptoms after a concussion.

Missing School Days Following Sport-Related Concussion in High School Athletes

Sport-related concussions (SRC) can significantly impact students' attendance and academic performance, highlighting the importance of gradual return-to-learn protocols for recovery. Understanding the association between missed school days and recovery, especially across genders, is vital for effective concussion management in high school athletes. To describe missed school days in high school athletes with SRC and to determine associations between missed school days and authorized clearance to return to competition; secondarily, to determine whether school days missed differed by gender. Cohort study among student athletes participating in athletics sponsored by the Michigan High School Athletic Association (MHSAA) during academic years 2015 to 2023. SRC was a participant eligibility criterion and was defined as a head injury during participation in a MHSAA-sanctioned event. Data were analyzed from August 2015 to June 2023. Primary exposure was missed school days; additional exposures included gender, year of season, concussion history, event type, sport level, contact level, and athletic trainer involvement. The primary outcome was time to full unrestricted clearance following SRC. The analysis included a total of 20 934 individuals with SRC (13 869 boys [66.25%]). Gender (χ23 = 167.40; P < .001), season (χ221 = 57.41; P < .001), event type (χ23 = 99.29; P < .001), sport level (χ29 = 68.15; P < .001), contact level (χ26 = 56.73; P < .001), and initial evaluation (χ23 = 147.13; P < .001) were independently associated with missed school days. Athletes took a median (IQR) of 11 (7-16) days to return to full unrestricted clearance. Relative to no missed school days, there was a significant mean increase of 57% (incidence rate ratio, 1.57; 95% CI, 1.52-1.62) in time to full unrestricted clearance for 3 or more missed school days. The estimated mean days to return to sport were 12.15 (95% CI, 12.00-12.30) for 0 missed school days, 12.68 (95% CI, 12.39-12.96) for 1 missed school day, 15.47 (95% CI, 15.06-15.87) for 2 missed school days, and 19.08 (95% CI, 18.55-19.62) for 3 or more missed school days. This cohort study found that high school athletes typically missed 2 or fewer school days after SRC, suggesting that concussion management teams adhered to current recommendations of 24 to 48 hours of initial rest. The dose association, with more missed school days associated with slower return to play, suggests athletes' missing more school days (eg, ≥3) may be associated with severity of concussion and warrant additional support to return to school and/or sport.

B - 33 A Preliminary Study of the Influence of Thoughts that Prevent Concussion Reporting in Female College Athletes

Abstract Objective To quantify the influence of barriers that prevent intention to report concussions in female athletes. Hypothesis: NCAA Division 1 (D1) athletes will have higher overall reporting barrier scores than Division 3 (D3). Method Participants/Setting: 70 participants started the study and 13 were removed due to incomplete questionnaires, resulting in 57 participants (38 from D1). Athletes participating in contact sports (e.g., soccer) were recruited via email or flyers posted in training rooms. Measurement: A 21-item online questionnaire consisting of eight demographic questions and 13 questions related to barriers that prevent reporting. The barrier items were modified from themes derived from a published qualitative study of 503 collegiate athletes who completed a reporting worksheet. Participants rated agreeability [0 (strongly disagree) to 100 (strongly agree)] for the items that prevent reporting. Results Descriptive statistics indicated barriers likely to prevent reporting (e.g., Losing Playing Time; M = 78.02, SD = 22.61) and those less likely (e.g., Negative Reaction from Teammates; M = 44.75, SD = 31.63). The overall barrier to reporting score was not significantly different between D1 (M = 817.34, SD = 247.90) and D3 (M = 740.11, SD = 225.74), t (55) = 1.141, p = 0.259, d = 0.32. The internal consistency of the 13 barrier items was good, α = 0.852. Conclusions Barriers to reporting with greater saliency were identified, which may need to be prioritized during concussion education. The overall questionnaire score did not significantly differ between D1 and D3 suggesting that barriers operate similarly at different levels of competition. The questionnaire’s good internal consistency suggests it has potential as a research tool.

Where is the research on sport-related concussion in Olympic athletes? A descriptive report and assessment of the impact of access to multidisciplinary care on recovery

ObjectivesThis cohort study reported descriptive statistics in athletes engaged in Summer and Winter Olympic sports who sustained a sport-related concussion (SRC) and assessed the impact of access to multidisciplinary care...

Comparative analysis of sport-related concussion: how do 8- to 12-year-old athletes differ from 13- to 17-year-old athletes?

Despite the growing literature on sport-related concussion (SRC) in high school and collegiate athletes, the understanding of how outcomes can vary in child athletes younger than 12 years of age remains limited. Therefore, the authors sought to compare injury characteristics and recovery in 8- to 12-year-old athletes with those of 13- to 17-year-old athletes following SRC. A single-institution retrospective cohort study was undertaken including 8- to 12-year-old and 13- to 17-year-old athletes seen at a regional SRC between November 2017 and January 2022. Demographic information, injury characteristics, Post-Concussion Symptom Scale (PCSS) scores, and recovery (i.e., return to learn [RTL], symptom resolution, and return to play [RTP]) were compared between 8- to 12-year-old and 13- to 17-year-old athletes using the Mann-Whitney U-test and chi-square test. A total of 147 athletes (8- to 12-year-old athletes: n = 49; 13- to 17-year-old athletes: n = 98) were included. The mean ages for the younger and older groups were 10.9 ± 0.9 and 15.7 ± 1.3 years, respectively. Athletes aged 8-12 years and 13-17 years had similar median times to initial healthcare presentation (1 vs 2 days, p = 0.37). Athletes aged 8-12 years were more likely to present to the emergency department (ED) (44.9% vs 25.5%, p = 0.02) and receive head imaging (36.7% vs 19.4%, p = 0.02). Initial PCSS scores were similar between the groups (21.5 vs 22.0, p = 0.99). Athletes aged 8-12 years took longer to RTL (median 6.0 [IQR 4.0-13.0] days vs median 4.0 [IQR 2.0-8.0] days, p = 0.04). However, time to symptom resolution (median 16.0 [IQR 7.0-42.0] days vs median 13.5 [IQR 6.3-22.5] days, p = 0.34) and RTP (median 22.5 [IQR 10.0-54.8] days vs median 15.0 [IQR 10.0-24.0] days, p = 0.17) were not significantly different. Comparing 8- to 12-year-old with 13- to 17-year-old concussed athletes, the authors found that the initial PCSS score did not differ, although the younger group was more likely to present to the ED and receive head imaging. The 8- to 12-year-old athletes took more time to RTL, although no differences were found in time to symptom resolution or RTP.

Differential neural mechanisms for movement adaptations following neuromuscular training in young female athletes with a history of sports-related concussion

Sports-related concussion (SRC) in adolescent athletes is associated with an increased risk of subsequent lower extremity injury. Neuromuscular training (NMT) has shown promise for reducing lower extremity injuries following SRC, however, neural adaptations in response to changes in lower extremity biomechanics following NMT in athletes with a history of SRC (HxSRC) remains poorly understood. Therefore, the purpose of this study was to identify changes in neural activity associated with lower extremity movement adaptations following a six-week NMT intervention in athletes with a HxSRC. Thirty-two right-hand/foot-dominant female adolescent athletes (16 with self-reported HxSRC, 16 age- and anthropometrically-matched controls) completed a bilateral leg press task with 3D motion analysis during functional magnetic resonance imaging (fMRI). Movement adaptations were defined as a change in frontal and sagittal plane range of motion (ROM) during the fMRI bilateral leg press task. Significant pre- to post-NMT reductions were observed in the non-dominant (left) mean frontal plane ROM. Whole-brain neural correlate analysis revealed that increased cerebellar activity was significantly associated with reduced mean left-knee frontal ROM for matched controls. Exploratory within group analyses identified neural correlates in the postcentral gyrus for the HxSRC group which was associated with reduced mean left-knee frontal plane ROM. These distinct longitudinal changes provide preliminary evidence of differential neural activity associated with NMT to support knee frontal plane control in athletes with and without a HxSRC.

Trends in recovery from repeated concussion in collegiate athletes in collision sport

Sports-related concussion (SRC) is a growing concern across all age groups, particularly among collegiate athletes facing rigorous academic and athletic challenges linked to performance. For this reason, a large body of research is about this demographic. While our approach to studying concussions is more sophisticated than ever, much remains to be learned. This review addressed three specific areas of literature concerning SRC. First, does a previous concussion history predispose an individual to future head injuries? Second, does the number of concussions impacts return to play (RTP) time? And third, does the interval between concussions affect the recovery trajectory? While this is not a comprehensive review, we have compiled compelling evidence strongly favoring all three of these questions.

Concussion Reduction in Division I and II Athletes: Effects of Simple Cervical Spine Exercise Regimen.

Primary preventative medicine lacks a consensus on effective concussion prevention strategies for collegiate athletes. Cervical strength has been identified as a potential factor in concussion risk reduction. This study evaluates the impact of a commercially available, portable cervical muscle stretching and strengthening device, NeckX®, on cervical strength, range of motion (ROM), and concussion incidence in collegiate athletes participating in high-concussion-risk sports. A single-arm prospective cohort study was conducted with 162 collegiate athletes from various sports. Participants underwent a 12-week neck exercise protocol using the NeckX® device. Clinical data, including neck strength and ROM, were collected at weeks 0, 6, and 12. Concussion incidence was self-reported by participants and cross-referenced with records from the athletic department. Data were analyzed for significant neck strength and ROM changes throughout the 12-week study. A two-way analysis of variance multiple comparisons with the Tukey-Kramer significant difference test was utilized, using the Holm-Sidak method, with an alpha of 0.05. All athletic teams experienced a significant increase in cervical strength during the 12-week intervention (α = 0.05, p < 0.05). Increases in cervical flexion and extension force were most consistent between teams. Cervical ROM increased significantly in male and female soccer players (α = 0.05, p < 0.05). The overall incidence of head and neck injuries, including concussions, was reduced to 6.60% during the study period, the lowest recorded value in the university's athletic department history. The use of the NeckX® device for 12 weeks was effective in enhancing pericervical muscle strength and ROM while reducing concussion incidence in collegiate athletes participating in high-concussion-risk sports. Interestingly, the positive outcomes were consistent for both males and females, indicating the universal advantages of neck training among collegiate athletes. These findings support existing research on the benefits of cervical strengthening exercises for reducing concussions in collegiate athletes and highlight the convenience and affordability of using this device.

Assessment of Sports Concussion in Female Athletes: A Role for Neuroinformatics?

Over the past decade, the intricacies of sports-related concussions among female athletes have become readily apparent. Traditional clinical methods for diagnosing concussions suffer limitations when applied to female athletes, often failing to capture subtle changes in brain structure and function. Advanced neuroinformatics techniques and machine learning models have become invaluable assets in this endeavor. While these technologies have been extensively employed in understanding concussion in male athletes, there remains a significant gap in our comprehension of their effectiveness for female athletes. With its remarkable data analysis capacity, machine learning offers a promising avenue to bridge this deficit. By harnessing the power of machine learning, researchers can link observed phenotypic neuroimaging data to sex-specific biological mechanisms, unraveling the mysteries of concussions in female athletes. Furthermore, embedding methods within machine learning enable examining brain architecture and its alterations beyond the conventional anatomical reference frame. In turn, allows researchers to gain deeper insights into the dynamics of concussions, treatment responses, and recovery processes. This paper endeavors to address the crucial issue of sex differences in multimodal neuroimaging experimental design and machine learning approaches within female athlete populations, ultimately ensuring that they receive the tailored care they require when facing the challenges of concussions. Through better data integration, feature identification, knowledge representation, validation, etc., neuroinformaticists, are ideally suited to bring clarity, context, and explainabilty to the study of sports-related head injuries in males and in females, and helping to define recovery.

Do high-risk head trauma sports athletes have impaired vestibular function?

PurposeThe primary aim of this study was to examine the vestibular function of athletes involved in high-risk head trauma sports by means of complete vHIT testing of all six semicircular canals (SCCs). The secondary objective was to investigate whether the vestibular function is significantly reduced among athletes within certain high-risk sports. MethodsA prospective cross-sectional study of 137 adult athletes in football, handball, boxing, horseback riding, and ice hockey with a minimum of one reported sports-related head injury within the past five years. All subjects underwent screening with a complete examination of all six SCCs with vHIT and fulfillment of the dizziness handicap inventory (DHI). ResultsTwo subjects (1.5 %) fulfilled the criteria of having a pathological vHIT. Some degree of impairment of the vestibular function was seen when data was divided into individual sports and time since the last head injury. Likewise, no subjective dizziness was seen in the group of athletes when evaluated by total DHI scores. This score did not differ significantly between groups when subgrouped into number of head injuries or time since the last head injury. When divided into type of sport, total DHI scores differed significantly between groups. These total DHI-scores did, however, all fall within the range of the “no dizziness handicap” classification. ConclusionThe results suggest that the vestibular function of athletes in high-risk head trauma sports is unaffected by the practice of a high-risk head trauma sport. Therefore, vHIT has no clinical utility in the assessment of a sports-related concussion (SRC) in athletes with no subjective feeling of dizziness.

Exploring Symptom Overlaps: Post-COVID-19 Neurological Syndrome and Post-Concussion Syndrome in Athletes.

The COVID-19 pandemic has introduced new challenges in managing neurological conditions, particularly among athletes. This paper explores the intersection of post-COVID-19 neurological syndrome (PCNS/PASC) and post-concussion syndrome (PCS), focusing on their implications in sports medicine. Our analysis covers the symptomatology, pathophysiology, and management strategies for PCNS/PASC and PPCS, with special attention paid to the unique challenges faced by athletes recovering from these conditions, including the risk of symptom exacerbation and prolonged recovery. Key findings reveal that both PCNS/PASC and PPCS present with overlapping symptoms such as cognitive difficulties, exercise intolerance, and mental health issues, but differ in specific manifestations like anosmia and ageusia, unique to COVID-19. Pathophysiological analysis reveals similarities in blood-brain barrier disruption (BBB) but differences in the extent of immune activation. Management strategies emphasize a gradual increase in physical activity, close symptom monitoring, and psychological support, with a tailored approach for athletes. Specific interventions include progressive aerobic exercises, resistance training, and cognitive rehabilitation. Furthermore, our study highlights the importance of integrating neurology, psychiatry, physical therapy, and sports medicine to develop comprehensive care strategies. Our findings underscore the dual challenge of COVID-19 and concussion in athletes, necessitating a nuanced, interdisciplinary approach to effective management. Future research should focus on the long-term neurological effects of both conditions and optimizing treatment protocols to improve patient outcomes. This comprehensive understanding is crucial for advancing the management of athletes affected by these overlapping conditions and ensuring their safe return to sports.

A - 48 Predictors of Prolonged Recovery after Concussion in Collegiate Athletes: a LIMBIC MATARS Consortium Investigation

Abstract Purpose To investigate predictors of prolonged recovery after concussion in collegiate athletes. Method Data for this cross-sectional, retrospective chart review of collegiate athletes diagnosed with concussion (n = 1044 concussions), who were on average 20-years of age, were collected during the 2015–16 to 2019–20 athletic seasons. The majority (92% [959/1044]) of athletes achieved symptom resolution at rest and made an unrestricted return-to-sport by 23 days after injury. The remaining athletes (8% n = 85[36.5% female]), with symptoms that lasted beyond 23 days after concussion were considered to have prolonged recovery. Linear regression was used to determine predictors of prolonged recovery; times to symptom-freedom and unrestricted return-to-sport were dependent variables and variables associated with medical and psychiatric history, and some post-concussion symptoms, were independent variables. Results Athletes with prolonged recovery generally recovered on median (interquartile range) 32 (17) days after injury. The majority (42% [36/84]) participated in football. A self-reported history of anxiety [Β = 0.577, p = 0.01], depression [Β = 0.462, p = 0.04], a history of headache [Β = 0.84, p &amp;lt; 0.001], and migraine [Β = 0.761, p &amp;lt; 0.001] were predictors of prolonged recovery. A history of prior concussion and higher symptom burden immediately after concussion did not predict prolonged recovery (all p &amp;gt; 0.05). Conclusions Similar to related research, our findings suggest a self-reported history of psychiatric conditions, headache, and migraine associate with prolonged recovery in collegiate athletes. Our findings highlight the importance of mood symptom monitoring, early psychological intervention, and management of headache following concussion. Importantly, the majority of our sample, inclusive of collegiate athletes with prolonged recovery, recovered approximately one-month after injury.

A - 47 Missed Steps: Collegiate Athletes’ Beliefs Towards Physical Activity and Kinesiophobia after Acute Concussion

Abstract Purpose Physical activity (PA) may support recovery following concussion in collegiate athletes. Fear of PA (i.e., kinesiophobia), may influence recovery from concussion. The purpose was to examine perception of PA, as well as how biological sex and mood history, influenced kinesiophobia values after concussion. Method Division I collegiate athletes (n = 183[42% female], 20.1+/−1.5 years of age) participated in this descriptive cohort study. Participants completed the Tampa Scale of Kinesiophobia-17 (TSK) within 72 hours of concussion. The TSK’s fourth, twelfth, and fourteenth items query: “My pain would probably be relieved if I were to exercise”, “Although my condition is painful, I would be better off if I were physically active”, and “It’s really not safe for a person with a condition like mine to be physically active”, in relationship to PA after concussion on a four-point Likert scale. Mann Whitney U tests were used to compare total TSK values by biological sex and history of anxiety/depression. Results Most participants (72% and 63%) disagreed with the fourth and twelfth items, respectively. Fifty-three percent of participants agreed with the fourteenth item. On median [interquartile range], females had significantly higher (p &amp;lt; 0.001) kinesiophobia (38.0[9]) than males (34.0[8.0]). Participants with (40.0[7.5]) compared to those without (34.5[9.0]) a history of anxiety/depression had significantly higher (p &amp;lt; 0.001) kinesiophobia values. Conclusions The majority of collegiate athletes indicated that PA would not support recovery from concussion. Total kinesiophobia scores were also influenced by biological sex and a history of anxiety/depression. Misconceptions of PA after concussion should be addressed by clinicians to facilitate recovery from the injury.

Examining for gender differences in return to learn following sport-related concussion in high school student athletes.

Prior studies have investigated associations between gender, symptom resolution, and time to return to play following sport-related concussion (SRC). However, there is a notable gap in research regarding the association between gender and return to learn (RTL) in adolescents. Therefore, this study 1) compared the patterns of RTL between boys and girls who are high school student athletes, and 2) evaluated the possible association between gender and time to RTL after adjusting for covariates. A retrospective cohort study of a prospective surveillance program that monitored concussion recovery of athletes in high schools throughout the state of Maine between February 2015 and January 2023 was performed. The primary independent variable was gender, dichotomized as boys and girls. The primary outcome was time to RTL, defined by the number of days for an athlete to return to school without accommodations. Mann-Whitney U-tests were used to compare RTL between the boys and girls. Each athlete's RTL status was dichotomized (i.e., returned vs had not returned) at several time points following injury (i.e., 1, 2, 3, and 4 weeks), and chi-square tests were performed to compare the proportions who achieved RTL between groups. Multivariable linear regression analyses were performed to evaluate the predictive value of gender on RTL. Covariates included age, number of previous concussions, history of learning disability or attention-deficit disorder or attention-deficit/hyperactivity disorder, history of a psychological condition, history of headaches or migraines, initial Sport Concussion Assessment Tool (SCAT3/SCAT5) score, and days to evaluation. Of 895 high school athletes, 488 (54.5%) were boys and 407 (45.5%) were girls. There was no statistically significant difference in median [IQR] days to RTL between genders (6.0 [3.0-11.0] vs 6.0 [3.0-12.0] days; U = 84,365.00, p < 0.375). A greater proportion of boys successfully returned to learn without accommodations by 3 weeks following concussion (93.5% vs 89.4%; χ2 = 4.68, p = 0.030), but no differences were found at 1, 2, or 4 weeks. A multivariable model predicting days to RTL showed that gender was not a significant predictor of RTL (p > 0.05). Longer days to evaluation (β = 0.10, p = 0.021) and higher initial SCAT3/SCAT5 scores (β = 0.15, p < 0.001) predicted longer RTL. In a cohort of high school athletes, RTL did not differ between boys and girls following SRC. Gender was not a significant predictor of RTL. Longer days to evaluation and higher initial symptom scores were associated with longer RTL.

Poster 399: The 10-Year Decreasing Trend of Youth Soccer Concussions Presenting to U.S. Emergency Departments

Objectives: Soccer is one of the most popular youth sports with nearly 3 million annual participants in the United States alone. Importantly, concussion incidence and awareness in youth soccer has prompted implementation of various protective measures. Despite these interventions, no studies have investigated the prevalence of youth soccer concussions over time. The purpose of this study is to analyze trends and etiologies of youth soccer concussions presenting to United States emergency departments (EDs). Methods: Data from National Electronic Injury Surveillance System were analyzed for soccer players 2 to 18 years old sustaining concussions from January 2013 to December 2022. Patient data collected included age, sex, mechanism of injury, diagnosis, loss of consciousness, and disposition. Raw data were used to calculate national estimates based on assigned statistical sample weight of each hospital. Results: 182,462 youth soccer concussions were diagnosed in US EDs (52.6% male). Most common mechanism of injury was head to ball (29%). Between 2013 and 2022, concussions decreased 28%. Overall concussions decreased by 1,449 per year (95% CI: -2383 to -515, p=0.007). Not specified concussions decreased by 340 per year (95% CI: -501 to -180, p=0.001), head to body by 378 per year (95% CI: -527 to -229, p&lt;0.001), head to ground by 275 per year (95% CI: -463 to -87, p=0.01), and other mechanisms by 56 per year (95% CI: -109 to -3, p=0.04). There were no changes in head to ball or head-to-head mechanisms. Exclusion of years 2020 and 2021 due to COVID demonstrated decreases in not specified concussions by 256 per year (95% CI = -394 to -118, p=0.004), head to body by 314 per year (95% CI: -431 to -196, p=0.001), and head to ground by 182 per year (95% CI: -331 to -33, p=0.02). Conclusions: There is a decreasing trend in youth soccer concussions from 2013 to 2022. Although concussion risk is greatest from contact with the ball, there was no decrease in head to ball concussions during the study period despite implementation and utilization of protective gear. This study contributes to growing literature regarding concussions in youth soccer athletes.

Understanding Abnormal Examination Findings During Concussion Recovery: A Retrospective Chart Review.

Physical examination findings in athletes with sport-related concussion (SRC) are not well described in the literature. The objective of this study was to describe physical examination findings during the first month following concussion in athletes, with a focus on the effect of sex, age, and time since injury. This was a retrospective electronic medical record (EMR) review of physical examination findings in 500 patients aged 6-24 who were initially seen within 15 days of SRC at a multidisciplinary outpatient academic concussion clinic between 2017 and 2019. A standardized concussion examination built in the EMR recorded mental status, cranial nerve, vestibulo-ocular motor screen, and balance findings for all patients. The primary outcome was the frequency of abnormal examination findings during the first 30 days postinjury, which was further analyzed by sex, age, and time since injury using mixed logistic regression models. The most common abnormal examination findings overall were eyes-closed single-leg stance, vestibular-ocular reflex, visual motion sensitivity, the neck examination, and eyes-closed tandem stance. Abnormal findings were more frequent in female athletes for vestibular ocular reflex and visual motion sensitivity. The frequency of abnormal findings increased with age for vestibulo-ocular reflex, visual motion sensitivity, the neck examination, convergence testing, and eyes-open single-leg stance, whereas abnormalities decreased in frequency with age for eyes-open tandem stance and tandem gait. The frequency of abnormal findings generally decreased with time over the first 4 weeks following injury. A comprehensive physical examination is pivotal for evaluation of athletes with concussion. These findings highlight high-yield components of the concussion examination and support use of these examination components as injury markers. Future work should investigate associations between physical examination findings and postconcussion symptoms and recovery outcomes. This retrospective cohort study provides Class IV evidence that neurologic examination with specifically designed clinical tests are helpful for diagnosis of traumatic brain injury in young athletes at age 6-24.

The Prevalence and Influence of New or Worsened Neck Pain After a Sport-Related Concussion in Collegiate Athletes: A Study From the CARE Consortium

Background: Neck pain in a concussion population is an emerging area of study that has been shown to have a negative influence on recovery. This effect has not yet been studied in collegiate athletes. Hypothesis: New or worsened neck pain is common after a concussion (>30%), negatively influences recovery, and is associated with patient sex and level of contact in sport. Study Design: Cohort study; Level of evidence, 2. Methods: Varsity-level athletes from 29 National Collegiate Athletic Association member institutions as well as nonvarsity sport athletes at military service academies were eligible for enrollment. Participants completed a preseason baseline assessment and follow-up assessments at 6 and 24 to 48 hours after a concussion, when they were symptom-free, and when they returned to unrestricted play. Data collection occurred between January 2014 and September 2018. Results: A total of 2163 injuries were studied. New or worsened neck pain was reported with 47.0% of injuries. New or worsened neck pain was associated with patient sex (higher in female athletes), an altered mental status after the injury, the mechanism of injury, and what the athlete collided with. The presence of new/worsened neck pain was associated with delayed recovery. Those with new or worsened neck pain had 11.1 days of symptoms versus 8.8 days in those without (P < .001). They were also less likely to have a resolution of self-reported symptoms in ≤7 days (P < .001). However, the mean duration of the return-to-play protocol was not significantly different for those with new or worsened neck pain (7.5 ± 7.7 days) than those without (7.4 ± 8.3 days) (P = .592). Conclusion: This novel study shows that neck pain was common in collegiate athletes sustaining a concussion, was influenced by many factors, and negatively affected recovery.

Evaluation of the SCAT 5 tool in the assessment of concussion in Para athletes: a Delphi study

ObjectivesTo investigate if the sport concussion assessment tool version 5 (SCAT5) could be suitable for application to Para athletes with a visual impairment, a spinal cord injury, or a limb...

Examining Acute Symptoms After Sport-Related Concussion in Collegiate Athletes With Preinjury Migraines.

To examine whether a personal history of migraines is associated with worse acute symptom burden after sport-related concussion (SRC). Retrospective cohort study. National Collegiate Athletic Association Division III collegiate programs. Collegiate athletes from a prospective concussion surveillance system between 09, 2014, and 01, 2023. Preinjury migraines (yes/no) were self-reported by athletes. Post-Concussion Symptom Scale (PCSS) were collected within 3 days postinjury. Mann-Whitney U tests compared total PCSS scores and individual symptom scores between athletes with and without preinjury migraines. Chi-squared tests were used to compare proportions of athletes endorsing individual symptoms (ie, item score ≥1) between 2 groups. Multivariable regression analyzed potential predictors of PCSS scores. Of 1190 athletes with SRC, 93 (7.8%) reported a preinjury history of migraines. No significant difference in total PCSS scores was found between athletes with and without preinjury migraines (22.0 ± 16.4 vs 20.5 ± 15.8, U = 48 719.0, P = 0.471). Athletes with preinjury migraines reported greater severity of "sensitivity to light" (1.59 ± 1.59 vs 1.23 ± 1.41, P = 0.040) and "feeling more emotional" (0.91 ± 1.27 vs 0.70 ± 1.30; P = 0.008) and were more likely to endorse "feeling more emotional" (45.2% vs 29.5%, P = 0.002). No differences were found across all other symptoms, including headaches (migraine = 87.1% vs no migraine = 86.3%, P = 0.835). In a multivariable model, a history of migraine was not a significant predictor of acute PCSS scores, but those with a history of psychological disorders (β = 0.12, P <0 .001) and greater number of days to symptom evaluation (β = 0.08, P = 0.005) had higher PCSS scores. Collegiate athletes with a pre-existing history of migraines did not have higher acute symptom burden after SRC.