Concussion Education Research Articles

A-23 Neurorehabilitation of Equestrians with Post-Concussive Syndrome Decreases Symptom Severity

Abstract Purpose: The literature shows the risk of concussion for equestrians is equivalent to or greater than athletes in contact sports with approximately half of all equestrians reporting one or more concussions in their career. Despite this, the majority of equestrians do not receive care for their concussion which can lead to chronic neuropsychological symptoms and post-concussion syndrome. Methods: A neurorehabilitation clinic treated 6 equestrians, 100% female with an average age of 40.5 years (+/−9.5), with post-concussion syndrome following head injuries received while riding. A 5-day, multi-modal neurorehabilitation program was administered in 10 one-hour treatment sessions. Each session consisted of a patient-specific combination of photobiomodulation, repetitive peripheral somatosensory stimuli, neuromuscular reeducation, vestibular rehabilitation, orthoptic exercises, cognitive exercises, and/or off-vertical axis rotation utilizing a multi-axis rotational chair. Results: On intake, average overall symptom severity score of the SCAT5 graded symptom checklist was 44.17 (+/−23.90), and average severity of emotional domain symptoms (Nervousness/Anxiety, Irritability, Sadness, More Emotional) was 6.67 (+/−4.80). On exit, the average emotional domain symptom severity score decreased by 67.50% (2.17 +/−2.14) while the average total symptom severity score decreased by 57.74% (18.67 +/−14.60). Conclusions: The results show that neurorehabilitation was beneficial at decreasing overall symptom severity in equestrians with post-concussion syndrome, especially symptoms within the emotional domain. The authors suggest further research be performed with a more diverse and larger population and further concussion education be provided to equestrians to promote seeking care following a head injury.

A-27 Stakeholder Attitudes and Perceptions regarding Concussion in Athletes with Intellectual Disabilities

Abstract Purpose: Sports-related concussion (SRC) is a public health concern with particular complexities that occur in Special Olympics (SO) because injuries and acute identification tools are not well understood for athletes with intellectual disabilities (ID). The purpose of this study was to explore current education, recognition and management strategies among coaches and caregivers in Special Olympics North America (SONA). Methods: A descriptive survey via the Qualtrics platform was distributed to coaches and caregivers in SONA through their electronic newsletter. Analyses included descriptive statistics and Chi square frequencies. Results: Out of a total 103 returned surveys, 77 were fully completed by coaches (83%) and caregivers (17%) from 10 states. The majority of coaches (91%) completed concussion education within the last two years. Sixty-one percent of coaches reported coaching a contact or high concussion-risk sport; moreover, these coaches were more likely to recognize injuries (p = 0.02). Forty-three percent of coaches disclosed that concussions may be underreported in SO, but 72.5% agreed that concussion are serious injuries. Although coaches generally felt prepared to recognize (95%) and remove (95%) athletes with SRC symptoms, management strategies to recognize (34%) or treat (39%) SRC athletes with ID was low. Coaches described feeling less confident to manage these return-to-play decisions following injury (76%). Non-healthcare professionals were first responders for injuries during non-competition (68%) events and competition (14%). Conclusions: Coaches involved in SO should complete tailored concussion education training to enhance recognition and management strategies. Future initiatives should target curriculum adapted to communication needs of athletes with ID.

Age of First Concussion and Cognitive, Psychological, and Physical Outcomes in NCAA Collegiate Student Athletes.

Concussions are common among youth athletes and could disrupt critical neurodevelopment. This study examined the association between age of first concussion (AFC) and neurocognitive performance, psychological distress, postural stability, and symptoms commonly associated with concussion in healthy collegiate men and women student athletes. Participants included 4267 collegiate athletes from various contact, limited-contact, and non-contact sports (1818 women and 2449 men) who completed baseline assessments as part of the Concussion Assessment, Research and Education (CARE) Consortium. Psychological distress was assessed with the Brief Symptom Inventory 18; neurocognitive performance was assessed with the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT); symptoms commonly associated with concussion were assessed with the ImPACT Post-Concussion Symptom Scale; postural stability was assessed with the Balance Error Scoring System. Generalized linear models were used to examine the effects of AFC on clinical outcomes separately in men and women. Later AFC was associated with lower global (Exp(B) = 0.96, P = 0.001) and somatic (Exp(B) = 0.96, P = 0.002) psychological distress on the Brief Symptom Inventory 18 and faster ImPACT reaction time (B = - 0.003, P = 0.001) in women. AFC was not associated with any clinical outcomes in men. Younger AFC was associated with some differences in psychological distress and reaction time among women but not men; however, these results are likely not clinically meaningful. Sociodemographic disparities, pre-existing conditions, and sport type may impact clinical and cognitive outcomes in collegiate athletes more than concussion history. Future work should examine the relationship between AFC and lifespan-related outcomes.

Outlining the Invisible: Experiences and Perspectives Regarding Concussion Recovery, Return-to-Work, and Resource Gaps.

Appropriate supports and accommodations are necessary to ensure full concussion recovery and return-to-work (RTW). This research investigated barriers and facilitators to concussion recovery and RTW, and resource gaps reported by adults with concussion (‘workers’) and workplace and healthcare professionals (‘workplaces’). Semi-structured interviews and focus groups were conducted with workers (n = 31) and workplaces (n = 16) across British Columbia. Data were analyzed using inductive content analysis. Facilitators to workers’ concussion recovery and RTW included treatment, social support, and workplace and lifestyle modifications. To address barriers, both groups recommended: (a) widespread concussion and RTW education and training (b) standardized concussion recovery guidelines; (c) changing attitudes toward concussion; (d) mental health supports; and (e) increasing awareness that every concussion is unique. Findings can inform best practice for concussion recovery and RTW among professionals in workplaces, healthcare, occupational health and safety, and workers’ compensation boards.

Concussions in Collegiate Club Sports: Investigating Concussion Education, Knowledge, and Attitudes

Approximately 9 million college students participate in organized sports, with 460,000 college athletes participating at the collegiate level (e.g., NCAA, NAIA) and the remaining 8.5 million playing club and intramural teams. Nationally, an estimated 1.7 to 3 million sports-related concussions (SRCs) occur per year. Despite the overwhelming number of student-athletes participating in collegiate club sports, literature on SRC education, knowledge and attitudes is limited when looking at collegiate club athletes. The purpose of this study is to explore current concussion education given to collegiate club sports athletes and understand players' concussion knowledge and attitudes. A cross-sectional study design using a modified version of Rosenbaum Concussion Knowledge and Attitudes Survey-Student Version (RoCKAS-ST) was emailed to all members within the 33 student-led club sport organizations at a Southeastern university. Seventy-one club athletes from 22 of the club sport organizations responded to the survey. Thirty-two participants (45.1%) reported that they have received at least one sports-related concussion and 39 (54.9%) reported never receiving a SRC. Fifty-five participants (77.5%) reported not receiving a concussion education. Total knowledge was found to have significant differences between participants who received a concussion education and participants who did not (t[69] = 1.135; p = 0.048). No significant differences were found in attitude between collegiate club sport athletes who received a concussion education and players who did not receive a concussion education (t[68] = 0.37; p = 0.700). The study indicated that a majority of collegiate club sport athletes do not receive a concussion education, which impacts their knowledge of concussions. Further research is needed to determine effective concussion prevention education for this population.

A Knowledge Translation Framework for Improving Concussion Education Among Medical Students and Physicians

Objective: The objective of this paper is to outline key principles required for a knowledge translation (KT) strategy on concussion education for medical trainees and physicians to promote knowledge retention and practice change. Design: Qualitative review of the literature on concussion education for medical trainees and physicians utilizing the Canadian Institute of Health Research (CIHR) Knowledge to Action (KTA) Cycle as a framework. Results: Medical education on concussion appears to be increasing, but many knowledge gaps persist. Although many concussion guidelines and standardized assessments have been developed, many physicians are either not aware of them, do not use them, or provide inaccurate or inconsistent discharge instructions. Focused, interactive concussion education sessions, education outreach by trained facilitators, and adoption of a spiral curriculum are preferred modalities. To facilitate concussion education, medical professionals must recognize the importance of concussion in their practice. Interventions should deliver high-yield information and be integrated into existing programs such as academic half days (AHD) and the Maintenance of Certification Program (MOC). Many KT tools and interventions have been developed, such as the Concussion Awareness Training Tool (CATT) for Medical Professionals, but evidence of their utilization and effectiveness is limited. Existing tools should be reviewed, updated, implemented, and evaluated for their effectiveness of improving both conceptual and instrumental knowledge. Conclusion: KT strategies for concussion medical education should utilize the CIHR KTA Cycle principles outlined in this review as a guide to design interventions that improve the concussion knowledge of medical trainees and physicians.

Similar Concussion Rates in Spring Football and Preseason: Findings From the Concussion Assessment, Research and Education Consortium.

Increasing attention has been directed toward identifying aspects of football participation for targeted policy change that reduces the concussion risk. Prior researchers evaluated concussion risks during the preseason and regular seasons, leaving the spring season largely unexplored. In this nationally representative observational investigation of 19 National Collegiate Athletic Association Division I collegiate football programs, we assessed concussion rates and head impact exposures during the preseason, regular season, and spring practices from 2014 to 2019. All participating programs recorded the incidence of concussions, and a subset (n = 6) also measured head impact exposures. Analyses by time of year and session type indicated that concussion rates and head impact exposures during all practice sessions and contact practices were higher in the spring and preseason than those in the regular season (P < .05). Concussion rates during the spring season and preseason were statistically similar. We identified comparable concussion risks in the spring season and preseason, highlighting the need for targeted policy interventions to protect athlete health and safety.

Stakeholder-Engaged Development of a Theory-Driven, Feasible, and Acceptable Approach to Concussion Education.

Concussion education is widely mandated and largely ineffective. Recent consensus guidance on concussion education asserts the importance of (1) theory-driven programming that targets the team as a system and (2) working with end users throughout the development process, and considering issues such as feasibility, acceptability, and sustainability. Consistent with this guidance, and in collaboration with youth sport stakeholders in two regions of the United States, we developed a novel approach to concussion education: Pre-game safety huddles. Safety huddles have the following two core components: (1) athletes, coaches, and other stakeholders come together before the start of each game and (2) opinion leaders (coaches, referees) affirm the importance of care seeking for suspected concussion. The aim of this article is to provide an overview of the collaborative process through which we refined the safety huddle concept into an acceptable and feasible intervention with potential for sustainable implementation in diverse youth sports settings with minimal resource demands. In describing our process and discussing challenges and opportunities, we hope to provide an example for others seeking to develop and implement injury prevention interventions in youth sports settings.

A qualitative study of factors influencing adult stakeholder concussion communication with youth athletes

ABSTRACT Research suggests adult stakeholder (coach, referee and administrator) communication about concussion influences the likelihood of athletes reporting concussive symptoms. The goal of this study was to develop a conceptual model to describe factors contributing to adult stakeholder (AS) concussion communication with youth athletes, to inform future concussion education interventions. We conducted a qualitative interview study with n = 63 AS in youth American football and football (soccer) in Washington and Georgia, analysing interviews using a coding structure based on the Theory of Planned Behavior. Across our sample, AS could describe concussion symptoms and mechanism in detail (Knowledge). AS believed that playing with a concussion could be dangerous, though many had experienced a concussion themselves and not had any negative outcomes (Attitudes). AS believed they were responsible for concussion safety (Normative beliefs), but described that messaging from institutions did not emphasise the role of AS in concussion safety. AS were comfortable in their ability to engage in concussion communication (Self-efficacy), but some expressed concern that talking about concussion might not improve safety but instead result in overreport of symptoms (Controllability). In conclusion, AS have good knowledge of concussion safety, but no clear mandate from their institution to discuss concussion with youth athletes, and concerns that such communication would not improve safety. Future research should utilise these findings to improve the effectiveness of concussion educational interventions for coaches, referees and administrators.

The Impact of Concussion Education on Injury Disclosure in High School Athletes: A Critically Appraised Topic

Clinical Scenario: Sport-related concussions are common injuries during sport-related activities. Evaluations of these injuries involve symptom reporting. Unfortunately, concussion symptoms are widely underreported by athletes, and can lead to longer recovery times. Concussion education programs were created to encourage reporting of symptoms by athletes. Clinical Question: Does concussion education impact injury disclosure in high school athletes? Summary of Key Findings: Three studies were included in this appraisal. Two studies utilized an educational lecture, and one study utilized an informational video providing the concussion education. All three studies found significant increases in injury history disclosure from pre-education to immediate post-education. Clinical Bottom Line: There is moderate evidence to support the idea that education has a positive impact on concussion reporting behaviors. These studies found positive results immediately following concussion education therefore it may be beneficial to provide concussion education several times a year. Strength of Recommendation: There is Level B evidence to support the idea that implementing concussion education will impact concussion reporting behaviors as it pertains to injury history disclosure.

K-12 Athletic Trainers’ Current Concussion Baseline Practice Patterns

Background:Concussion baseline assessments are often administered during the pre-season of sports. Current recommendations suggest that baseline assessments may be useful in aiding and interpreting post-injury evaluations but are not necessary. However, it has become common practice for athletic trainers (ATs) to administer and implement baseline assessments in athletes.Hypothesis/Purpose:The purpose was to determine K-12 ATs’ current concussion baseline assessment practice patterns.Methods:A Qualtrics survey was designed and implemented to 443 ATs (193 males, 244 females, 5 prefer not to answer, n=1 missing). Most respondents had earned a master’s degree (n=288, 65.0%), and were employed full-time (n=381,86.4%). Respondents were solicited over email to complete the survey which consisted of multipart, multiple-choice, and open-ended questions. Responses are reported as frequencies and percentages. Chi-square analysis was run to determine group (years of experience) and baseline practice patterns, p<0.05.Results:Seventy-five percent of respondents (n=330) reported administering baseline concussion assessments, with 37 (8.4%) reporting they do not administer baseline assessments but plan to in the future. The top five most reported assessment tools used were ImPACT (n=245, 55.3%), SCAT 5 (n=59, 13.3%), CNS Vital signs (n=25, 5.6%), BESS (n=25, 5.6%), and VOMS (n=22, 5.0%). The majority of respondents reported standard of care (n=226, 51%), provide better care (n=202, 45.6%%), school/organization policy (n=197,44.5%), to help diagnose concussion (n=139, 31.4%), concussion education (n=117, 26.4%), and liability (n=101, 22.8%), as the top reasons for using concussion baseline assessments. No differences were found between ATs with less than 10 years of experience, 11-20 years of experience, or 21+ years of experience in having formal training on administration of baseline assessments (p=.164), or having received formal training on interpretation of baseline assessments (p=.104). However, differences were noted by years of experience for reviewing baseline assessments for validity 2= 8.68, p=.013, and for those who restrict testing when individuals are sleep deprived 2=10.06 p=0.039. The majority reported receiving formal training to administer (n=209, 66.8%) and to interpret (n=178, 56.9%) neurocognitive baseline assessment. The majority of respondents report feeling extremely comfortable (n=214, 69%) and extremely competent (n=205, 65.9) in administering neurocognitive assessments, and moderately comfortable (n=117, 38.2%) and moderately competent (n=137, 45.1%) in test interpretation.Conclusion:The majority of ATs reported administering baseline concussion assessments and felt comfortable and competent in the administration and interpretation of assessments in adolescent athletes. Most ATs reported standard of care and providing better care as reasons for implementing assessments.

Barriers to concussion reporting in collegiate athletes: an analysis of a peer-led worksheet activity

Objective: To determine if a peer-led concussion reporting worksheet activity could elucidate barriers to reporting in collegiate athletes. Participants: Five hundred and three athletes from 7 universities across all three NCAA divisions. Methods: A supplementary qualitative analysis of responses to a concussion reporting worksheet completed during an RCT of a novel peer concussion education program. The first column of the worksheet required participants to list thoughts that prevent reporting and the second column required replacement thoughts that facilitate reporting. Results: A qualitative phenomenological thematic analysis of responses to the first column of the worksheets identified themes that coalesced into three areas: 1) missing out on athletic and social events, 2) losing one’s competitive edge, and 3) negative interpersonal interaction/self-perception. Conclusions: Barriers to concussion reporting from several areas central to the collegiate athlete experience were identified. These barriers should be considered during clinical assessment and when developing concussion education programs.

A Scoping Review: Mapping the Evidence for Undergraduate Concussion Education and Proposing the Content for Medical Student Concussion Teaching.

Introduction: Concussion is a common yet complex condition, with each new case requiring assessment by a medical doctor. Recent research has shown that doctors working in the UK have significant knowledge deficits regarding concussion diagnosis and management. Aim: The aim of this scoping review was to map out the evidence about how undergraduate medical students are being educated about concussion. Method: This scoping review involved seven research papers identified by searching five online databases in October 2020. Search terms relevant to concussion included: brain injuries, post-concussion syndrome, brain concussion and concussion, combined with search criteria for undergraduate education: medical students, undergraduate medical education, or curriculum. Results: All seven papers were published in North America, with five papers recruiting medical students from single institutions (n = 590) and two papers surveying universities. Canadian medical schools have shown an upward trend in the quantity of teaching about concussion-specific teaching: from 0.57 to 2.65 h between 2012 and 2018. Lectures were the commonest mode of delivery of teaching, followed by problem-based learning and clinical rotations. The studies reach a common conclusion that medical students are not being adequately prepared for diagnosing and managing concussion, with insufficient undergraduate teaching, particularly exposure during clinical rotations, cited as the cause. Conclusions: Concussion: education of medical students is inadequate in North America. Medical schools should help address this by providing lectures and clinical presentations on concussion to learn from, particularly via problem-based learning. There is a paucity of evidence about concussion education in other geographical areas.

Estimated Duration of Continued Sport Participation Following Concussions and Its Association with Recovery Outcomes in Collegiate Athletes: Findings from the NCAA/DoD CARE Consortium.

Continued participation after sport-related concussion (SRC) worsens outcomes, but it is unknown if duration of continued participation after SRC impacts recovery outcomes, and which athletes who continue to participate are at greatest risk for poor SRC outcomes. The purpose of this National Collegiate Athletic Association/Department of Defense (NCAA/DoD) Concussion Assessment, Research, and Education (CARE) Consortium study was to evaluate the association of estimated duration of continued participation after SRC with symptom severity and recovery time in collegiate athletes. Clinicians estimated if/how long athletes continued participation after SRC. Collegiate athletes who continued participation after suspected SRC (n = 195/373, 52.3%) completed the Graded Symptom Checklist to evaluate the severity of total symptoms and migraine/fatigue, cognitive/ocular, and affective symptom clusters. Linear regression analyzed the associations between estimated duration of continued participation, symptom severity, and recovery time. Binary logistic regression examined the association of estimated duration of continued participation with the odds of recovery ≥ 14 and ≥ 21days. Statistical significance was p < 0.05. Athletes who continued to participate did so for 27.9 ± 25.3min (mean ± standard deviation; range 1-90min). Longer estimated continued participation (1-90min) was associated with greater symptom severity (β = 0.122, p = 0.02), affective (β = 0.171, p = 0.001) and migraine/fatigue symptoms (β = 0.104, p = 0.049), longer symptom duration (β = 0.193, p < 0.001), and longer time missed (β = 0.156, p = 0.003). Longer estimated continued participation positively interacted with female sex (cognitive/ocular: female R2 = 0.03, male R2 = 0.01, p = 0.02; affective: female R2 = 0.06, male R2 = 0.02, p = 0.006), migraine history (affective symptoms: no migraine R2 = 0.02; migraine R2 = 0.18; p = 0.04), and concussion history (affective: 2 + prior concussions [R2 = 0.14] compared with those with 1 [R2 = 0.07] or 0 [R2 < 0.01] prior concussions [p = 0.003]). Longer estimated duration of continued participation after SRC was associated with higher symptom severity, particularly affective and migraine/fatigue; longer symptom duration; and more time missed from sport. SRC outcomes in those who continue to play may be especially severe for female athletes, athletes with migraine history, and athletes with prior concussion(s). The findings can help clinicians and administrators to educate athletes on the importance of immediate removal following a suspected SRC.

Concussion Education in the School Setting: A Scoping Review.

ABSTRACTBACKGROUNDConcussions are a prevalent injury among youth, and concussion education has the potential to promote positive concussion‐related behaviors. Recent recommendations and legislation have increased concussion education provided in schools; however, little is known about the education context, delivery method, development, and evaluation. A scoping review was conducted to identify peer‐reviewed literature on concussion education delivered in the school setting.METHODSSix databases were searched (MEDLINE, CINAHL, EMBASE, PsycINFO, SPORTDiscus, and ERIC) to identify published articles from 2002 to July 16, 2020 that delivered concussion education in the school setting. Included studies described the concussion education and were written in English.RESULTSA total of 11,373 articles were identified and screened, with 27 studies meeting eligibility criteria and therefore, included. The studies delivered education to various stakeholders including students (n = 12; 44.4%), coaches (n = 5; 18.5%), educators (n = 3; 11.1%), parents (n = 1; 3.7%), and a mixed audience (n = 6; 22.2%). The education format varied and six studies (22.2%) developed the education based on a theory, model, or framework.CONCLUSIONSThis study found substantial variability in the context, delivery method, development, and evaluation of education delivered in schools and further evaluation of this education is needed to ensure it is best‐suited for school‐based stakeholders.

Barriers to and facilitators of return to learning following a sport-related concussion: Perspectives of female secondary school students.

To identify barriers to and facilitators of return to learning (RTL) for female secondary school students following a sport-related concussion (SRC), and to identify critical junctures on the injury-to-recovery continuum that can be targeted to enhance the RTL process. A grounded theory approach using in-depth qualitative interviews. Secondary schools within the York Region District School Board in Ontario. Ten female secondary school students who presented to a sports medicine physician with an SRC in 2015 or 2016. Five of the students received a Green Folder intervention containing an RTL strategy, while 5 students received no RTL intervention following their SRC. In-depth interviews were conducted in person or by telephone. All interviews were audiorecorded and transcribed. The transcriptions were analyzed, coded, and examined for common themes by 2 independent reviewers. Barriers to RTL included a lack of a graduated RTL process, students' own internal stress, poor communication of expectations, lack of concussion education, and inadequate support from teachers. Facilitators of RTL included academic accommodations and having a primary contact person within the school system. Owing to inconsistent implementation, the impact of the Green Folder intervention as a facilitator of RTL remains unknown. Results of this study support existing findings in the realm of concussion research. A novel finding includes the importance of a primary contact person as a facilitator of RTL. This person could help to overcome some of the identified barriers to RTL and improve outcomes by assisting with academic accommodations, providing reassurance regarding these accommodations, improving education among teachers and students, and enhancing communication between stakeholders.

472 Effects of Recurrent Mild Traumatic Brain Injuries on Incidence, Severity, and Recovery of Concussion in Young Student-Athletes

INTRODUCTION: Currently, it is known that athletes who sustain recurrent concussions are at an increased risk for long-term neurological consequences. Moreover, in the short term, athletes with a history of concussions are significantly more likely to sustain future concussions. Although the increased incidence of mTBI among athletes with a history of concussions has been well documented, there is less consensus about how recurrent concussions affect the severity and recovery of the next head trauma. METHODS: Data from 11 563 ImPACT baseline evaluations of US student-athletes aged 12 to 22 years were separated into 2 cohorts: subjects reporting 2 or more previous concussions (PC; n = 976 baseline evaluations) at baseline and a control group reporting zero previous concussions (CT; n = 7743 baseline evaluations). Subjects reporting 1 prior concussion were excluded. Differences in SND incidence, severity, and recovery between the 2 cohorts were assessed using chi-squared tests, t tests, survival analyses, and multivariate regressions. RESULTS: The PC cohort had a higher incidence of head injury leading to ImPACT (436.7 per 1000 person-years vs 194.4 per 1000 person-years, P &lt; .0001) and a higher incidence of SND (140.4 vs 71.8, P &lt; .0001) than controls. However, the Severity Index (SI) demonstrated that SND severity was lower in the PC group (7.55 vs 8.59, P = .04). Adjusted analyses similarly demonstrated that the PC cohort had increased SND incidence (odds ratio = 1.93; 95% CI, 1.61 to 2.31; P &lt; .0001), decreased SI (β = −1.37; 95% CI, −2.40 to −0.34; P = .009), and equivalent recovery (hazard ratio = 0.98; 95% CI, 0.76 to 1.72; P = .90). CONCLUSION: Participants with a history of concussion have a higher incidence of SND but present with lower severity SND, which may be a result of increased concussion education or symptom awareness. Recurrent concussion has no significant impact on acute neurocognitive recovery. Together, these results provide evidence against the supposition that a history of concussion increases the severity of future SND.

Utility of VOMS, SCAT3, and ImPACT Baseline Evaluations for Acute Concussion Identification in Collegiate Athletes: Findings From the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium

Background: The Vestibular/Ocular-Motor Screening (VOMS) is a valuable component of acute (<72 hours) sports-related concussion (SRC) assessments and is increasingly used with the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) instrument and the third edition of the Sport Concussion Assessment Tool (SCAT3). Research has suggested that VOMS acute postinjury scores are useful in identifying acute concussion. However, the utility of preseason baseline measurements to improve diagnostic accuracy remains ambiguous. To this end, there is a need to determine how reliable VOMS baseline assessments are across years and whether incorporating individuals’ baseline performance improves diagnostic yield for acute concussions. Purpose: To analyze VOMS, SCAT3, and ImPACT to evaluate the test-retest reliability of consecutive-year preseason baseline assessments to directly compare the diagnostic utility of these tools when incorporating baseline assessments versus using postinjury data alone to identify acute SRC. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Preseason and postinjury VOMS, SCAT3, ImPACT Post-Concussion Symptom Scale (PCSS), and ImPACT composite scores were analyzed for 3958 preseason (47.7% female) and 496 acute (≤48 hours) SRC (37.5% female) collegiate athlete evaluations in the National Collegiate Athletic Association—Department of Defense Concussion Assessment Research and Education Consortium. Descriptive statistics, Kolmogorov-Smirnov significance, and Cohen d effect size were calculated. Consecutive-year baseline reliability was evaluated for a subset of 447 athlete encounters using Pearson r, Cohen κ, Cohen d, and 2-way mixed intraclass correlation coefficients (ICCs). Wilcoxon signed rank tests were used to determine the statistical significance between population performances, and the 90% reliable change index (RCI) was calculated from the test-retest results. Preseason to postinjury change scores were then calculated from each tool’s RCI. Finally, receiver operating characteristic (ROC) curve analyses were conducted, and DeLong method was used to compare the area under the curve (AUC) of raw postinjury scores versus change scores from preseason baseline assessments. Potential effects of sex, medical history (learning disorders or attention-deficit/hyperactivity disorder), and outlier data were also explored. Results: Effect sizes were large, and overall predictive utilities were clinically useful for postinjury VOMS Total (d = 2.44; AUC = 0.85), the SCAT3 Symptom Evaluation total severity score (d = 1.74; AUC = 0.82), and the ImPACT PCSS total severity score (d = 1.67; AUC = 0.80). Comparatively, effect sizes were small and predictive utilities were poor for Standardized Assessment of Concussion (SAC), modified Balance Error Scoring System (mBESS), and all ImPACT composites (d = 0.11-0.46; AUC = 0.48-0.59). Preseason baseline test-retest reliability was poor to moderate (r = 0.23-0.52; κ = 0.32-0.36; ICC = 0.36-0.68) for all assessments except ImPACT Visual Motion Sensitivity (r = 0.73; ICC = 0.85). Incorporating baseline scores for VOMS Total, SCAT3 (Symptom Evaluation, SAC, mBESS), ImPACT PCSS, or ImPACT composites did not significantly improve AUCs. Conclusion: VOMS Total and symptom severity (SCAT3, PCSS) total scores had large effect sizes and clinically useful AUCs for identifying acute concussion. However, all tools demonstrated high within-patient test-retest variability, resulting in poor reliability. The findings in this sample of collegiate athletes suggest that incorporating baseline assessments does not significantly increase diagnostic yield for acute concussion.

Knowledge of, and Attitudes Toward, Concussion in Japanese Male Collegiate Athletes.

Japan has no streamlined concussion education for collegiate athletes, and guidelines vary by sport. In particular, research on knowledge of, and attitudes toward, concussion is necessary for the establishment of concussion education for Japanese collegiate athletes. The aim of the present study was to assess the knowledge of, and attitudes toward, concussion in Japanese male collegiate athletes and to investigate their experiences with suspected concussion symptoms. An online questionnaire was administered to 390 collegiate athletes participating in the following five sports with a high incidence of concussion: rugby union, soccer, basketball, American football, and judo. Of the 121 valid responses, 91 (77.1%) indicated that they had experienced suspected concussion symptoms at least once and 46 of these 91 respondents had not reported their symptoms of suspected concussion at least once. Athletes who had never experienced concussion symptoms were significantly less likely to recognize the symptoms of concussion (p < 0.001). Most athletes recognized headache and dizziness as suspected concussion symptoms. However, the recognition rate for several symptoms was lower than the prevalence of these symptoms as shown in previous studies. This suggests that educational initiatives might be important to bridge the gap between athletes' knowledge and understanding of frequently occurring concussion symptoms and to improve reporting behavior.

Neurodevelopmental Disorders and Risk of Concussion: Findings from the National Collegiate Athletic Association Department of Defense Grand Alliance Concussion Assessment, Research, and Education (NCAA-DOD CARE) Consortium (2014-2017).

Evidence suggests neurodevelopmental disorders (NDs) may be associated with an increased incidence of concussion, but no studies have cross-sectionally and longitudinally assessed the associations of NDs and sex with concussion in collegiate athletes. We sought to assess the odds and relative risk (RR) of concussion in athletes self-reporting a diagnosis of attention deficit/hyperactivity disorder (ADHD), learning disability (LD), and ADHD+LD. Data from the Concussion Assessment, Research and Education (CARE) Consortium (2014-2017) were used to evaluate the likelihood of concussion for male and female athletes with ADHD, LD, and ADHD+LD, relative to controls. Odds ratios (ORs) of concussion history prior to enrollment and relative risk ratios for incurring a concussion following enrollment, with and without concussion history were calculated for all groups. Athletes with self-reported diagnosis of ADHD, LD, and ADHD+LD were more likely to report a single concussion (OR range = 1.528 to 1.828) and multiple concussions (OR range = 1.849 to 2.365) prior to enrollment in the CARE Consortium, irrespective of sex compared with control athletes. While enrolled in CARE, male athletes with ADHD, LD, and ADHD+LD had greater risk of incurring a concussion (RR range = 1.369 to 2.243) than controls, irrespective of concussion history. Male athletes with ADHD+LD with concussion history (RR = 2.221) and without concussion history (RR = 1.835) had greater risk of incurring a concussion than controls. These results suggest NDs may be associated with increased odds of single and multiple concussions, irrespective of sex. However, when we accounted for concussion history, it appears only male athletes with ADHD+LD had greater risk than respective controls. There were no significant differences between females and males with ADHD, LD, or ADHD+LD for either odds of concussion history or risk for incurring concussion.