Concussion In High School Athletes Research Articles

The Role Of Level Of Play In Concussions In High School Athletes

The Role Of Level Of Play In Concussions In High School Athletes

The Role of Level of Play in Concussions in High School Athletes.

To examine level of play (LOP) as a risk factor for concussion severity and recovery-related outcomes among high school athletes, stratified by sex, and among boys, by sport (football, non-football male sports). Secondary analysis of data collected through the High School Reporting Information Online surveillance system for academic years 2007-2008 through 2018-2019. A total of 9916 concussions were reported between the academic years 2007-2008 and 2018-2019 from 9 sports (5189 from football; 2096 from non-football male sports; 2631 from female sports). Examined the association between LOP (Freshman, Junior Varsity [JV], and Varsity teams) and concussion outcomes (number of concussion symptoms, symptom resolution time [SRT], and time to return to play [RTP]). Compared with Varsity football athletes, concussed JV football athletes had on average 0.19 fewer concussion symptoms, longer SRT (>1 week vs <1 week: odds ratio [OR] = 1.3; 95% confidence interval [CI], 1.1-1.5), and longer RTP (1-3 weeks vs <1 week: OR = 1.5; 95% CI, 1.2-1.9; >3 weeks vs <1 week: OR = 1.6; 95% CI, 1.1-2.3). Compared with Varsity football athletes, Freshman football athletes had on average 0.48 fewer concussion symptoms, longer SRT (OR = 1.3; 95% CI, 1.1-1.5), and longer RTP (1-3 weeks vs <1 week: OR = 1.5; 95% CI, 1.1-2.0; >3 weeks vs <1 week: OR = 2.0; 95% CI, 1.3-3.0). Similarly, compared with female athletes on Varsity teams, concussed JV female athletes had longer RTP (1-3 weeks vs <1 week: OR = 1.8; 95% CI, 1.2-2.7). Trend analyses revealed an increase in the number of concussion symptoms between 2015-2016 and 2018-2019, a decrease between 2009-2010 and 2018-2019 for SRT of less than 1 week, and an increase between 2014-2015 and 2018-2019 for RTP of less than 1 week among Varsity football athletes. Among Varsity female athletes, there was a linear decrease during the study period for RTP of less than 1 week. Despite a higher number of symptoms overall and in recent years, Varsity football players had shorter RTP than Freshman and JV athletes.

Prior Concussion History and Clinical Recovery After Sport-Related Concussion in High School Athletes.

Clinical recovery after sport-related concussion varies as a function of pre-injury and acute factors. Whether, or the extent to which, concussion history is associated with clinical outcome after sport-related concussion is uncertain, because research has produced mixed findings. The present study aimed to assess whether a history of previous concussions was associated with prolonged clinical recovery after a subsequent sport-related concussion. The sample comprised 780 adolescent student athletes (mean age = 16.3, standard deviation = 1.3 years; 56.8% boys, 43.2% girls) whose school participated in the Maine Concussion Management Initiative (MCMI). Survival analyses were used to compare recovery times among adolescents with a history of 0, 1, or ≥2 previous concussions after a subsequent sport-related concussion. The two primary outcomes of interest were the number of days to return to school and sports. There were no statistically significant differences in total time to return to school and sports, or the proportion of adolescents who returned to school and sports at most intervals (e.g., 7, 14, 28 days), between those with 0, 1, or ≥2 previous concussions. A greater proportion of adolescents, however, with a history of ≥2 previous concussions remained out of sports at 28 days compared with those with no previous concussions (23.5% vs. 12.7%; odds ratio [OR] = 2.10, 95% confidence interval [CI] 1.18-3.73). Having sustained prior concussions was not associated with time to return to school after a subsequent sport-related concussion. A greater proportion of adolescents, however, with two or more previous concussions experienced a prolonged return to sports. Further research is warranted to identify risk factors for worse outcomes among the subset of adolescents with a history of multiple previous concussions who experience prolonged recoveries.

A-187 Prior Concussion History and Recovery Time Following Sport-Related Concussion in High School Athletes

Abstract Objective: To examine whether adolescents with prior concussions take longer to return to school and/or sports following a subsequent sport-related concussion. Method: Injury surveillance data for 780 adolescents (M age=16.3, SD=1.3 years) were analyzed. Adolescents were divided into three groups: (a) no prior concussion history (69%; n=538), (b) history of one prior concussion (19.2%; n=150), and (c) history of two or more prior concussions (11.8%; n=92). We analyzed between-group differences in time to return to school and sports. Results: Groups did not differ in time to return to school (K-W: χ2(2)=0.95, p=.62; Log Rank: χ2 (2)=2.83, p=.24) or sports (K-W: χ2(2)=2.19, p=0.33; Log Rank: χ2 (2)=3.95, p=.14). However, a greater proportion of student athletes with two or more prior concussions had not returned to their sport at 28 days postinjury compared to those with no prior concussions (23.5% vs. 12.7%; OR=2.10, 95% CI 1.18-3.73). Of note, the two or more prior concussion group contained a higher proportion of adolescents with potential pre-injury risk factors for complicated recovery, namely, depression and migraines. Conclusions: Prior concussion history was not associated with longer time to return to school nor return to sport when examined as a continuous variable. However, at 28 days postinjury, a greater proportion of athletes with two or more prior concussions remained out of sports compared to those with no prior concussions.

Prevalence of Acute Neck Pain Following Sports-Related Concussion in High School Athletes.

To explore the prevalence of acute neck pain in high school athletes following sports-related concussion (SRC) and to examine the role of acute neck pain in modifying or amplifying concurrent concussive symptoms. Retrospective observational. High school sporting events. High school athletes who suffered a sports-related concussion between the 2011 and 2019 academic years academic years from the National Athletic Treatment, Injury and Outcomes Network (NATION) Study. Not applicable. Prevalence of neck pain (yes/no) along with 33 other commonly reported concussion symptoms, number of symptoms reported, mechanism of injury (contact with person/surface or object), sport type (contact/noncontact), and injury history (first time/repeated injury). One hundred thirty-eight of 401 athletes (33.9%) indicated acute neck pain following SRC. Those with neck pain reported significantly more symptoms overall (M = 13.53, SD = 6.89) relative to their non-neck pain counterparts (M = 8.46, SD = 5.68; t [191.35] = 7.11, P < 0.001). Athletes with SRC due to contact with a surface were significantly less likely to report neck pain than those reported contact with a person. Neck pain, repeated injury, and female sex were significantly associated with a greater number of concussion symptoms in the acute phase. Our data suggest that acute neck pain is a frequent acute symptom following SRC and signals the necessity for additional screening to seek and identify comorbid cervical pathology. Prospective studies should seek to access the benefit of cervical therapy in the early stages in SRC patients with neck pain to reduce the risk of persistent postconcussion symptoms.

The effect of concussion on subsequent musculoskeletal injury risk in high school athletes.

Studies have demonstrated an increased risk of musculoskeletal (MSK) injury after concussion in collegiate and professional athletes, but there has been relatively little study of this relationship in younger athletes. To determine the odds of experiencing a subsequent MSK injury after concussion in high school athletes. It was hypothesized that concussion would increase the risk of MSK injury within 365 days of the concussion event. Retrospective observational study. Twelve high school sports programs. Athletes (n=14,461) from athletic training room records queried between 2010 and 2017. History of concussion and history of concussion and MSK injury in the year preceding MSK injury. General estimating equation analyses were conducted to examine the odds of MSK injury related to (1) concussion within the preceding 365 days of injury; and (2) concussion and MSK injury within the preceding 365 days of concussion. Respectively, 8% and 8.3% of athletes were identified with a concussion and MSK injury. After controlling for gender and sport, athletes with a concussion and prior MSK injury (odds ratio=2.19, 95% confidence interval: 1.02-4.67) and athletes with a concussion alone (odds ratio= 1.67, 95% confidence interval: 1.15-2.44) both had higher odds of experiencing a subsequent MSK injury compared to athletes without prior concussion. High school athletes who sustain a concussion have elevated odds of MSK injury at rates comparable to those for collegiate athletes. These findings support the use of neuromuscular-based rehabilitation and injury prevention protocols in the post-concussion period. These findings may also suggest exploring methods to modify concussion return-to-play criteria with the goal to reduce the risk of future MSK injury.

Cognitive profiles following sport-related concussion in high school athletes.

Heterogeneity is common following traumatic brain injury (TBI) with important implications for clinical outcome. Research in moderate to severe TBI identifies differentiated cognitive profiles. There is little research investigating potential clusters following sport concussion. Cluster analysis was used to determine patterns of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) performance at three time points (72 hr, 4-7 days, and 8-30 days postconcussion). Participants included 1,817 high-school athletes (Mage = 15.5; 37.9% female) who completed ImPACT following concussion. Separate cluster analyses of cognitive scores were conducted at each postconcussion timepoint. Results indicated three clusters of cognitive performance within 1 week postinjury, while a two-cluster solution was identified at longer intervals (8-30 days). Clusters differed primarily by level of performance and also exhibited stratified differences in symptom severity and magnitude of change in cognitive function and symptom-reporting from pre- to postconcussion. The lowest performing cluster in each PC group was Mildly-to-Moderately Impaired and exhibited the highest rates of complicated recovery, suggesting an association between the current clusters and protracted recovery. Results provide preliminary evidence that ImPACT can identify clusters of athletes based on cognitive performance postconcussion that differ in clinically meaningful ways, including symptoms, magnitude of change from baseline, and concussion recovery outcomes. Discriminant functions can classify athletes into clusters based on postconcussion scores and a supplemental excel calculator is provided for such purposes. Absence of full demographic data regarding race/ethnicity and socioeconomic status may limit generalizability. Future work should investigate whether these clusters may assist in return-to-play decision-making by identifying at-risk athletes who may benefit from targeted intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Supplemental Material for Cognitive Profiles Following Sport-Related Concussion in High School Athletes

Supplemental Material for Cognitive Profiles Following Sport-Related Concussion in High School Athletes

Lower Extremity Musculoskeletal Injury Is Associated with Increased Risk of Concussion in High School Athletes

Objectives:Previous research indicates that concussion increases the risk of lower extremity injuries (LE) after return to sport. However, no study has examined the risk of precedent lower extremity injuries and their relationship to the development of a sport related concussion (SRC). To determine if the risk of combined injuries (LE injury-SRC) is elevated in high school athletes accounting for athlete sport and gender.Methods:33,386 high school athletes were monitored over 4 seasons. 4223 LE injuries and 1132 concussions were reported. Injured athletes were identified by their school athletic trainer (AT) time-loss injury during a team-sponsored practice or game. ATs documented the date, mechanism, and sport of injury. Injured athletes were referred to a board-certified sports medicine physician for diagnoses and follow up care. Cumulative injury rates were calculated with 95% confidence intervals. Rate ratios were used to compare frequency of SRC after RTS following a LE injury. Comparisons were made overall cohort between those participating athletes with and without isolated and combined injuries as well as by gender. (α=0.05).Results:A cumulative incidence for athletes sustaining an isolated SRC was 2.3/100 athletes (95% CI= 2.1-2.5) and for isolated LE injury was 11.5/100 (95% CI=11.2-11.9) athletes. Athletes presenting with a LE injury had an increased risk (RR= 4.7; 95% CI = 4.2-5.2) of sustaining a subsequent SRC within 1 year when compared to athletes that did not suffer precedent LE injuries. Male athletes presenting with a LE injury had an increased risk (RR= 4.9; 95% CI = 4.2-5.7) of sustaining a subsequent SRC within 1 year when compared to male athletes that did not suffer precedent LE injuries. Female athletes presenting with a LE injury had an increased risk (RR= 4.4; 95% CI = 3.6-5.2) of sustaining a subsequent SRC within 1 year when compared to female athletes that did not suffer precedent LE injuries. In football, presenting with a LE injury had an increased risk (RR= 5.8; 95% CI = 4.5-7.4) of sustaining a subsequent SRC within 1 year when compared to football athletes that did not suffer precedent LE injuries.Conclusion:Our results are the first to show that high school athletes who suffer a time-loss LE injury are at 4.4-5.8 times increased risk to suffer a sports related concussion within the next year. Additional studies are warranted to confirm these findings.

A-09 Time to Unrestricted Participation Following Sport-Related Concussion in High School Athletes

Abstract Objective To measure time-to-unrestricted participation in high school athletes following a sport-related concussion (SRC) diagnosis. Method This was a descriptive epidemiological study using the Michigan High School Athletic Association (MHSAA) online Head Injury Reporting System (HIRS). This study included 10,411 (65.9%) male and 5,412 (34.1%) female SRC cases that occurred in 20 sports with greater than 30 SRC cases during the 2015–2016 to 2018–2019 academic years. The HIRS includes dates for SRC injury events and medical clearance for unrestricted return-to-participation for each case; dates were used to calculate recovery time. Kaplan-Meier time-to-event analysis identified crude proportions of athletes that had not obtained medical clearance in weekly increments (e.g., 7 days, 14 days, 21 days, 28 days, 35 days) across sports. Results The median time-to-unrestricted participation was 11 days. Overall, 71.8% of SRC cases took longer than 7 days to return, 29.6% of SRC cases took longer than 14 days, 13.1% of cases took longer than 21 days to return, and 6.5% took longer than 28 days to return to their respective sports. Results by sport show that over 25% of gymnasts took longer than 28 days to return-to-unrestricted participation, followed by competitive cheerleaders (15.5%), wrestlers (12.1%), and male divers (12.0%). Conclusions Almost one in three high school athletes with SRC took longer than 14 days to return-to-unrestricted participation. These results serve as proportional time estimates for return-to-unrestricted participation across a sample of 20 high school sports; and provide rationale to further evaluate recovery patterns in individual sport groups.

Preliminary Study of Fear of Re-Injury following Sport-Related Concussion in High School Athletes

ABSTRACTThe influence of fear of re-injury that this variable has on recovery outcomes following sports-related concussion remains unknown. We examined changes in fear of re-injury throughout concussion recovery, and compared changes in neurocognitive, symptom, vestibular/ocular motor, and recovery time outcomes between concussed adolescent athletes who endorsed high and low fear of re-injury. Individuals with high fear of re-injury were more symptomatic and more likely to exhibit vestibular/ocular motor symptoms over clinical cutoffs than those with low fear of re-injury. Recovery time was not significantly different between the groups. These findings may help explain performance on more subjective concussion assessments.

The Influence of Athletic Trainers on the Incidence and Management of Concussions in High School Athletes.

In many US high schools, the athletic trainer (AT) has the responsibility to identify and manage athletes with concussions. Although the availability of ATs varies a great deal among schools, how the level of AT availability in high schools affects the reported incidence and management of sport-related concussions (SRCs) is unknown. To determine how the presence of an AT affects the reporting and management of SRCs. Prospective cohort study. A total of 2459 (female = 37.5%, age = 16.1 ± 1.2 years) athletes from 31 Wisconsin high schools were categorized as having low availability (LoAT), mid availability (MidAT), or high availability (HiAT) of ATs. Athletic trainers recorded the incidence, days lost from sport, and postconcussion management through return to sport. The incidence of SRC reporting among categories was examined using a multivariate Cox proportional hazards model. Fisher exact tests were used to determine if postconcussion management differed based on AT availability. The incidence of reported SRCs was lower for the LoAT schools (2.4%) compared with the MidAT (5.6%, hazard ratio = 2.59, P = .043) and HiAT (7.0%, hazard ratio = 3.33, P = .002) schools. The median time before the first AT interaction was longer for LoAT schools (24.0 hours) than for MidAT (0.5 hours, post hoc P = .012) and HiAT (0.2 hours, post hoc P = .023) schools. The number of post-SRC interactions was different in all groups (LoAT = 2 interactions, MidAT = 3, and HiAT = 4; all post hoc P values < .05). Days lost were greater for MidAT and HiAT (both 14 days lost) schools compared with LoAT schools (11.5 days lost, post hoc P = .231 and P = .029, respectively). Athletes at LoAT schools were less likely to undergo a return-to-play protocol (9/18 SRCs, 50.0%) than athletes at MidAT (44/47 SRCs, 93.6%; post hoc P = .001) or HiAT (64/64 SRCs, 100%; post hoc P < .001) schools. The level of AT availability positively influenced the reported incidence of SRCs as well as postconcussion management activities in this sample of high schools.

Exploring Multivariate Predictors of Return to School and Sports Following Concussion in High School Athletes

To examine whether demographic and pre-injury health conditions are related to functional recovery following sport-related concussion among high school athletes.

Case Series of Cervical Strain Mimicking Concussion in High School Athletes (P6.314)

Case Series of Cervical Strain Mimicking Concussion in High School Athletes (P6.314)

Lower Extremity Musculoskeletal Injury Risk After Concussion Recovery in High School Athletes.

Although an association between concussion and musculoskeletal injury has been described in collegiate and professional athletes, no researchers have investigated an association in younger athletes. To determine if concussion in high school athletes increased the risk for lower extremity musculoskeletal injury after return to activity. Observational cohort study. One hundred ninety-six high schools across 26 states. We used data from the National Athletic Treatment, Injury and Outcomes Network surveillance system. Athletic trainers provided information about sport-related concussions and musculoskeletal injuries in athletes in 27 sports, along with missed activity time due to these injuries. Three general estimating equations were modeled to predict the odds of sustaining (1) any lower extremity injury, (2) a time-loss lower extremity injury, or (3) a non-time-loss lower extremity injury after concussion. Predictors were the total number of previous injuries, number of previous concussions, number of previous lower extremity injuries, number of previous upper extremity injuries, and sport contact classification. The initial dataset contained data from 18 216 athletes (females = 39%, n = 6887) and 46 217 injuries. Lower extremity injuries accounted for most injuries (56.3%), and concussions for 4.3% of total injuries. For every previous concussion, the odds of sustaining a subsequent time-loss lower extremity injury increased 34% (odds ratio [OR] = 1.34; 95% confidence interval [CI] = 1.13, 1.60). The number of previous concussions had no effect on the odds of sustaining any subsequent lower extremity injury (OR = 0.97; 95% CI = 0.89, 1.05) or a non-time-loss injury (OR = 1.01; 95% CI = 0.92, 1.10). Among high school athletes, concussion increased the odds of sustaining subsequent time-loss lower extremity injuries but not non-time-loss injuries. By definition, time-loss injuries may be considered more severe than non-time-loss injuries. The exact mechanism underlying the increased risk of lower extremity injury after concussion remains elusive and should be further explored in future research.

New and Recurrent Concussions in High-School Athletes Before and After Traumatic Brain Injury Laws, 2005-2016.

To examine the trends of new and recurrent sports-related concussions in high-school athletes before and after youth sports traumatic brain injury laws. We used an interrupted time-series design and analyzed the concussion data (2005-2016) from High School Reporting Injury Online. We examined the trends of new or recurrent concussion rates among US representative high-school athletes participating in 9 sports across prelaw, immediate-postlaw, and postlaw periods by using general linear models. We defined 1 athlete exposure as attending 1 competition or practice. We included a total of 8043 reported concussions (88.7% new, 11.3% recurrent). The average annual concussion rate was 39.8 per 100 000 athlete exposures. We observed significantly increased trends of reported new and recurrent concussions from the prelaw, through immediate-postlaw, into the postlaw period. However, the recurrent concussion rate showed a significant decline 2.6 years after the laws went into effect. Football exhibited different trends compared with other boys' sports and girls' sports. Observed trends of increased concussion rates are likely attributable to increased identification and reporting. Additional research is needed to evaluate intended long-term impact of traumatic brain injury laws.

Evaluating the Recovery Curve for Clinically Assessed Reaction Time After Concussion.

A change in reaction time is one of various clinical measures of neurocognitive function that can be monitored after concussion and has been reported to be among the most sensitive indicators of cognitive impairment. To determine the timeline for clinically assessed simple reaction time to return to baseline after a concussion in high school athletes. Observational study. Athletic training room. Twenty-one high school-aged volunteers. Participants completed 8 trials of the ruler-drop test during each session. Along with baseline measures, a total of 6 additional test sessions were completed over the course of 4 weeks after a concussion (days 3, 7, 10, 14, 21, and 28). The mean reaction times calculated for all participants from each of the 7 test sessions were analyzed to assess the change in reaction time over the 7 time intervals. After a concussion and compared with baseline, simple reaction time was, on average, 26 milliseconds slower at 48 to 72 hours postinjury (P < .001), almost 18 milliseconds slower on day 7 (P < .001), and about 9 milliseconds slower on day 10 (P < .001). Simple reaction time did not return to baseline levels until day 14 postinjury. Clinically assessed simple reaction time appeared to return to baseline levels within a timeframe that mirrors other measures of cognitive performance (approximately 14 days).

Epidemiology of Sport-Related Concussions in High School Athletes: National Athletic Treatment, Injury and Outcomes Network (NATION), 2011-2012 Through 2013-2014.

Sports participation is one of the leading causes of concussions among nearly 8 million US high school student-athletes. To describe the epidemiology of sport-related concussion (SRC) in 27 high school sports during the 2011-2012 through 2013-2014 academic years. Descriptive epidemiology study. Aggregate injury and exposure data from 27 sports in 147 high schools in the National Athletic Treatment, Injury and Outcomes Network (NATION). Boy and girl high school athletes during the 2011-2012 through 2013-2014 academic years. Sport-related concussion counts, percentages, rates per 10 000 athlete-exposures (AEs), rate ratios (RRs), and injury proportion ratios (IPRs) were reported with 95% confidence intervals (CIs). Rate ratios and IPRs with 95% CIs not containing 1.0 were considered significant. Overall, 2004 SRCs were reported among 27 high school sports, for a rate of 3.89 per 10 000 AEs. Football had the highest SRC rate (9.21/10 000 AEs), followed by boys' lacrosse (6.65/10 000 AEs) and girls' soccer (6.11/10 000 AEs). The SRC rate was higher in competition than in practice (RR = 3.30; 95% CI = 3.02, 3.60). Among sex-comparable sports, the SRC rate was higher in girls than in boys (RR = 1.56; 95% CI = 1.34, 1.81); however, the proportion of SRCs due to player-to-player contact was higher in boys than in girls (IPR = 1.48; 95% CI = 1.27, 1.73). Common symptoms reported among all athletes with SRCs were headache (94.7%), dizziness (74.8%), and difficulty concentrating (61.0%). Only 0.8% of players with SRCs returned to play within 24 hours. The majority of athletes with SRCs (65.8%) returned to play between 7 and 28 days. More players had symptoms resolve after 7 days (48.8%) than less than a week (40.7%). Our findings provide updated high school SRC incidence estimates and further evidence of sex differences in reported SRCs. Few athletes with SRCs returned to play within 24 hours or a week. Most injured players returned after 7 days, despite a smaller proportion having symptoms resolve within a week.

Epidemiology of Sport-Related Concussions in High School Athletes: National Athletic Treatment, Injury and Outcomes Network (NATION), 2011–2012 Through 2013–2014

Epidemiology of Sport-Related Concussions in High School Athletes: National Athletic Treatment, Injury and Outcomes Network (NATION), 2011–2012 Through 2013–2014

Multiple Past Concussions in High School Athletes with ADHD (P7.170)

Multiple Past Concussions in High School Athletes with ADHD (P7.170)