Incidence Of Concussion Research Articles

69 Reducing the Economic Burden of Concussion: A Remote Model of Neuropsychological Care in Rural America

Objective:When neuropsychologists serve as consultants to schools, concussion management programs are associated with fewer referrals, faster cognitive recovery, and reduced incidence of protracted recovery compared to programs with physician consultants. However, accessing neuropsychological services can be challenging due to geographical and financial barriers. Particularly in rural areas, travel associated with post-concussion management can represent as a significant financial and time burden. Increasing accessibility to neuropsychologists has the potential to address these concerns, while also providing quality care to moreindividuals. The current study aims to assess the cost-effectiveness and clinical outcomes of a remote, neuropsychologist-led consultation model of concussion management. We hypothesized that this remote model would save patients both money and time, while also improving patient outcomes.Participants and Methods:604 high school concussion cases occurring between May 2019 and May 2022 were reviewed; 571 were included in the current analysis. The sample was 51% male with a mean age of 15.8 years (SD=1.32). All students took ImPACT tests following suspected concussions, with tests administered at the school by certified athletic trainers or nurses. Test results were electronically reviewed by the consulting neuropsychologist. Interpretations and recommendations were then sent via email to the school official. Cognitive recovery, defined as the days from the injury to the final ImPACT test, and incidence of repeat concussions, or concussions occurring within 3 months of a previous concussion, were used as indicators of patient outcomes. Financial burden was determined by calculating the round-trip distance in miles from the patient’s school to the neuropsychologist’s medical center, then multiplying this number by the 2022 standard mileage reimbursement rate of $0.63/mile to determine the travel cost for a single consultation.Results:The sample consisted of 571 individual concussion cases and 1,285 total ImPACT tests. An average of 2.25 tests were administered for each concussion case (SD=0.90), with an average of 18.47 days to the final test (SD=16.59). 8 concussions (1.4% of total concussions) occurred within 3 months of a previous injury. The distance from schools to the closest available neuropsychologist ranged from 2.4 to 102 miles. The remote nature of the consultation model allowed for patients to avoid up to 204 miles, or up to 4.5 hours, of driving for each consultation. Thus, patients saved anywhere from $3.00 to $127.50 in travel costs per consultation.Conclusions:The remote nature of this consultation model yielded a similar cognitive recovery time to previous literature, indicating that it may be as effective as in-person consultation. Repeat concussions represented less than 1.5% of concussion cases, indicating that care was successful enough to prevent second concussions in the majority of the sample. The remote nature of the model also saved patients time (up to 4.5 hours of driving) and money (up to $127.50 in travel costs). Thus, a remote consultation model has the potential to increase access to first-rate concussion care in rural settings, while also being cost- and time-effective for patients.

Tackling the tackle 1: A descriptive analysis of 14,679 tackles and risk factors for high tackles in a community-level male amateur rugby union competition during a lowered tackle height law variation trial

ObjectivesIn rugby union (rugby), the tackle is the most frequent cause of concussion and thus a target for intervention to reduce concussion incidence. The aim of this study is to describe tackle characteristics and factors associated with illegal high tackles in amateur community-level rugby during a lowered (armpit level) tackle height law variation trial. DesignProspective observational cohort study. MethodsVideo surveillance of a single season, four-league competition with coding of video data according to a predefined coding framework. Descriptive statistics of tackle detail and logistic regression was performed to analyse factors associated with high tackles. ResultsOne hundred and eight matches with 14,679 tackles and a mean of 137 (±30) tackles per match were analysed. High tackles (above armpit level) had significantly greater odds of occurring in the lower (2nd–4th) leagues (OR: 1.95; 95 % CI: 1.6–2.4; p < 0.001), front-on tackles (OR: 1.61; 95 % CI: 1.3–2.0; p < 0.001), arm tackles (OR: 1.65; 95 % CI: 1.3–2.1; p < 0.001), bent-at-waist ball carrier (OR: 1.93; 95 % CI: 1.6–2.4; p < 0.001), falling/diving ball carrier (OR: 2.21; 95 % CI: 1.6–3.1; p < 0.001), and an upright tackler (OR: 3.38; 95 % CI: 2.7–4.2; p < 0.001). A falling/diving tackler had significantly lower odds of being associated with a high tackle (OR: 0.44; 95 % CI: 0.3–0.6; p < 0.001). ConclusionsOverall mean tackles per match were similar to those of senior amateur and elite rugby. League, tackle type, tackle aspect, and player body positions were associated with high tackles. These findings reiterate the need for ongoing efforts to identify and implement mitigating strategies to reduce tackle-related injury risk.

Concussion in Kids

Abstract The incidence of concussions in kids has increased over the past decade. Concussions occur from blunt force trauma and are often caused by sports-related head injuries. Clinical presentation varies by individual, and symptoms typically resolve within a couple of weeks from the injury. Key domains for diagnosis, clinical presentation, and clinical management include somatic, cognitive, emotional, and sleep-related disturbances. Patient education is an essential component of care for concussion prevention and recovery. Pediatric nurses play a pivotal role in patient education and optimizing care for kids suffering from a concussion and associated complications. Most concussions resolve without complications over time, but with continued education and research, a mild traumatic brain injury will become less problematic through continued prevention methods and early diagnosis.

Incidence of Concussions in Elite Female Water Polo: A Retrospective Analysis.

Current evidence for concussions is mixed in water polo players. Surveys suggest rates as high as 36%, whereas surveillance studies at international competitions often fail to report them at all. The goal of this study was to examine the incidence of concussions in elite female water polo players from surveillance tools implemented longitudinally. Retrospective chart analysis of 10 years spanning between 2012 and 2022. National teams or professional sports. Female players from the Canadian senior national water polo teams that participated in international competitions and trained more than 10 hours per week in a competitive environment. Included player position, recurrence, and time loss before full return to play. Prevalence of concussion diagnosis. Forty-three concussions were identified over the 10 years observed at a median count of 3 concussions per year. Cumulative days lost spanned between 25 and 348 days per team*year. Altogether, this produced a median rate of 14.3 injuries per 100 player*years. Goalkeepers in the sample suffered the highest rates of concussion (25.8%), compared with players in other positions (22.8% of centers and 16.7% of drivers). This study found evidence for prevalence of concussions in elite female water polo players. Improved guidelines preceded a significant reduction in time loss after the year 2017. This adds to a body of knowledge suggesting that improved surveillance methods are needed to detect and care for concussions in this population.

A technique for in situ intracranial strain measurement within a helmeted deformable headform

Despite the broad use of helmets, incidence of concussion remains high. Current methods for helmet evaluation focus on the measurement of head kinematics as the primary tool for quantifying risk of brain injury. Though the primary cause of mild Traumatic Brain Injury (mTBI) is thought to be intracranial strain, helmet testing methodologies are not able to directly resolve these parameters. Computational injury models and impact severity measures are currently used to approximate intracranial strains from head kinematics and predict injury outcomes. Advancing new methodologies that enable experimental intracranial strain measurements in a physical model would be useful in the evaluation of helmet performance. This study presents a proof-of-concept head surrogate and novel helmet evaluation platform that allows for the measurement of intracranial strain using high-speed X-ray digital image correlation (XDIC). In the present work, the head surrogate was subjected to a series of bare and helmeted impacts using a pneumatically-driven linear impactor. Impacts were captured at 5,000 fps using a high-speed X-ray cineradiography system, and strain fields were computed using digital image correlation. This test platform, once validated, will open the door to using brain tissue-level measurements to evaluate helmet performance, providing a tool that can be translated to represent mTBI injury mechanisms, benefiting the helmet design processes.

Incidence of concussion in men's Super League, Championship, and Academy rugby league matches between 2016 and 2022

ObjectivesTo quantify the incidence of concussion and compare between playing levels in male rugby league. DesignRetrospective cohort. MethodsBetween 2016 and 2022, medically diagnosed concussions in Super League, Championship, and Academy competitions were reported to the Rugby Football League via club medical staff. Anonymised data were analysed using generalised linear mixed-effects models by season, month, and between competitions. ResultsOverall, 1403 concussions were identified from 104,209 player-match hours. Concussion incidence for Super League, Championship, and Academy was 15.5, 10.5, and 14.3 per 1000 player-match hours, respectively. Championship concussion incidence was significantly lower than the Super League (p < 0.001) and Academy (p < 0.001). No significant differences were identified between years for Super League (range: 13.3 to 18.8 per 1000 player-match hours) and Championship (range: 8.4 to 12.1 per 1000 player-match hours). In Academy (range: 9.6 to 20.5 per 1000 player-match hours), concussion incidence was significantly greater in 2021 compared to earlier years (2016, p = 0.01 and 2017, p = 0.03). No significant differences were identified between months for any competition. ConclusionsThe incidence of concussion is greater in Super League and Academy compared to the Championship. Academy concussion incidence has increased over time. Different factors between and within competitions, such as changes to medical standards and knowledge, could have influenced the identification and diagnosis of concussion.

Sport level and sex differences in sport-related concussion among Japanese collegiate athletes: Epidemiology, knowledge, reporting behaviors, and reported symptoms.

This study investigated the incidence of sport-related concussion (SRC) in sports, effect of athlete knowledge on reporting behavior differences between collegiate and non-collegiate athletes, and differences in SRC symptoms between sexes and level of participation. In this cross-sectional survey, 1 344 Japanese collegiate and non-collegiate athletes from a single institute were analyzed. Using a web-based survey, demographics, general SRC, knowledge of SRC, the most recent SRC reporting behaviors, and symptom presentation were examined. The prevalence of SRC during the academic year 2016-2017 was 2.68 (95% confidence interval [CI]: 1.88-3.69) across all sports. The prevalence of SRC was 33.3 (95% CI: 17.96-51.83) in rugby union and 8.33 (95% CI: 1.03-27.00) in women's soccer. The prevalence of SRC in males (3.47 [95% CI: 2.38-4.86] was 3.65 times higher than that in females (0.95 [95% CI: 0.26-2.41]). In total, the mean total score of knowledge was 5.30 (4.2) across 25 questions; dizziness was the most well-known symptom (867/1 344, 64.5%), followed by headache (59.3%). Being more emotional (44/1 345, 3.3%) was the least frequently known symptom. Level of participation did not affect scores (5.16 [3.96] vs. 5.52 [4.54]; p​=​0.131). All 87 disclosing participants experienced drowsiness and irritability and felt more emotional. In terms of sex and participant level, no significant differences were found in any symptoms. This study found very low rates of concussion education in Japan. Dissemination of concussion education is essential in the future to recognize concussion earlier and prevent severe concussive injury.

Time Of Season And Concussion Incidence For Sex-comparable Middle School Sports

Time Of Season And Concussion Incidence For Sex-comparable Middle School Sports

American Football Soft-Shell Helmet Covers Reduce Head Impact Severity: A Critically Appraised Topic

Focused Clinical Question: Do soft-shell helmet covers reduce head impact severity in American football helmets? Clinical Bottom Line: There is consistent SORT level C evidence to support that soft-shell helmet covers reduce measures of head impact severity and measures of linear and rotational acceleration. The impact reductions occurred at magnitudes less than the average reported concussive impact, which limits the application of the evidence with respect to concussion incidence or risk among American football players.

Time Of Season And Concussion Incidence For Middle School Collision Sports

Time Of Season And Concussion Incidence For Middle School Collision Sports

Position comparison of sport-related concussions in female youth soccer players

ABSTRACT Objectives Youth soccer participation, particularly among females, continues to grow worldwide. With the high incidence of sport-related concussion (SRC) in soccer, it is important to investigate if SRC occurs disproportionally by positions. Our hypothesis was to see no positional differences in SRCs, SRC-related characteristics, and outcomes among in female youth soccer athletes. Methods Data were prospectively collected from participants at a single sports medicine institution between August 2015-April 2021. Female participants aged 8–18 diagnosed with SRC sustained during an organized soccer practice, scrimmage, or game were separated into 4 groups based on position: Forward, Midfielder, Defender, and Goalkeeper. Demographics, medical history, injury-related details, and outcomes were reviewed. A chi-square test or Fisher’s exact test was used for categorical variables. Continuous variables were compared with Mann-Whitney or Kruskal-Wallis test. Results Two hundred fourteen participants were included: 52 Forwards, 65 Midfielders, 63 Defenders, and 34 Goalkeepers. There were no significant differences between the groups in age, race, ethnicity, or previous concussion history. Differences in mechanism existed with Goalkeepers most commonly reporting Head to Body Part. Goalkeepers, which make up 1/11 of the total positions on the field, had a significantly higher proportion of SRCs compared to Field Positions. (9.1% vs 15.9%) At 3-month post-enrollment, there were no significant differences in reported symptoms or return-to-play between the different positions. Conclusion In youth female soccer players, goalkeepers sustained a higher proportion of sport-related concussions compared to field players based upon the composition of a soccer team. The mechanism of injury also differed among the different soccer positions. However, no differences in concussion characteristics, outcomes, or RTP were seen across the different soccer positions.

Effect of the 2018 NCAA Kickoff Rule Change on Concussion Rates in Collegiate Football: Results From a Division 1 Conference.

Kickoff plays in American football are associated with an increased risk of concussion compared with other play types. In 2018, the National Collegiate Athletic Association (NCAA) Football Rules Committee altered the kickoff rules so a fair catch inside the 25-yard line results in a touchback, with the ensuing drive starting on the 25-yard line. The intention was to decrease the number of kickoff returns with a corresponding decrease in the rate of concussions on kickoff plays. To determine whether the 2018 rule changes had the intended effects in an NCAA Division 1 Conference. Cohort study; Level of evidence, 3. The study population included football athletes in the NCAA Pacific-12 (Pac-12) Conference. Data on the total number of plays, punts, kickoffs, touchbacks, and fair catches were obtained for all in-conference games from the 2016 to 2021 seasons. The number of game concussions and the play type were provided by each conference institution. Incidence of concussions occurring during kickoff plays before (2016-2017) and after (2018-2021) the rule change were compared with a difference-in-difference analysis using Poisson general linear models. There were 242 concussions in 108,774 total plays in the study period, with an overall concussion rate of 2.2 per 1000 plays. The percentage of touchbacks increased significantly from 45% to 51% (P < .001) and the percentage of fair catches increased from 1% to 7% (P < .001) from before to after the rule change. Kickoffs accounted for 6% of plays both before and after the rule change and 11% of concussions before and 14% after the change. The mean annual concussion rate (per 1000 plays) on kickoffs was 3.42 before and 5.31 after the rule change (rate difference: 1.89; 95% confidence interval, -1.22 to 5.01). Touchbacks and fair catches increased after the kickoff rule change, but there was not a corresponding decrease in concussions during kickoff plays as anticipated. Concussions occurring during other football plays remained stable.

The Relationship Between Neck Strength and Sports-Related Concussion in Team Sports: A Systematic Review With Meta-analysis.

OBJECTIVE: We aimed to quantify the relationship between neck strength and sports-related concussion (SRC) for athletes participating in team sports. DESIGN: Etiology systematic review with meta-analysis. LITERATURE SEARCH: PubMed, PsycINFO, MEDLINE, CINAHL, CENTRAL, and Scopus were searched on March 17, 2022, and updated on April 18, 2023. STUDY SELECTION CRITERIA: Team sports where an opponent invades the player's territory (eg, football, rugby, basketball) that reported at least 1 measure of neck strength, and 1 measure of SRC incidence, using cohort, case-control, or cross-sectional study designs. The Newcastle-Ottawa scale was used to assess risk of bias; certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. DATA SYNTHESIS: Studies were summarized qualitatively and quantitatively. To understand the relationship between neck strength and future SRC incidence, random-effects meta-analysis was conducted on prospective longitudinal studies. RESULTS: From a total of 1445 search results, eight studies including 7625 participants met the inclusion criteria. Five studies reported a relationship between greater neck strength or motor control and reduced concussion incidence. Pooled results from 4 studies indicated small (r = 0.08-0.14) nonsignificant effects with substantial heterogeneity (I2>90%). The considerable heterogeneity is likely a result of synthesized studies with vastly different sample characteristics, including participant age, playing level, and sports. CONCLUSIONS: There was very low-certainty evidence suggesting a small, nonsignificant relationship between greater neck strength and a lower risk of sustaining a SRC. J Orthop Sports Phys Ther 2023;53(10):1-9. Epub: 10 July 2023. doi:10.2519/jospt.2023.11727.

Paper 60: Effect of Mouthguard Type on Severity of Concussion During Game-Related College Football Competition. A 16-Season Prospective Study

Objectives: Prior studies have either claimed or disputed the role of mouthguard protection in reducing the incidence of concussion. Other than investigating a decrease in concussion rate, no long term studies have specifically compared the effect of type of mouthguard protection on the severity of concussion. The increasing incidence of head trauma in sport, the potential for long-term traumatic brain injury, and concerns of rising medical costs, dictate a focus on variables that may influence concussion severity in contact sports. Therefore, this study quantified the effect of mouthguard type on severity of concussion during game-related college football competition. Methods: 40 universities were evaluated over 16 competitive seasons (2006-2021) across all Football Bowl Subdivision (FBS) conferences. Mouthguard type was divided into two groups based on dentist- fitted and self-fitted (generic/boil and bite). Outcomes of interest included concussion severity (simple: 0-10 days time loss, complex: &gt; 10 days time loss), injury category, player position, injury situation, injury mechanism, elective imaging, and playing surface. Data were subject to multivariate analyses of variance (MANOVA) and Wilks’ λ criteria using GLM procedures, and expressed as incidence rates (lR) per 10 game season. Results: Of the 2,332 games documented, 9,563 total injuries were reported, resulting in 708 (589 simple, 119 complex) concussion cases, consisting of 653 player-to-player contacts and 55 player-to- surface impacts. MANOVA indicated significant main effects of mouthguard type by concussion severity ( F1,705 = 3.587; P = .028), player position by team ( F2,705 = 3.551; P = .029), player position by skill position ( F8,699 = 2.373; P = .016), and injury mechanism ( F6,701 = 4.467; P &lt; .001). Post hoc analyses indicated a significantly lower ( P = .023) incidence of complex concussions [1.3, (95% CI, 0.9-1.6) vs 2.1 (1.7-2.5)], with a significantly higher ( P = 0.014) occurrence of simple concussions [8.7, (95% CI, 8.4-9.1) vs 7.9 (7.5- 8.3)] while wearing dentist-fitted versus self-fitted mouthguards, respectively. Although significantly greater ( P &lt;.05) incidences of concussion were documented across offensive teams [4.3, (95% CI, 3.8- 4.8) vs 3.3 (2.9-3.8)], quarterbacks [0.9, (95% CI, 0.6-1.2) vs 0.3 (0.2-0.6)], and players tackled above the waist [2.8, (95% CI, 2.4-3.3) vs 1.7 (1.4-2.1)] than observed across other teams and injury mechanisms while wearing dentist-fitted as compared to self-fitted mouthguards, respectively. The majority of these cases, however, were diagnosed as simple concussions. Of the 1,150 games (49.3%) played on a 3-layer artificial turf (≥9.0 lbs/ft2) infill system and 1,182 games (50.7%) played on natural grass, surface-related concussions on artificial turf (n = 26; 3.7% of total concussions; 21 simple, 5 complex concussions) and natural grass (n = 30; 4.2 % of total concussions; 23 simple, 7 complex concussions) were minimal and less severe on both surfaces than often perceived. Conclusions: The significantly lower incidence of complex concussions documented with dentist-fitted mouthguards during college football competition may reflect greater shock absorption and redistribution of energy during head impact due to more optimal fit and fabrication when compared to self-fitted mouth protection, translating to less severity of trauma and more expedient return to play. This longitudinal study directly compares and addresses type of mouthguards as they relate specifically to concussion severity. Although findings of this study may be generalizable only to this level of football competition, further research is warranted into lower levels of competition, e.g., high school, youth football, where the use of self-fitted mouthguards is prevalent.

Poster 369: Analysis of National Hockey League Player Performance After Concussion and Financial Costs Associated with Implementation of an Updated Concussion Protocol: A Retrospective Comparative Study

Objectives: Background: An updated National Hockey League (NHL) concussion protocol (NHLCP) was established in the 2016–2017 season to mitigate the negative outcomes of sport-related concussions. However, few studies on the effects of implementing the NHLCP have been performed. Purpose: To define concussion incidence and investigate differences in NHL player performance after a concussion during periods before and after implementation of the NHLCP and to assess the financial impact on NHL teams associated with NHLCP implementation. We hypothesized that concussion incidence would increase and player performance would remain the same after NHLCP implementation. Methods: A retrospective review of NHL players who sustained a concussion before (2000–2001 to 2015–2016 seasons) and after (2016–2017 to 2020–2021 seasons) implementation of the NHLCP (pre- NHLCP and post-NHLCP groups). For each group, multiple performance metrics 30 days, 1 season, and 3 seasons before and after concussion were compared for both groups. Return to play, total concussion cost, and association of return to play with cost were investigated with regression analysis. Results: For both groups, no significant differences in standard performance were observed during the 30-day and 1-season time periods before and after concussion. Mean return to play was significantly higher in the pre-NHLCP than in the post-NHLCP group (20.1 vs 15.7 days; P=0.022). Mean adjusted player salary was not different between groups, but mean adjusted replacement player salary was significantly higher in the post-NHLCP group ($744,505 vs $896,942; P= 0.032). Mean cost of time missed did not differ between groups. Mean return to play time significantly decreased over the entire study period 2000–2021 (R2=0.335, P=0.005), and mean return to play time was positively associated with cost (R2=0.215, P=0.030). Conclusions: Concussion incidence did not change after implementation of the updated NHLCP, but players had significantly less missed time from injury after protocol implementation. Changes in player performance 30 days and 1 year before and after concussion injury were not different before and after NHLCP implementation. [Table: see text][Table: see text]

Poster 380: Decreased concussion incidence following revised contact rules; An updated epidemiology of NFL concussions from 2017-2022

Objectives: The incidence of concussions in football, and the media attention that followed, has garnered scientific investigation, prompted technological advances in protective gear, and altered the rules of the game, including the NFL’s “Targeting” rule, which began in 2018. In previously studied seasons, certain positions, such as offensive skill players, had higher rates of concussions while defensive secondary and offensive line players suffered the greatest number of concussions, but the severity of these concussions has not been reported. The advent of the “Targeting” rule has been shown to reduce concussions in collegiate football leagues, but its effect on NFL and professional-level players is unknown. The objectives of this retrospective study were to describe the epidemiology of concussions among professional football players in the NFL during the last five seasons, determine changes in incidence over the study period, and characterize positional differences in rate and games missed. Methods: The current study was a descriptive epidemiological study that retrospectively reviewed all concussions that occurred in the five NFL seasons from the 2017-2018 season through the 2021-2022 season that resulted in at least one game missed. Total concussions, total games missed due to concussion, and average games missed per concussion were extracted from publicly available injury reports and were cross-referenced with publicly available sources. Concussion rates were calculated per 1,000 athletic exposures (AEs). A sub-analysis was performed by year, game unit, position type, and game week. Results: In 1,216 regular season games in the five NFL seasons, there were a total of 368 concussions for a rate of 0.30 concussions per game and 7.04 concussions per 1,000 AEs. More concussions were concentrated in the last one-third of the regular season. There was a statically significant decrease (38%; p&lt;0.05) in total concussions between the 2017-2018 season (102 total concussions) and the four seasons between 2018-2019 and 2021-2022 (average of 73.8 concussions per year). During the five seasons, there were 1,014 games missed due to concussion, an average of 2.76 games missed per concussion, and 0.056 games missed due to concussion per 1,000 AEs. Following the 2017-2018 season, there was a 53% decrease in the total games missed due to concussion (Figure 1b) and a 38% decrease in the average games missed per concussion (Figure 1c). Descriptively, both offensive and defensive units had decreased concussion rates and average games missed per concussion in the four seasons after 2017 (Figure 2). Defensive backs (10.46 per 1,000 AEs) and tight ends (10.69 per 1,000 AEs) had the highest concussion rates. The defensive line had the highest average games missed per concussion at 3.97 (Table 1). Conclusions: The introduction of the “Targeting” rule in the NFL beginning in the 2018 season correlated with a decrease in total concussions per year, total games missed per concussion, and games missed per concussion. Both offensive and defensive units experienced similar reductions in concussion incidence and severity. Overall, the updated epidemiology of NFL concussions suggests that efforts to protect professional football players from concussions have been successful, however, players continue to experience concussions that require them to miss multiple games. [Table: see text]

Incidence of concussion and associated risk factors in collegiate soccer: findings from the NCAA-DoD CARE consortium

ABSTRACT This retrospective cohort study aims to examine concussion incidence rates (IR) in collegiate soccer players and compare IRs based on risk factors including sex, competition level, games/practices, history of concussion, and playing position. Collegiate soccer players were recruited (n = 2,471) from 23 institutions from the NCAA-DoD Concussion Assessment, Research, and Education (CARE) Consortium. Incidence rates for concussion per 1000 athlete exposures (AEs) were calculated across the 2015–16/2016–17 seasons. Incidence rates (IR) comparing risk factor groups were also calculated. A total of 162 concussions occurred during the study, for an IR of 0.08/1000 AEs. Females were more likely to have a concussion than males overall (IR = 1.47) and were more likely to have a concussion in games (IR = 1.42) and practices (IR = 2.91). Concussions were more likely during competition compared to practice (IR = 2.53), and less likely in Division III, compared to Divisions I and II, χ2 = 6.5, p > .05. In the concussed group, male sex was associated with 2.47 times higher odds of playing defender and 2.29 times higher odds of a collision mechanism. Results confirm previous findings that females and game exposures have higher concussion IR than males and practice exposures. Findings also supported sex differences in IRs based on exposure type, position, and mechanism.

Self-reported concussions in Canada: A cross-sectional study.

Traumatic brain injuries (TBIs) are a major public health concern impacting the lives of many Canadians. Among all TBIs, concussions are the most common. However, to date, the incidence of concussions among the Canadian population, has remained unknown. To address this data surveillance gap, this study presents national estimates on the percentage of Canadians aged 12 years or older (excluding those living in the territories) who sustained one or more concussions in 2019. This study used data collected from the Traumatic Brain Injury Rapid Response (TBIRR) module of the 2020 Canadian Community Health Survey, a cross-sectional health survey. Descriptive statistics and logistic regressions were conducted to summarize the information in the TBIRR module. This study found that approximately 1.6% of Canadians aged 12 years or older reported sustaining one or more concussions in 2019. Age was significantly associated with concussion incidence after controlling for sex and annual household income, and the locations and activities surrounding respondents' most serious concussions varied by age group. Over one-third of respondents sustained multiple concussions. The results suggest that certain populations, particularly younger individuals, may be more affected by concussions. While circumstances surrounding concussions vary by age group, the most important contributing factors were sports or physical activities among youth and falls among the adult population. Monitoring concussions among the national population is an important activity in injury surveillance, as it can help evaluate the efficacy of injury prevention intervention and better understand knowledge gaps and the burden of this injury.

A-39 A Comparison of Concussion Reporting between the Olympic and Paralympic Games

Abstract Purpose Research has established that the Paralympic Games have a higher injury rate than the Olympic Games, but less is known about how concussion rates may differ between these two populations. Concussions in Paralympic athletes are more difficult to accurately diagnose due to the lack of robust concussion guidelines specific to para athletes. This literature review sought to compare reporting of concussion symptoms and incidence between the Paralympic and Olympic Games since 2010. Data Selection: Searches of Google Scholar, PubMed, and ResearchGate were performed to identify Paralympic and Olympic injury and surveillance study data. Hand-searching citation lists yielded additional results. Articles were included if they reported head injury and/or concussion data. Results Fourteen articles were included that provided injury surveillance study data from 2010 to 2022. Data on head injury and concussion incidence and diagnosis were extracted and reviewed. Between 2010 and 2018, higher concussion rates were reported in Olympic athletes, possibly due to the lack of concussion-specific injury questions for Paralympic athletes. When concussion-specific injury questions for Paralympic athletes were implemented in 2018, data suggests that Paralympic athletes sustained more concussions than Olympic athletes. Additionally, the review suggested potential under-reporting of concussions in Paralympic athletes, despite symptoms, suggesting incidence may be higher than reported. Conclusions Higher concussion rates in the Paralympic Games and possible under-reporting of concussions highlights the need for improved identification and evaluation of concussions in Paralympic athletes. Establishing robust guidelines for the identification, evaluation, and management of concussions for para athletes is critical to increase their safety.

A-34 Incidence of Sport-Related Concussion in Adaptive Sports: A Scoping Review

Abstract Purpose Despite an increase in sport-related concussion (SRC) research for non-adaptive athletes, research on para athletes is sparse. The purpose of this scoping review was to examine the incidence of SRCs in para athletes to understand their risk for SRCs. Methods This review was registered with Open Science Framework and adhered to PRISMA-ScR guidelines. Searches of electronic databases (CINAHL, Google Scholar, MEDLINE, SPORTDiscus, and Web of Science) were conducted from database creation to February 1, 2023. Articles selected examined SRC incidence in para sports. Results Reviewers screened 202 title-abstracts and 32 articles qualified for full-text review, with 12 articles qualifying for data extraction for information on SRC incidence. Incidence rates varied across studies, ranging from no reported concussions to concussions accounting for 43% of injuries in a given sport. Sledge hockey and wheelchair basketball were the most frequently studied populations. Data suggested that para athletes are likely to sustain concussions at a similar rate to non-adaptive athletes. While data on sex differences were scarce, female athletes appeared to sustain more concussions than male athletes. Conclusions Based on limited published data, the incidence of SRCs in para athletes appears to be most prevalent in wheelchair basketball and sledge hockey and more common in female than male athletes. Given the limitations of published data, knowledge regarding incidence in other para sports is minimal. It will be important for future research to capture data across multiple para sports to determine concussion risk and inform the development and implementation of protocols for assessing and managing SRCs.