Concussion Protocols Research Articles

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]

The National Football League Concussion Protocol: A Review.

Sport-related concussion remains an area of high concern for contact sport athletes and their families, as well as for the medical and scientific communities. The National Football League (NFL), along with the NFL Players Association and experts in the field, has developed protocols for the detection and management of sport-related concussions. This article reviews the NFL's most recent concussion protocol including preseason education and baseline testing for players, concussion surveillance by gameday medical teams and neurotrauma consultants and athletic trainers, gameday concussion protocol and procedures, and return to participation guidelines.

Heading Towards Accountability: An Analysis of the Efficacy of Concussion Protocol

The objective of this study was to evaluate the success of concussion protocols and accommodations, focusing on what factors were most influential. The approach will be a qualitative one, involving the use of open-ended questions and interviews to extract subjective responses. This approach was taken to encourage authentic answers and data. It concludes with an analysis of the data which reveals that while academic accommodations are beneficial, concussion protocols are not.

Exploring athletic trainers'experience and perceptions associated with a multifaceted approach to concussion management.

To explore high school athletic trainers'experience with, and perceptions of, a multifaceted approach to concussion management. A total of20 high school athletic trainers that are certified and licensed to practice (if their state requires a license to practice) participated in this study. A general qualitative design with descriptive coding and saturation was met at 20 interviews. Lack of standardization allows assessment, referraland return-to-play experiences to vary significantly; referral experiences vary pending upon athletic trainers ability to refer to a trusted and responsive physician;barriers include clearances from unqualified physicians; pressure from coaches, parentsand students to return students to play;benefits include increased knowledge and awareness resulting in more effective care for students. Athletic trainers have varying experiences and perceptions regarding their approaches to concussion management. However, there were many notable similarities in the experiences, pressures, barriers and benefits when applying their concussion protocol.

Primary Care Considerations for the Baseball Athlete.

To summarize current guidance and best practices surrounding non-orthopedic medical concerns in baseball. Discussion of COVID19-related practice changes pertaining to the prevention and screening of communicable respiratory illness, concussion protocol updates, the enhanced role of a multi-disciplinary team of mental health professionals. Prevention, appropriate screening, and early identification remain cornerstones of effective primary care both within the general population as well as for the baseball athlete.

International perspectives on trends in paediatric sports-related concussion: knowledge, management, unanswered questions

PurposeIn the last 20 years, concussion has received increased attention in the media, with distinct recognition of sports-related concussion (SRC). Much of this attention has centred on the paediatric population, due to concerns over adolescent brain development and the high numbers of teenagers playing contact sport. This qualitative study explored (1) what experts in the field of concussion perceive regarding trends in paediatric concussion awareness and management, and (2) how responses to these questions differ by country (US vs. NZ) and by discipline (research vs. sports coaching vs. sports medicine).MethodsAfter the development of a semi-structured interview template, questions were coded for interviews of six (N = 6) experts in academia, medicine, and coaching: three in the United States (N = 3) and three in New Zealand (N = 3). Interviews were then transcribed and qualitatively analysed using a thematic narrative analysis. Emergent themes included concussion knowledge, management, and unanswered questions.ResultsFindings showed general commonalities on the importance of concussion education, the improvement of concussion awareness, compliance to concussion protocols, and the need to research long-term outcomes. Fewer commonalities were found regarding the level of concussion reporting, the impact of multiple concussions, whether paediatric and adult concussion should be treated similarly, and the utility of concussion tests.ConclusionsConcussion experts agree on many areas; however, divergent opinions were apparent. Further original research is required within the paediatric population to analyse the efficacy of current concussion guidelines.

'It's All Downhill from Here': A Scoping Review of Sports-Related Concussion (SRC) Protocols in Downhill Mountain Biking (DHI), with Recommendations for SRC Policy in Professional DMB.

Introduction: Downhill mountain biking (DHI) is a form of cycling and does not currently have a specific sports-related concussion (SRC) assessment. Objective: To review the extent, range and nature of research investigating SRC in DMB, provide a summary of key literature findings relating to its identification and management, and then develop a SRC protocol specific to DMB. Design: Scoping review as per recognised methods. Setting: Literature-based. The following databases were searched: MEDLINE, EMBASE, Scopus and Web of Science, with no restrictions on date. Results were limited to the English language. Participants: Six articles were included in the review from 64 identified articles. The article had to specifically include an analysis of adult downhill riders for inclusion. Outcome measures: Study type, study group (amateur/professional), concussion incidence, concussion assessment and recommendations. Main Results: Concussion incidence was identified as between 5–23%. No study outlined a trackside assessment of cyclists or a protocol for return to play where SRC was identified. Several authors identified that riders often continued to participate despite the presence of a concussion. No sport-specific SRC assessment was determined for DHI, and a SRC assessment was therefore developed. Conclusions: This review illustrates the lack of studies and formal protocol in SRC assessment for DHI. In light of this, we propose a three-stage framework specific to the sport to best identify a concussion and act where appropriate while minimising disruption to competition. This framework involves assessing the cyclist on the ‘sideline’, a second assessment post-event in the medical room and a third assessment the following day. A SRC consensus meeting specific for DHI is suggested with an identified need for updated guidance from UCI, requiring possible rule changes for the sport.

Design and Construction of Intelligent Corridor of Tourist Attractions Based on Sensor Network

This paper presents an in-depth analysis and study of traditional corridor construction and tourism system planning using intelligent sensing networks. This paper proposes a node deployment and coverage optimization method for HWSNs based on particle swarm optimization emperor butterfly algorithm and extreme learning machine, with the objectives of reducing node deployment cost, reducing coverage redundancy and voids, improving monitoring area coverage, and increasing the agility of data processing by 15.03%, efficiency by 12.15%, and stability by 11.31%. In the paper, the static parameter table of the sensor is stored inside the smart sensor or stored on the IoT cloud platform to achieve automatic registration of the static parameters of the smart sensor. According to the characteristics of dynamic parameters of smart sensors, an autonegotiation algorithm is designed to realize the dynamic parameters of smart sensors to be determined by autonegotiation and complete registration without human intervention, which includes four parts: utility function, concussion protocol, proposal generation strategy, and response mechanism. The intelligent sensing system is composed of three parts: smart sensor, IoT gateway, and IoT cloud platform; the functions of each part in the system are analyzed, and MAR and STM32F4 are selected as the core board of smart sensor and IoT gateway. And for the problems of time-consuming and tedious access to smart sensors in the system, we propose to study the adaptive sensor UART serial port parameters and automatic registration of sensor parameters. Based on the analysis of the current environment and resource characteristics of the traditional corridor, the current situation of ecotourism resources of the traditional corridor is sorted out, an evaluation index system is established to evaluate ecotourism resources, and the current development basis is analyzed from four aspects: natural environment, tourism resources, product development, and infrastructure. Finally, to promote the sustainable development of the ecotourism corridor in the Chengdu section of the southern foot of the Qinling Mountains, the planning and development strategies to match the ecotourism corridor in the Chengdu section of the southern foot of the Qinling Mountains are proposed in four aspects: transportation organization optimization, ecological landscape enhancement, support system construction, and regional tourism development.

Concussions in the Women’s National Basketball Association: Analysis of Incidence, Return-to-Play Timing, and Player Performance From 1997 to 2020

Background:The extent to which concussions affect Women’s National Basketball Association (WNBA) athletes has not been thoroughly examined.Purpose:To evaluate the incidence and impact of concussion injuries occurring in the WNBA.Study Design:Descriptive epidemiology study.Methods:Publicly available records were searched to identify all documented basketball-related concussions from WNBA seasons 1997 to 2020. Player demographics, injury details, and basketball career information were collected. Concussion incidence and return-to-play (RTP) timing were evaluated before and after the institution of the WNBA concussion protocol in 2012. Minutes per game and game score per minute were compared 5 games before and 5 games after the concussion was sustained. Player game availability and RTP performance were also compared with an age-, body mass index–, position-, and experience-matched control group of players who did not sustain any injuries during the index season.Results:A total of 70 concussions among 55 players were reported in the WNBA from 1997 to 2020, with a mean incidence of 2.9 ± 2.3 concussions per season. After the implementation of the WNBA concussion protocol, the incidence significantly increased from 1.7 to 5.0 concussions per season (P < .001). All players returned after a first-time concussion, missing a mean of 3.8 ± 4.7 games and 17.9 ± 20.7 days. After the adoption of the concussion protocol, the time to RTP significantly increased with games missed (P = .006) and days missed (P = .006). Minutes per game and game score per minute were not significantly affected by sustaining a concussion (P = .451 and P = .826, respectively).Conclusion:Since the adoption of the WNBA concussion protocol in the 2012 season, the incidence of concussions increased significantly. Athletes retained a high rate of RTP after missing a median of 4 games, and the time to RTP increased after the institution of the concussion protocol. Player game availability and performance within the same season were not significantly affected by concussion injuries after a successful RTP.

A brief descriptive outline of the rules of mixed martial arts and concussion in mixed martial arts.

Mixed martial arts (MMA), a combat sport consisting of wrestling, boxing, and martial arts, is a popular activity associated with danger and violence. Of concern are the repetitive head impacts, both subconcussive and concussive, sustained by MMA athletes. The rules of MMA encourage head strikes, but there was no formal concussion protocol in the Ultimate Fighting Championship (UFC) until 2021. Because the UFC was established less than 30 years, the long-term consequences of these repetitive concussive head blows are lacking. In this review, we focus on current literature sought to summarize the current knowledge of repetitive head impacts and concussions in MMA. The objectives were to outline (a) the rules of MMA; (b) the postconcussion protocol for UFC athletes; (c) current behavioral and biochemical diagnostic measures; (d) epidemiology and prevalence of concussion in MMA; (e) long-term effects of subconcussive repetitive head impacts; (f) biomechanics of head impacts; and (g) considerations and research topics that warrant future research.

Use of Novel Concussion Protocol With Infralow Frequency Neuromodulation Demonstrates Significant Treatment Response in Patients With Persistent Postconcussion Symptoms, a Retrospective Study.

IntroductionConcussion is a growing public health concern. No uniformly established therapy exists; neurofeedback studies report treatment value. We use infralow frequency neuromodulation (ILF) to remediate disabling neurological symptoms caused by traumatic brain injury (TBI) and noted improved outcomes with a novel concussion protocol. Postconcussion symptoms (PCS) and persistent postconcussion symptoms (PPCS; >3 months post head injury) are designated timelines for protracted neurological complaints following TBI. We performed a retrospective study to explore effectiveness of ILF in PCS/PPCS and investigated the value of using this concussion protocol.MethodPatients with PCS/PPCS seen for their first neurology office visit or received their first neurofeedback session between 1 August 2018 and 31 January 2021 were entered. Outcomes were compared following treatment as usual (TAU) vs. TAU with ILF neurotherapy (TAU+ILF). The study cohort was limited to PPCS patients; the TAU+ILF group was restricted further to PPCS patients receiving at least 10 neurotherapy sessions. Within the TAU+ILF group, comparisons were made between those who trained at least 10 sessions using concussion protocol (TAU+ILF+CP) and those who trained for at least 10 sessions of ILF regardless of protocol (TAU+ILF-CP).ResultsAmong our resultant PPCS cohort (n = 59) leading persistent neurological complaints were headache (67.8%), memory impairment (57.6%), and brain fog (50.8%). PPCS patients in TAU+ILF+CP (n = 25) demonstrated greater net (p = 0.004) and percent (p = 0.026) improvement of symptoms compared to PPCS subjects in TAU (n = 26). PPCS patients in TAU+ILF-CP (n = 8) trended toward significant symptom improvements compared to TAU, and TAU+ILF+CP trended toward greater efficacy than TAU+ILF-CP.ConclusionPPCS patients who received TAU+ILF+CP demonstrated significantly greater improvement as a group when compared to TAU. When used as an integrative modality to treatment as usual in managing patients with PPCS, ILF neuromodulation with use of concussion protocol provided significant symptom improvements.

Comparison of Concurrent and Same-Day Balance Measurement Approaches in a Large Sample of Uninjured Collegiate Athletes.

BackgroundMeasures of postural stability are useful in assisting the diagnosing and managing of athlete concussion. Error counting using the Balance Error Scoring System (BESS) is the clinical standard, but has notable limitations. New technologies offer the potential to increase precision and optimize testing protocols; however, whether these devices enhance clinical assessment remains unclear.PurposeTo examine the relationships between metrics of balance performance using different measurement systems in uninjured, healthy collegiate athletes.Study DesignCross-sectional.MethodsFive hundred and thirty uninjured collegiate athletes were tested using the C3Logix app, which computes ellipsoid volume as a measure of postural stability during the six standard BESS conditions, while concurrently, errors were manually counted during each condition per standard BESS protocols. The association between concurrently measured ellipsoid volumes and error counts were examined with Spearman’s correlations. From this sample, 177 participants also performed two double-leg conditions on the Biodex BioSway force plate system on the same day. This system computes Sway Index as a measure of postural stability. The association of ellipsoid volume (C3Logix) and Sway Index (Biodex) was examined with Spearman’s correlations. Individual-level data were plotted to visually depict the relationships.ResultsC3Logix ellipsoid volume and concurrently recorded error counts were significantly correlated in five of the six BESS conditions (rs:.22-.62; p< 0.0001). C3Logix ellipsoid volume and Biodex Sway Index were significantly correlated in both conditions (rs=.22-.27, p< 0.004). However, substantial variability was shown in postural stability across all three measurement approaches.ConclusionModest correlation coefficients between simultaneous and same-day balance assessments in uninjured collegiate athletes suggest a need to further optimize clinical protocols for concussion diagnosis.Level of Evidence2b

A Cross-Sectional Decision-Making Approach to Inform Neuropsychological Battery Development in Professional Hockey.

Neuropsychologists commonly use a large battery of tests to inform clinical decisions. Decision analysis can be used to determine which individual tests play a role in the decision-making process. The objective of this project was to conduct quantitative and qualitative decision analysis of decisions by team neuropsychologists with professional hockey players being evaluated as part of the National Hockey League (NHL)/NHL Players Association Concussion Protocol. We extracted neuropsychological data from an NHL clinical program database. Team neuropsychologists evaluated concussed players using a hybrid neuropsychological test battery. The neuropsychologists then determined whether players were experiencing concussion-related cognitive difficulties. Logistic regression was used to examine which tests accounted for unique variance in the decision-making process. We also conducted a survey of NHL neuropsychologists, asking them to rate the usefulness of each test in the battery. Five of the fifteen measures accounted for unique variance in team neuropsychologists' decisions, including the ImPACT Verbal Memory Composite, Visual Motor Composite, Reaction Time Composite, Symptom Score, and Brief Visuospatial Memory Test-Revised Delayed Recall. Notable discrepancies were uncovered between quantitative indications of usefulness and self-reported qualitative perceptions of test usefulness when making decisions. Qualitatively, clinicians reported that the Hopkins Verbal Learning Test-Revised, Symbol Digit Modalities Test, ImPACT Reaction Time, and Color Trails 2 were the most useful tests when making decisions. Along with validation studies, decision analysis can be used as part of a comprehensive evaluation process to inform the development of best-practice batteries for use among athletes with sports concussion.

The lived experience of sport-related concussion: A collaborative inquiry in elite sport

Sport-related concussion(s) (SRCs) pose a complex problem to researchers and practitioners alike. The psychological and emotional experience of these injuries requires individualized and multidisciplinary intervention to promote wellbeing and effective recovery. These interventions require a thorough understanding of the SRC experience. Thus, collaborative inquiry, a novel approach in the SRC domain, was employed to give athletes a voice in how their experience is portrayed and understood within the research and applied communities. Data were generated over two years through on-going discussion and reflection between the researchers and twelve elite athletes who experienced SRCs. Athletes advocated for a broader view of their injury that considers the interplay of sociocultural factors and the individual’s psychosocial experience. Mutual engagement through interviews, member reflections, focus groups, follow-up emails, and further reflective conversations generated two composite narratives. These narratives are interpreted using Bronfenbrenner’s Ecological Systems Theory to underline the interplay of factors: (1) microsystem (athletic identity), (2) mesosystem ((dis)trust in relationships), (3) exosystem (concussion protocols), (4) macrosystem (sport culture), and (5) chronosystem (timing related to major events and recovery). Through this unique combination of methodology and theory within SRC research, we aim to highlight opportunities for applied intervention, multidisciplinary collaboration, and future scientific exploration Lay summary: Elite athletes who experienced concussions collaboratively created stories which highlight the complexity of concussions. These stories and accompanying analysis are intended to help practitioners and researchers further understand some of the psychological, social, and cultural factors that contribute to injury experience and recovery. Practical Implications: This article aims to facilitate an understanding of some of the complex and interacting factors that impact an elite athlete’s experience with concussion. Through a narrative exploration of athletes’ experiences and a multi-systems theory, this article highlights potential targets for applied sport psychology and rehabilitative interventions. Specifically, psychological, social, and cultural barriers and factors are identified as potential intervention areas, all of which have been largely ignored in existing return-to-sport protocols.

Treatment Decisions in Pediatric Sports Medicine: Do Personal and Professional Bias Affect Decision-Making?

Background:Personal and professional biases can affect decision-making regarding important issues in pediatric sports medicine. Gaining insight into the opinions of health care professionals who specialize in pediatric sports medicine will provide information that may be useful for directing ongoing research in this field.Hypothesis:It was hypothesized that surgeons would demonstrate bias toward early surgical intervention versus nonsurgeons. In addition, it was hypothesized that youth sports medicine professionals who were parents of a child with a previous major sports injury or concussion would be less likely to allow their child to play American tackle football or return to football after a concussion.Study Design:Cross-sectional study.Methods:An online survey was provided to the active members of the Pediatric Research in Sports Medicine Society. We used both professional background information and responses to questions related to personal experiences with youth sports injuries to determine potential factors associated with underlying biases. Survey responses among subgroups were compared using the Fisher exact test. The Pearson correlation coefficient was used to evaluate years in practice versus opioid use.Results:Of the survey participants, 62.5% were pediatric surgeons, and 37.5% represented different nonsurgical youth sports medicine professions. Surgeons were less likely than nonsurgeons to agree to allow their child to return to football after sustaining a concussion and completing a concussion protocol (48% vs 76%, P = .013). Surgeons were more likely than nonsurgeons to agree to both elective shoulder stabilization after a first-time dislocation and elective drilling of a stable knee osteochondritis dissecans (OCD) before nonoperative treatment (41% vs 10%, P = .003 and 52% vs 23%, P = .013, respectively). Those who reported having a child with a concussion history were more likely to support him or her returning to football after a concussion (65% vs 33%, P = .026).Conclusion:Surgeons were more likely to favor elective shoulder-stabilization surgery after a first-time dislocation and drilling of a stable knee OCD instead of nonoperative management. Personal experience of having a child who sustained a major sports injury or concussion did not demonstrate a bias against participation in football or return to football after a concussion.

A-137 Role of Neuropsychology in Framing and Assisting the Development of Recovery Efforts: Education for Providers across Disciplines

Abstract Objective Information regarding differences in concussion and mild TBI recovery management protocols and recovery expectations vary across disciplines. This often leads to imprecise expectations for prognosis and adverse impacts on effective treatment and recovery. National groups and institutions provide training regarding concussion by neuropsychologists and rehabilitation psychologists to psychologists; however, broadband cross-discipline training is limited. Clinically, psychoeducation and clarification fall on Neuropsychologists and Rehabilitation psychologists. The purpose of this poster is to highlight the importance of the role of neuropsychologists in the education of concussion versus TBI recovery to support medical providers, teachers, and educators to facilitate appropriate care. Data Selection The current literature was review and obtained through the search within various databases such as PsycInfo, Google Scholar, and OhioLink. Keywords such as concussion, mild traumatic brain injury, psychoeducation, and neuropsychology were utilized to provide an inclusive review of the current research (2016–2021). Data Synthesis The focus of existing literature supports the education of concussions for patients and their families. Much of the literature supports the role of many disciplines to aid in recovery. There is limited research to support neuropsychology/Rehabilitation psychology’s efficacy to provide didactic training for providers of different fields supporting this population. Conclusion Through research, advocacy, and program development, the field of Neuropsychology and Rehabilitation psychology can utilize the holistic framework of the brain–body relationship to further facilitate the discussion of concussion and TBI recovery for providers of other disciplines serving these populations. Since treatment is multi-disciplinary for this clinical population, further programmatic evaluation provides interdisciplinary didactics to improve patient care.

Raising Concussion Awareness among Amateur Athletes: An Examination of the Centers for Disease Control and Prevention’s (CDC) Heads Up Campaign

ABSTRACT Attention to concussion prevention and management has grown in recent years due to the potentially long-term, debilitating effects a head injury can have on an individual. Although multiple campaigns have been designed to target this issue, there remains a need to evaluate the persuasive principles used to advocate for safety measures and protocols, specifically within youth sports. With this in mind, we applied the health belief model (HBM) in our content analysis of the Centers for Disease Control and Prevention’s (CDC) Heads Up concussion awareness campaign. Campaign videos (N = 35) were coded for threat severity, threat susceptibility, benefits, barriers, self-efficacy, and cues to action. The majority of videos communicated the seriousness of concussions and attempts to communicate concussion susceptibility were driven by personal stories, rather than facts and statistics demonstrating concussion prevalence. Less than half of the videos communicated the benefits of following concussion protocols and only a third of the messages described barriers to following recommended protocols. The majority of videos aimed to elevate self-efficacy among athletes and parents, but not coaches, by focusing on identifying symptoms and concussion avoidance. The implications for concussion prevention and management among athletes, parents, and coaches are discussed.

A - 11 Are Self-Reported Cognitive Symptoms an Accurate Evaluation of Cognitive Functioning?

Abstract Objective The purpose of this study was to evaluate whether self-reports of cognitive symptoms were associated with cognitive test performances. Methods The sample included 112 Canadian Football League (CFL) athletes who were diagnosed using CFL concussion protocols. All participants underwent a cognitive assessment at baseline and prior to medical clearance. The battery included the immediate post-concussion assessment and cognitive testing (ImPACT) and The Post-Concussion Symptom Checklist. Results Self-reported cognitive symptoms and cognitive test performances were evaluated using Spearman’s rank correlations (rho; ρ). There were significant negative correlations between post-concussion verbal memory composite and the self-reported cognitive symptoms total (ρ = −0.22). Similar patterns were found for visual memory composite and the self-reported cognitive symptom total (ρ = −0.19). Paired-samples t-tests were used to assess differences between pre- and post-concussion scores. Cases were omitted if there were no pre- or post-test. If multiple concussions were sustained, the first assessment was used (n = 99). There was a significant difference between the pre- and post-test results between the subjective cognitive symptom total (t = −2.034, p &amp;gt; 0.05). Conclusions These outcomes suggest that CFL athletes report significantly higher cognitive symptoms following a concussion. Additionally, the pre-test subjective measures were not correlated to objective cognitive functioning. However, post-concussion subjective measures were negatively correlated with verbal and visual memory. This suggests that self-reports were more accurate at assessing their overall functioning following a concussion.

Epidemiological analysis of injury occurrence and current prevention strategies on international amateur football level during the UEFA Regions Cup 2019

IntroductionFootball is the most popular sport worldwide and results in a high frequency of injuries. So far, mainly injuries in professional football have been investigated, and the literature lacks data regarding detailed injury epidemiology and current prevention data in amateur football tournaments.Materials and methodsA prospective cohort study investigated an international amateur football tournament, the UEFA Regions’ Cup, which took place in 2019 in Germany. Injury epidemiology, current prevention strategies of the teams and the implementation of the UEFA concussion protocol were investigated in detail by means of standardized injury definitions and data samples for football (Fuller et al., Scand J Med Sci Sports 16:83–92, https://doi.org/10.1111/j.1600-0838.2006.00528.x, 2006).Results138 player of 8 teams participated in this study, while 39 players were excluded. Overall injury incidence was 12.5 per 1000 h total football exposure, 43.5 per 1000 h for match exposure. No injuries were registered during training. Injury prevalence was 14.1% per player and 1.1 injuries per match were registered. The lower extremity was predominantly affected by injuries (71.4%) and the majority of injuries (78.6%) were non-severe injury types like contusions (50%) and sprains (18.2%). Two head injuries, one contusion and one skin lesion, were handled by the guidelines of the UEFA concussion protocol. 44.4% of the players indicated at least one previous injury before tournament, 45.3% of them during the last two football seasons before start of the tournament. Injury prevention performance was included in all participating teams during the tournament by warm up or training strategies (100%). During the warm-up program just 5 exercises of the FIFA 11 + program was detected by this investigation in participating teams to be done by more half of the teams. Running exercises were the most frequently performed exercises, while trunk muscle exercises were less represented (14.3%).ConclusionThis study presents for the first time epidemiological injury and prevention data of the UEFA Regions Cup. Injury incidence was higher compared to injury reports of regular seasons, but lower compared to other amateur football tournaments. Currently used prevention programs revealed trunk muscle exercises as often neglected.

Heads Up Play: Acute Assessment and Management of Basketball-Related Craniofacial Injuries by On-Court Personnel.

With a following of over 825 million people, basketball currently ranks amongst the world's most popular sports. Despite a number of concussion awareness and player safety protocols that have been implemented at the professional level of organized play, a standardized, layperson-friendly algorithm for the acute management of basketball-related craniofacial injuries does not appear to presently exist. This 10-year retrospective cohort study was conducted using the National Electronic Injury Surveillance System database to examine basketball-related craniofacial injuries from 2010 to 2019. Within the National Electronic Injury Surveillance System dataset, factors including patient age, gender, diagnosis, injury type, and injury location were included in our analysis. Overall, 22,529 basketball-related craniofacial injuries occurred between 2010 and 2019 in players ages 5 to 49 years old. Adolescent (12-18-year-old) and young adult (19-34-year-old) age groups had the highest incidence of craniofacial injuries. The adolescent cohort experienced a significantly greater proportion of concussions and lower proportion of both facial lacerations and fractures compared with the within group null hypothesis of equal proportions (P < 0.05). The young adult cohort experienced a significantly greater proportion of facial lacerations and fractures and lower proportion of concussions, contusions/abrasions, hematomas, and internal injuries compared to this cohort's null hypothesis (P < 0.05). Males experienced a significantly greater proportion of fractures, lacerations, and dental injuries and lower proportion of concussions, contusions/abrasions, and internal injuries compared to the hypothesized equality of proportions (P < 0.05). Females experienced a significantly greater proportion of concussions, contusions/abrasions, and internal injuries and lower proportion of fractures, lacerations, and dental injuries compared to the hypothesized equality of proportions (P < 0.05). Although several steps have already been taken at the professional level to try to promote player safety, particularly with concussion protocols and prevention of lower extremity injuries, there remains a paucity of resources to guide management of other types of acute craniofacial injury. The role of layperson-friendly educational interventions remains intriguing as a potential means of improving outcomes regardless of socioeconomic status or health literacy. Additional studies still need to be completed to determine efficacy and best future direction.