Incidence Of Sports-related Concussions Research Articles

Avenues for prevention using the epidemiology of sport-related concussion from a large high school surveillance study.

Epidemiology provides fundamental opportunities to protect student-athlete health. The goal of this study was to describe the epidemiology of sport-related concussion (SRC) across 8 years (2015/2016-2022/2023) and compare boys' and girls' sports for SRC incidence and SRC mechanisms. This was a retrospective cohort study performed using a statewide high school head injury surveillance system of high school student-athletes (n = 2,182,128; boys, n = 1,267,389; girls, n = 914,739). Exposures of interest included study year and boys and girls in comparable sports. Clinical incidence was calculated by dividing SRC counts in each sport by the number of participants per 100 player-seasons and presented with 95% CIs. The 2019/2020 and 2020/2021 data were included in the analysis, however caution is warranted due to the COVID-19 pandemic. Clinical incidence ratios (CIRs) were estimated for sex-comparable sports, and significance was determined if 95% CIs excluded 1.00. The authors compared mechanism of injury in boys' and girls' comparable sports with chi-square analyses (p < 0.05). Among 25,482 total SRCs, the overall clinical incidence of SRC for all boys and girls was 1.17 (95% CI 1.15-1.18) per 100 player-seasons across all years. Across all years, the overall clinical incidence in boys' sports was 1.34 (95% CI 1.32-1.36) per 100 player-seasons, and 0.93 (95% CI 0.91-0.95) per 100 player-seasons in girls' sports. Boys' sports with the highest clinical incidence included football, ice hockey, and wrestling. Girls' sports with the highest clinical incidence included basketball, soccer, lacrosse, competitive cheer, and gymnastics. Girls consistently had higher SRC rates relative to boys for baseball/softball, basketball, and soccer (CIR range 1.65 [95% CI 1.41-1.93] to 3.32 [95% CI 2.67-4.16]). Girls had lower SRC in lacrosse in 2015/2016 (CIR 0.63, 95% CI 0.40-0.97); no difference in 2016/2017-2020/2021, but had higher clinical incidence in 2021/2022 (CIR 1.69, 95% CI 1.18-2.44) relative to boys. In boys the most common mechanism of SRC occurred from person-to-person contact (n = 8752, 62.8%), whereas girls commonly sustained SRC from person-to-object contact (n = 2369, 33.4%) and from person-to-person contact (n = 2368, 33.4%). There were significant associations between boys' versus girls' sports and mechanism of injury within baseball/softball (χ2 = 12.71, p = 0.005); basketball (χ2 = 36.47, p < 0.001); lacrosse (χ2 = 185.15, p < 0.001); and soccer (χ2 = 122.70, p < 0.001). These findings can help understand the potential impact of interventions aimed at preventing or reducing SRC. Including girls' sports within this study extends research for a largely underrepresented group.

Nutritional Considerations of Irish Performance Dietitians and Nutritionists in Concussion Injury Management.

Sport-related concussion incidence has increased in many team-based sports, such as rugby, Gaelic (camogie, hurling, football), and hockey. Concussion disrupts athletes' brain function, causing an "energy crisis" that requires energy and nutrient support to restore function and heal. Performance dietitians and nutritionists play a role in supporting athletes' post-injury nutritional demands. This study aimed to investigate Irish performance dietitians' and nutritionists' knowledge and implementation of nutritional strategies to manage and support athletes' recovery following concussion. In-depth, semi-structured interviews were conducted with seventeen (n = 17) Irish performance dietitians and nutritionists recruited from the Sport and Exercise Nutrition register and other sporting body networks across Ireland. Participants practised or had practised with amateur and/or professional athletes within the last ten years. All interviews and their transcripts were thematically analysed to extract relevant insights. These data provided valuable insights revealing performance dietitians and nutritionists: (1) their awareness of concussion events and (2) their use of nutritional supports for concussion management. Furthermore, the research highlighted their implementation of 'novel nutritional protocols' specifically designed to support and manage athletes' concussion recovery. There was a clear contrast between participants who had an awareness and knowledge of the importance of nutrition for brain recovery after sport-related concussion(s) and those who did not. Participants presenting with a practical understanding mentioned re-emphasising certain foods and supplements they were already recommending to athletes in the event of a concussion. Performance dietitians and nutritionists were keeping up to date with nutrition research on concussions, but limited evidence has prevented them from implementing protocols in practice. Meanwhile, participants mentioned trialling/recommending nutritional protocols, such as carbohydrate reloading, reducing omega-6 intake, and acutely supplementing creatine, omega-3 fish oils high in Docosahexaenoic acid, and probiotics to support brain healing. Performance dietitians' and nutritionists' use of nutrition protocols with athletes following concussion was linked to their knowledge and the limited scientific evidence available. Nutrition implementation, therefore, may be overlooked or implemented with uncertainty, which could negatively affect athletes' recovery following sports-related concussions.

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.

Do Climate and Environmental Characteristics Influence Concussion Incidence in Outdoor Contact Sports? A Systematic Review.

To obtain a comprehensive understanding of the implications of environmental and climate factors on sport-related concussion incidence in outdoor contact sports. MEDLINE (via Ovid), Embase (via Elsevier), CINAHL Complete (via EBSCOhost), SPORTDiscus (via EBSCOhost), and Scopus (via Elsevier). Studies that report incidence of sport-related concussion, assess data from athletes participating in outdoor contact sports, report on 1 or more climate or environmental factors, and report a diagnosis of concussion performed by a licensed medical professional were included. Reasons for exclusion included no report on extrinsic or environmental factors, no data on sport-related concussion incidence, and self-report of concussion diagnosis. This systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using 2 reviewers at each phase and a third reviewer for conflict resolution. A total of 7558 articles were reviewed, and 20 met the inclusion criteria. There was moderate to strong strength of evidence concluding no difference between surface type (grass versus artificial) on sport-related concussion risk. Moderate to strong strength of evidence was found supporting no difference in sport-related concussion incidence based on game location (home versus away). There was no consensus on the effects of altitude or temperature on sport-related concussion incidence. One high-quality study found a decreased risk of sport-related concussion when playing in wet versus dry conditions. Heterogenous populations and data collection methods prevented extraction and meta-analysis. Although a consensus on specific environmental and climate factors that influence sport-related concussion incidence was limited, the majority of studies were of high quality and gave insight into opportunities for future investigation. Administrators of large injury surveillance databases should consider including specific environmental and climate factors to provide investigators with robust data sets to better understand potential associations with sport-related concussion.

A comparison of clinical assessment with common diagnostic tools for monitoring concussion recovery in adolescent rugby union players

ObjectivesTo characterise the incidence, severity and recovery of sport-related concussion (SRC) in schoolboy rugby players and explore whether the Sports Concussion Assessment Tool (SCAT), Cogstate Brief Battery (CBB) and the King-Devick test (K-D test) can be used to monitor concussion status through to full recovery. DesignProspective cohort study. SettingRugby union has a high rate of SRC; however, there is little research investigating how concussion affects adolescent rugby players. ParticipantsSchoolboy rugby players. Main outcome measuresParticipants completed baseline tests in the preseason. Participants diagnosed with SRC during the season attended for post-concussion testing on a weekly basis until recovered. Results135 schoolboy rugby players (16.7 ± 0.82y) participated in the study. There were 18 SRCs in 16 participants. Concussion incidence was 9/1000 player hours. CBB and K-D tests were poorly associated with clinical assessment and produced high false negative rates (0.58 and 0.52 respectively). ConclusionsThis study reports a relatively high match SRC incidence for an adolescent population. Analysis of clinical recovery with CBB and K-D test revealed a relatively poor ability to accurately monitor concussion status compared to clinical assessment suggesting that these tools should not be used in isolation for monitoring SRC recovery in adolescents.

Sport-Related Concussion: A Cognitive Perspective.

The incidence of sport-related concussion (SRC) has been increasing in different sports and its impact on long-term cognitive function is increasingly recognized. In this study, we review the epidemiology, neuropathophysiology, clinical symptoms, and long-term consequences of SRC with a specific focus on cognition. Repeated concussions are associated with an increased risk of several neurologic diseases and long-term cognitive deficits. To improve cognitive outcomes in athletes with SRC, standardized guidelines for the assessment and management of SRC are vital. However, current concussion management guidelines lack procedures for rehabilitating acute and long-term cognitive symptoms. Increased awareness for the management and rehabilitation of cognitive symptoms in SRC is needed in all clinical neurologists treating professional and amateur athletes. We propose cognitive training as a prehabilitation tool to alleviate the severity of cognitive symptoms and as a rehabilitative tool to improve cognitive recovery postinjury.

Tackling sport-related concussion: effectiveness of lowering the maximum legal height of the tackle in amateur male rugby – a cross-sectional analytical study

ObjectiveRugby union (‘rugby’) is popular globally, with most of its participants being amateur. Concern regarding sport-related concussion (SRC) sustained during rugby is increasing. SRC occurs most frequently in the tackle,...

Headgear does not prevent sport-related concussion: a systematic review and meta-analysis of randomized controlled trials

Introduction: Sport-Related Concussion (SRC) is caused by a strong impact to the head that leads to neurological symptoms. Within the sporting community it is a widely held belief that Headgear (HG) protects against SRC leading some Australian football, soccer, and rugby clubs to mandate its use. The aim of this study was to evaluate the effectiveness of HG in reducing the incidence of SRC among athletes.

Impact of Playing Surface on Concussion Symptoms in Young American Football Players

To identify differences in symptoms following sports-related concussion (SRC) on natural grass vs artificial turf in youth and adolescent football players. There is continued interest in reducing risk of SRC in football, with playing surface being one potentially modifiable factor. It is estimated that 15-30% of concussions result from helmet-to-ground contact, and some studies have suggested a higher incidence of SRC on grass in competitive contact sports compared to turf. To our knowledge, our study is the first to investigate reported post-concussive symptoms after SRC as they relate to playing surface. Data were prospectively collected from the North Texas Concussion Registry (ConTex), a longitudinal multi-institutional concussion database. We selected male football players between the ages of 10 and 24 who sustained a helmet-to-ground SRC (GCS 13-15) on either grass or turf. Pre-injury information and post-concussive symptoms (Graded Symptom Checklist from the SCAT-5) were collected at an initial in-person visit within 2 weeks of injury and via electronic follow up at 3 months. Fifty-eight participants were included (grass = 32, turf = 26), and groups were similar in age (p = 0.089), time since injury (p = 0.500), history of headache (χ2 = 0.167), and prior history of concussion (χ2 = 0.868). Athletes who sustained SRC on grass reported significantly higher scores on the Graded Symptom Checklist (p = 0.018, mean 26.0 vs 11.4) and higher numbers of distinct symptoms (p = 0.013, mean 10.2 vs 5.5) compared to those who sustained SRC on turf. Symptoms that were rated significantly higher after SRC on grass included headache (p = 0.010), phonophobia (p = 0.014), dizziness (p = 0.001), fatigue (p = 0.021), blurred vision (p = 0.001), feeling "in a fog" (p = 0.014), difficulty remembering (p = 0.004), and feeling emotional (p = 0.041). Youth and adolescent football players who sustain SRC on grass report higher post-concussive symptom severity and burden. Elucidating differential effects of SRC on grass vs turf is important, as competitive playing surface is a modifiable risk factor.

Epidemiology of Concussions in National Collegiate Athletic Association (NCAA) Sports: 2014/15-2018/19

Background: Updated epidemiology studies examining sports-related concussions (SRCs) are critical in evaluating recent efforts aimed at reducing the incidence of SRCs in National Collegiate Athletic Association (NCAA) sports. Purpose: To describe the epidemiology of SRCs in 23 NCAA sports during the 2014/15-2018/19 academic years. Study Design: Descriptive epidemiology study. Methods: SRC and exposure data collected in the NCAA Injury Surveillance Program were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics by sport, event type (practices, competitions), injury mechanism (player contact, surface contact, equipment/apparatus contact), and injury history (new, recurrent). Injury rate ratios (IRRs) were used to examine differential injury rates, and injury proportion ratios (IPRs) were used to examine differential distributions. Results: A total of 3497 SRCs from 8,474,400 athlete-exposures (AEs) were reported during the study period (4.13 per 10,000 AEs); the competition-related SRC rate was higher than was the practice-related SRC rate (IRR, 4.12; 95% CI, 3.86-4.41). The highest SRC rates were observed in men’s ice hockey (7.35 per 10,000 AEs) and women’s soccer (7.15 per 10,000 AEs); rates in women’s soccer and volleyball increased during 2015/16-2018/19. Player contact was the most prevalently reported mechanism in men’s sports (77.0%), whereas equipment/apparatus contact was the most prevalently reported mechanism in women’s sports (39.2%). Sex-related differences were observed in soccer, basketball, softball/baseball, and swimming and diving. Most SRCs reported in men’s sports (84.3%) and women’s sports (81.1%) were reported as new injuries. Conclusion: Given the increasing SRC rates observed in women’s soccer and volleyball during the latter years of the study, these results indicate the need to direct further attention toward trajectories of SRC incidence in these sports. The prevalence of equipment/apparatus contact SRCs in women’s sports also suggests that SRC mechanisms in women’s sports warrant further investigation. As most SRCs during the study period were reported as new injuries, the prevalence of recurrent SRCs in men’s and women’s ice hockey is also noteworthy.

Headgear in prevention of sports related concussion- A literature review across various sports

Sports related concussion (SRC) remains a challenge for sports physicians to identify because of varied presentation and lack of diagnostic tool. Keeping in mind its long term effect various sports bodies introduced different preventive strategies to reduce incidence of SRC. Commercial headgear is currently being used by players of all ages and skill levels in certain sports to protect themselves from heading and direct impact, even though the protective effect on concussion has not been conclusively demonstrated and limited research has been done. Electronic databases and grey literatures were used to search the evidence using Medical Subject Headings sports headgear, concussion, helmet, cricket, soccer, American Football, boxing for the available research studies from 1990 up to April 2020. The wide variety of prospective surveillance as well as lab studies made the case even more confusing as the simulation model may not actually replicate the on field scenario. Moreover the type and component of the headgear need to be subjected based on sports specific demand. Hence this literature review is aimed at available evidences in different sports to find any consensus between use of headgear and prevention of SRC.

Incidence of sports-related concussion in elite para athletes – a 52-week prospective study

ABSTRACT Objective: To assess the 52-week incidence proportion and incidence rate of sports-related concussion (SRC) among elite Para athletes, and to analyze the injury mechanisms. Method: In total, 70 male and 37 female Swedish elite Para athletes (median age 29 years) with vision, physical and intellectual impairment, weekly self-reported sports-related injuries including concussion in an eHealth application adapted to Para athletes. Descriptive statistics were used to assess the incidence rate and incidence proportion. Chi-square statistics were used to analyze differences in the proportion of SRC. Results: A total of 13 SRC were reported: three athletes each sustained two SRC. The incidence proportion was 9.3% (95% CI 4.8–16.7), and the incidence rate 0.5 SRC/1000 hours (95% CI 0.3–0.9) of sports exposure. Athletes with vision impairment and female athletes reported a significantly higher proportion of SRC. A majority of the injuries (n = 9; 69%) occurred during sport-specific training. The injury mechanisms were collision with object (n = 7; 54%), collision with person (n = 4; 31%), and poor playing field conditions (n = 2; 16%). Conclusion: The incidence of concussion among elite Paralympic athletes is comparable to sports for able-bodied athletes. Athletes with vision impairment and female athletes reported a significantly higher incidence of SRC, and collisions were the most common injury mechanism. These results can form the basis for future preventive research studies.

Sensation-Seeking and Impulsivity in Athletes with Sport-Related Concussion.

Sport-related concussion (SRC) is a significant public health problem. Understanding the behavioral and personal factors that influence risk and incidence of SRC is critically important for appropriate care and management. Sensation-seeking and impulsivity have been posited to be two such factors that may be significantly associated with SRC. We performed a focused review of recent evidence of the relationships between sensation-seeking and impulsivity in athletes with SRC. While the research is relatively limited, extant findings demonstrate a significant relationship between sensation-seeking and contact sport participation and risk of prior and future SRC. Impulsivity appears to be common among athletes competing in high contact sports and may contribute to neural and functional brain changes following SRC; however, causal relationships between impulsivity, contact sport participation, and SRC have not been demonstrated. Both sensation-seeking and impulsivity are significantly associated with SRC in collegiate athletes. Interventions designed to ameliorate high levels of these constructs may prove to be beneficial avenues to reducing SRC risk and improving patient care and outcomes.

Clinical Recovery Timelines After Sport-Related Concussion in Men's and Women's Collegiate Sports.

Researchers have identified sex differences in sport-related concussion incidence and recovery time; however, few have examined sex differences in specific recovery trajectories: time to symptom resolution, return to academics, and return to athletic activity across collegiate sports. To examine sex differences in sport-related concussion recovery trajectories across a number of club and varsity sports with different levels of contact. Descriptive epidemiology study. Collegiate varsity and club sports. Sport-related concussions sustained by student-athletes (n = 1974; women = 38.8%) participating in Ivy League sports were monitored between 2013-2014 and 2018-2019. Athletic trainers collected concussive injury and recovery characteristics as part of the Ivy League-Big Ten Epidemiology of Concussion Study's surveillance system. Time to symptom resolution, return to academics, and return to limited and full sport participation were collected. Survival analyses determined the time from injury to each recovery outcome for male and female athletes by sport. Peto tests were used to compare recovery outcomes between men's and women's sports and by sport. The median (interquartile range [IQR]) was 9 days (IQR = 4-18 days) for time to symptom resolution overall, 8 days (IQR = 3-15 days) for return to academics, 12 days (IQR = 8-23 days) for return to limited sport participation, and 16 days (IQR = 10-29 days) for return to full sport participation. We observed differences overall between sexes for median time to symptom resolution (men = 8 days [IQR = 4-17 days], women = 9 days [IQR = 5-20 days]; P = .03) and return to academics (men = 7 days [IQR = 3-14 days], women = 9 days [IQR = 4-17 days]; P < .001) but not for median time to return to athletics (limited sport participation: P = .12, full sport participation: P = .58). Within-sport comparisons showed that women's lacrosse athletes had longer symptom resolution (P = .03) and return to academics (P = .04) compared with men's lacrosse athletes, whereas men's volleyball athletes took longer to return to limited (P = .02) and full (P = .049) sport participation than women's volleyball athletes. Recovery timelines between sexes were different. Athletes in women's sports experienced longer symptom durations and time to return to academics compared with men's sports, but athletes in men's and women's sports presented similar timelines for return to athletics.

Wrestling-related concussions and closed head injuries predominantly occur in high school age athletes.

Sports-related concussions (SRC) and closed head injuries (CHI) have recently garnered national attention given mounting concern for long-term neurological sequelae resulting from repetitive head trauma. Despite historically dangerous techniques in wrestling that involve impacts to the head, there is a paucity of epidemiologic data in regard to wrestling-related concussions (WRCs) in the United States (USA). The National Electronic Injury Surveillance System (NEISS) database was queried (2000-2018) to report national estimates and demographic characteristics of patients 6-25 years of age presenting to US emergency departments (EDs) with WRCs and CHIs. The average annual number of patients presenting to US EDs with WRCs or CHIs was 3465 (95% confidence interval [CI]: 2489-4441). Over one-third of patients were between 15 (17.7%; 95% CI: 15.8%-19.7%) and 16 (17.0%; 95% CI: 14.9%-19.1%) years of age, which comprised the peak age groups during which such head injuries were sustained. The vast majority of patients were male (96.3%; 95% CI: 94.8%-97.7%). Lastly, 6.2% (95% CI: 4.3-8.2%) of patients did not present to the ED on the same day that the injury was sustained. Due to the unique nature and culture of the sport, wrestlers may be more likely to attribute SRC or CHI symptoms to normal training-related fatigue, which can lead to underreporting or delayed diagnosis. It is therefore imperative that appropriate safety initiatives and concussion awareness campaigns be implemented in youth wrestling to decrease the incidence of SRCs at local and national levels.

Association between Sports-Related Concussion and Mouthguard Use among College Sports Players: A Case-Control Study Based on Propensity Score Matching.

Sports-related concussion (SRC) is a major public health concern. This study aimed to assess the association between mouthguard use and the incidence of SRC in college students through a case-control study using propensity score matching. In total, 195 of 2185 potential participants volunteered to participate in this study. We used Google Forms online to capture participants’ information, including: age; gender; height; weight; sports contact level; level of play; exposure time; frequency of mouthguard use; mouthguard type; and SRC experience. Data for 115 participants who played collision and contact sports were used for the analysis. The difference in the frequency of mouthguard use was assessed between matched pairs and the overall association between SRC and mouthguard use was evaluated. In the matched groups, those who had not experienced SRC wore a mouthguard more frequently than those who had experienced SRC (7/28 vs. 1/28; p = 0.051). Logistic regression analysis showed there was a significant negative association between the frequency of mouthguard use and the incidence of SRC (odds ratio 0.101; p = 0.041). Within the limitations of this study, these results suggest that mouthguard use may offer some benefit in preventing SRC.

A PROSPECTIVE STUDY ON THE INCIDENCE, MECHANISMS AND RISK FACTORS FOR SPORT RELATED CONCUSSIONS IN HIGH SCHOOL SOCCER PLAYERS

Background:There is a growing concern regarding the incidence of Sport Related Concussion (SRC) in high school soccer players. However, there is limited prospective data regarding the incidence, mechanism and risk factors for SRCs for this population.Hypothesis / Purpose:To prospectively document the incidence, mechanisms and risk factors for SRCs sustained by high school soccer players.Methods:High school soccer players from 32 high schools were invited to participate during academic years 2015/16 and 2016/17. Subjects completed a demographic form including their history of previous SRC and preseason PCSS symptom and severity scores from the SCAT3. Licensed Athletic trainers (ATs) and coaches recorded all (practice or competition) soccer exposures (SE). ATs reported the onset, mechanism, symptom resolution and days lost for each SRC sustained during the study. Descriptive statistics were calculated to describe the study population while Cox Proportional Hazards Ratios (HR: [95%], p-value) were used to compare the incidence of SRC among the baseline characteristics.Results:thousand eight hundred eighty-one subjects (Female = 62.8%, Age = 15.7+1.2 yrs.) participated in 96,947 SE (34.3% competition) during the study duration. Two hundred seventy subjects (14.4%) reported one, while 60 (3.2%) reported two previous SRCs. The median (IQR) preseason PCSS symptom score was 0.0 [0,3] while the severity score was 0.0 [0,4]. Eighty (4.3%) subjects sustained a SRC (0.825/1000 SE) during the study time period and reported a median PCSS symptom score of 10.0 [5.0,15.0] and PCSS severity score of 21.0 [14.0,41.0]. Concussion-related symptoms were reported for 6.0 [4.0,10.0] days and 13.0 [9.3, 20.0] soccer days were missed. SRCs occurred most often during competition (78.8%) and as the result of contact with another player (41.3%), the ball (35.0%) or playing surface (20.0%).Females were more likely to sustain a SRC than males (HR: 3.78 [2.00-7.14], p<0.001). Compared to subjects without a previous SRC, the rate was higher for subjects with one (HR: 2.70 (1.65-4.42), p<0.001) and two (HR: 3.71 (1.68-8.19), p=0.001) previous SRCs. Subjects with a preseason PCSS symptom and PCSS severity score > 0 had a higher rate of SRC (HR: 1.71 [1.10-2.65], p=0.017) than players who did not.Conclusions:This study provides details regarding the incidence, mechanisms and risk factors for SRCs in high school soccer players. Females, players with a previous history of SRC or those reporting a preseason PCSS symptom and severity score >0 were more likely to sustain a SRC playing soccer.

TRENDS IN US HIGH SCHOOL AND CLUB CHEER PRACTICE CONCUSSION REPORTING FROM 2012-2017

Background:Sport-related concussion (SRC) is one of the leading injuries among the 3.24 to 4.03 million athletes participating in cheerleading from 2012-2017. The purpose of this study was to provide a descriptive epidemiology of SRC in the school and club cheerleading practice setting from the 2012 to 2017 calendar years.Methods:Female cheerleading athletes, ages 12 to 18 participating in school or club cheer from 2012 to 2017 were included in the current study. Injury and exposure data from school and club cheerleading practices from the Rank One Health Injury Surveillance Database (ROH ISD) were analyzed. SRC counts, percentages, rates per 10,000 athletic exposures (AEs), rate ratios (RRs), and injury proportion ratios (IPRs) were reported with 95% confidence intervals (CIs). Any RR or IPR with a 95% CI not containing 1.0 were considered statistically significant.Results:From 2012-2017, 951 SRCs were recorded from a sample of 51,812 females participating in school cheerleading and 12,643 females participating in club cheerleading. Cheerleading SRCs accounted for 0.40% of all injuries in sports from 2012-2017. The total SRC rate in school cheerleading was 6.02/10,000 AEs (95% CI = 5.87, 6.17). The total SRC rate in club cheerleading was 11.98/10,000 AEs (95% CI = 11.74, 12.22). The SRC rate was higher in club practices than in school practices (RR = 1.99; 95% CI = 1.89, 2.09). More SRCs occurred at school cheerleading practices (65.62%) than club practices (34.48%). The proportion of SRCs from falls onto hardwood surfaces was higher in club cheerleading practices than school cheerleading practices (IPR = 1.69; 95% CI = 1.61, 1.77) while the proportion of falls onto padded surfaces was higher in school cheerleading practices than club cheerleading practices (IPR = 2.26; 95% CI = 2.18, 2.34).Conclusions:The findings from this study provide the largest SRC incidence rates for school and club cheerleading practices to date and reveal evidence of differences in the club and school practice settings. Club cheerleading practice SRCs occurred at a higher rate than school cheerleading practice SRCs and appear to be significantly reduced by practicing on padded surfaces. These findings should be considered when educating cheerleading coaches, parents, and athletes regrading concussion injury risks as well as identifying potential areas of injury prevention. Further research is warranted to identify potential causes for injury trends observed in the current study.

Video Analysis of Concussion Exposures in a National Collegiate Athletic Association Division I Football Team.

Background:Research into improving player safety of sport-related concussion (SRC) in American football has been an ongoing endeavor. In an attempt to better understand the incidence of SRCs in American football, research has focused on the characteristics of SRC during gameplay. Determining SRC specifics and assessing them quantitatively can help identify high-risk scenarios and predict exposure risk.Purpose:To identify and assess the incidence of SRCs in a National Collegiate Athletic Association football team by comparing field location, player positions, collision partners, and player cues.Study Design:Descriptive epidemiology study.Methods:We used physician sideline reports of diagnosed concussions from a Division I football team from September 2010 to December 2018. Game videos were analyzed to identify the field location where the SRC occurred, collision partner, and player behavior postconcussion. The incidence of in-game SRCs by position was also assessed. We used the “words of estimative probability” model to categorize each concussion as certain, almost certain, probable, or even on the basis of our confidence in identifying them using game film.Results:This study examined 44 SRCs that occurred over 9 seasons. The SRC incidence was significantly higher in the middle defense (5-20 yards from the line of scrimmage) compared with all other field locations (relative risk, 2.46; 95% CI, 1.14-5.29; P < .05). In-game collision partners were most commonly defensive backs. The most common player cue was a hand to helmet/face mask. The positions with the highest SRC incidence by athlete-exposure, game position, and position play belonged to the defensive backs, wide receivers, and running backs.Conclusion:The middle defense had a significantly higher incidence of SRCs than all other field locations. We pose a new method to categorize concussions during video analysis by using words of estimative probability. Knowledge of SRC gameplay characteristics can potentially guide the medical staff and medical observer to better identify them.

The Influence of Psychological Factors on the Incidence and Severity of Sports-Related Concussions: A Systematic Review

Background: An athlete’s preexisting psychological factors may influence the incidence and/or severity of sports-related concussions (SRCs). Purpose: To determine if emotional states, personality traits, temperament, life stressors, and explanatory styles (optimism vs pessimism) influence the incidence and severity of SRCs in athletes. Study Design: Systematic review. Methods: A systematic literature search of multiple major medical reference databases was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included that evaluated the effect of preexisting psychological factors on the incidence and severity of SRCs in male and female athletes participating in all sports. Results: The initial search identified 1195 articles. Ten studies met our inclusion criteria and were included in our analysis. Factors such as meanness, aggression, and psychoticism were associated with an increased incidence of SRCs. Baseline traits of irritability, sadness, nervousness, and depressive symptoms were associated with worse symptomatology after SRCs. In young athletes, preexisting psychiatric illnesses, family history of psychiatric illness, and significant life stressors were associated with an increased risk of developing postconcussion syndrome after SRCs. Conclusion: This systematic review demonstrated a potential relationship between an athlete’s preexisting psychological factors and the incidence and severity of SRCs. These associations are not entirely clear owing to the heterogeneity across included studies and the low-to-moderate certainty of evidence. Future studies should attempt to evaluate men and women independently, use well-validated psychological questionnaires, and limit the usage of self-reported SRCs, when possible. Furthermore, the potential efficacy of baseline psychological factor and/or symptom reports on the prevention and management of SRCs should be explored.