Concussion Management Research Articles

Precision Concussion Management: Approaches to Quantifying Head Injury Severity and Recovery.

Mitigating the substantial public health impact of concussion is a particularly difficult challenge. This is partly because concussion is a highly prevalent condition, and diagnosis is predominantly symptom-based. Much of contemporary concussion management relies on symptom interpretation and accurate reporting by patients. These types of reports may be influenced by a variety of factors for each individual, such as preexisting mental health conditions, headache disorders, and sleep conditions, among other factors. This can all be contributory to non-specific and potentially misleading clinical manifestations in the aftermath of a concussion. This review aimed to conduct an examination of the existing literature on emerging approaches for objectively evaluating potential concussion, as well as to highlight current gaps in understanding where further research is necessary. Objective assessments of visual and ocular motor concussion symptoms, specialized imaging techniques, and tissue-based concentrations of specific biomarkers have all shown promise for specifically characterizing diffuse brain injuries, and will be important to the future of concussion diagnosis and management. The consolidation of these approaches into a comprehensive examination progression will be the next horizon for increased precision in concussion diagnosis and treatment.

Racial identity and concussion diagnosis and recovery trajectories in collegiate athletes: a LIMBIC MATARS investigation

ABSTRACT Objective To determine if there were concussion diagnosis and recovery disparities between collegiate athletes with Black and White racial identities. Design Retrospective cohort study. Methods Concussion information was extracted from NCAA athlete medical files at LIMBIC MATARS member institutions from the 2015–16’ to 2019–20’ academic years. A total of 410 concussions from 9 institutions were included that provided all independent (i.e. racial identity of Black or White) and dependent variable information (i.e. dates of injury, diagnosis, symptom resolution, and return to sport) that were analyzed using Mann-Whitney U tests. The sample consisted of 114 (27.8%) concussions sustained by Black athletes and 296 (72.1%) sustained by White athletes. Results The overall sample had a median of 0 days between injury occurrence to diagnosis, 7 days to symptom resolution, and 12 days to return to sport. No significant timing differences were observed for concussion diagnosis (p = .14), symptom resolution (p = .39), or return to sport (p = 0.58) between collegiate athletes with Black versus White racial identities. Conclusions These findings may reflect equitable access to onsite sports medicine healthcare resources that facilitate concussion management in the collegiate sport setting. Future work should explore these associations with a larger and more diverse sample of collegiate athletes.

Management of sports-related concussion in the emergency department.

Sports-related concussion is a common presentation to the emergency department, with increasing evidence of short and long-term morbidity. The heterogeneity of symptoms and clinical outcomes, alongside a lack of familiarity with current guidance, can present significant challenges to clinicians. This article presents an overview of the current literature concerning assessment and management of sports-related concussion in the emergency department and outlines a framework for graduated return to activity as based upon the current national guidance.

Sports-based Autonomic Nervous System (ans) Functions: Clinical Baseline For Sport Related Concussion (src) Management.

Sports-based Autonomic Nervous System (ans) Functions: Clinical Baseline For Sport Related Concussion (src) Management.

Optometric Management of Concussion in Canadian Private Practice

Purpose The purpose of this study was to determine the current prescribing and assessment practices of optometrists in Canada seeing patients with persistent concussion-associated vision deficits. Methods A 6-question electronic survey was distributed to provincial and national boards of optometry in Canada. Questions pertaining to vision assessment, prescribing habits, daily living advice, appointment duration and follow-up appointment(s) were included. Practicing optometrists in Canada who have or have not managed concussion patients were eligible to complete the survey. Analysis consisted of categorizing and analyzing the frequency of responses provided. Results A total of 199 responses were received of which there were 142 completed responses (including 1 blank response). Of these, 13 optometrists indicated that they did not manage concussion. Of the 128 optometrists who indicated that they managed concussion 98% did a full eye exam. Visual acuity was assessed 96% of the time. Other frequent assessments were dry refraction 91%, pupil dilation 80%, and full binocular vision assessments 78%. Most respondents, 116, indicated that they provided advice on daily living activity and the most frequent advice was to limit activity, 64% (74/116). Responses were offered by 121 optometrists on appointment duration. Most frequently optometrists stated concussion appointments lasted between 30-60 minutes (69/121). Responses on follow-up were given by 119 optometrists and the most frequent follow-up was 1-2 months (27/119). Conclusion The results from this study provide insight on how optometrists in private practice are managing vision deficits following concussion. Further research on treatment effectiveness is required to develop an optometric protocol for the management of vision in patients with persistent concussion symptoms.

Concussion in facial trauma patients: a retrospective analysis of 100 patients from a UK major trauma centre

Concussion is a common and potentially debilitating condition. Research has shown that one-third of patients admitted with facial trauma have concurrent concussion. This study aimed to investigate the burden and management of concussion in patients presenting with acute facial trauma, and to identify potential risk factors within this population. A retrospective observational study was conducted at a UK major trauma centre between 1 January 2019 and 1 February2020. One hundred randomly selected patients who attended the acute clinic responsible for managing facial trauma were identified. No parametric data were included. The Mann-Whitney test was used to detect differences for continuous data, the X2 test for categorical data. Clinical significance was defined as p < 0.05. Forty of 100 patients (40%) had evidence of concussion, of which only 4/40 (10%) had evidence that head injury advice had been given. There was no statistically significant difference between the non-concussed and concussed groups for age (p = 0.145), gender (p = 0.921), mechanism of injury (p = 0.158), or location of facial injury (p = 0.451). Clinical features of concussion were found in 40% of patients suffering from facial injury. Despite this, we found that head injury advice was rarely given. In addition, we identified no risk factors for concussion within this population, highlighting the need to screen all patients who present with facial injury. To improve the identification and management of concussion in these patients, future work should focus on the development of simple screening tools for use in clinic, and the signposting of patients to existing written and online concussion resources.

Evaluation and Management of Blunt Head Trauma in the Pediatric Clinic.

Head injuries, and specifically blunt head trauma, are common among pediatric patients of all ages. Patients may present to their primary care provider, to urgent care, or to the emergency department after head trauma. Such injuries may occur as a result of a variety of mechanisms, including falls, motor vehicle collisions, or sports injuries. Clinical decision rules exist to help guide the clinician in the initial evaluation of head injury and in determining when head imaging may be indicated. One such guideline that is widely used in the United States is known as the PECARN (Pediatric Emergency Care Applied Research Network) criteria. Pediatricians should also evaluate for the presence of symptoms consistent with concussion that may occur as a result of blunt head trauma and be familiar with the management and sequelae of concussion and head injuries. [Pediatr Ann. 2023;52(8):e279-e281.].

“Alone in the dark”: A qualitative study of treatment experiences among young adults with a recent concussion and anxiety

ABSTRACT Purpose Young adults with anxiety are vulnerable to developing persistent symptoms following concussions. In order to develop psychosocial interventions to prevent persistent post-concussion symptoms, we need to understand patients’ 1) experiences with treatments offered by health care providers; 2) experiences with attempted concussion management strategies; and 3) needs after their injury. Methods We conducted in-depth interviews with 17 young adults with recent (≤ 10 weeks) concussions who have at least mild anxiety (Generalized Anxiety Disorder Assessment-7 ≥ 5). We used a hybrid deductive-inductive approach to thematic analysis. Results Findings provide insight into recommended treatments (e.g., active/avoidant strategies, accommodations, referrals), attempted strategies (e.g., lifestyle changes, pacing, relationships, acceptance-based coping skills), and patient needs (e.g., education, accommodations, referrals for cognitive and emotional skills). Participants frequently expressed that treatment recommendations were confusing and difficult to implement. They initiated non-prescribed strategies that helped promote recovery and expressed a desire for more interdisciplinary treatment and education on concussions. Conclusion Patients’ perceptions of health care provider recommendations after concussions did not fully meet patients’ perceived needs. Young adults with concussions and anxiety would benefit from more education, guidance, and psychosocial and rehabilitation services. Addressing these gaps may help align treatments with patients’ needs and therefore help optimize their recovery.

Unravelling the web: Experiences of adolescents returning to school following a concussion

ABSTRACT One in five adolescents will sustain a concussion in their lifetime. A concussion may result in symptoms that affect an adolescent’s ability to attend school and engage in learning tasks. This study was guided by interpretivism. We conducted one-on-one semi-structured interviews to explore the perspectives of 20 adolescents (ages 14–18) returning to school after a concussion. Interviews were coded inductively and analyzed using reflexive thematic analysis. Five interconnected themes emerged with returning to school and accessing school supports: (1) concussion symptoms affected adolescents’ schoolwork; (2) access to academic accommodations eased adolescents’ return to school; (3) having supportive and understanding friends, family, and teachers facilitated adolescents’ return to school; (4) communication amongst school stakeholders was desired, but often lacking; and (5) feeling anxious, frustrated, and sad with the return to school process. Adolescents' experiences were multifaceted and many factors contributed to their return to school experiences. Our findings can inform our understanding of the experiences of adolescents returning to school following concussion and can inform the development of concussion management supports at schools.

Concussion assessment and management — What do community-level cricket participants know?

ObjectivesTo explore Australian cricket participants' knowledge of concussion assessment and management, and awareness of current concussion guidelines. DesignCross-sectional survey. MethodsNovel and validated surveys were disseminated online, among over 16 year Australian cricket players and officials at the end of the 2018/19 cricket season. Data were collected on knowledge and awareness of concussion and analysed using descriptive statistics and crosstabulations. Further comparisons were made for the players between injured and non-injured, and helmet wearers and non-helmet wearers using Fisher's exact statistical test. ResultsBoth players (n = 224, 93 %) and officials (n = 36, 100 %) demonstrated strong knowledge of the importance of immediately evaluating suspected concussions. In comparison with players without helmets (n = 11), those using helmets (n = 135) considered replacing their helmets after a concussion to be vital to concussion assessment (p = 0.02). Overall, 80–97 % of players and 81–97 % of officials understood the importance of many factors regarding concussion management. When concussion management knowledge was compared by injury status, injured players (n = 17, 94 %) believed someone with a concussion should be hospitalised immediately, in contrast to non-injured players (n = 154, 69 %) (p = 0.04). Players (63 %) were less aware of concussion guidelines than officials (81 %). ConclusionsOverall, the knowledge of concussion assessment and management was satisfactory. However, there were discrepancies among players on some aspects of awareness of concussion guidelines. Increasing players' familiarity and experience in using the concussion guidelines is warranted. Targeted campaigns are needed to further improve concussion recognition and treatment at community-level cricket, so all participants play a role in making cricket a safe sport.

Concussion Management Among National Collegiate Athletic Association Swim Programs

The nuances of swimming make the application of traditional return-to-play progressions following concussion challenging. Our purpose was to describe athletic training services and concussion management protocols among National Collegiate Athletic Association swim programs and compare them between the National Collegiate Athletic Association divisions. We surveyed 228 athletic trainers assigned to or with knowledge of their institution’s swim programs from a convenience sample of 539 (response rate = 42.3%) athletic trainers. Athletic training services were provided to 98.6% (214/217) of the programs. Nearly 80% (164/207) of the programs administered baseline concussion testing to swimmers, with differences observed between divisions (p &lt; .001). No differences (p = .108) in the number of concussions sustained by swimmers in the past academic year were noted between divisions. Specific return-to-swim protocols were reported by 51.8% (115/222) of respondents with no differences in the presence of a specific return-to-swim protocol between divisions (p = .790). While concussions are reported less frequently in swimming than other sports, appropriate medical care, including a specific return-to-swim protocol, is warranted and provided for future use.

Circadian therapy interventions for glymphatic dysfunction in concussions injuries: A narrative review.

There are two primary threats to the brain after concussion. The first is a buildup of neurotoxic proteins in the brain. The second, a partial consequence of the first, is a sustained neuroinflammatory response that may lead to central sensitization and the development of persistent post-concussive symptoms. These threats make neurotoxin clearance a high clinical priority in the acute period after injury. The glymphatic system is the brain's primary mechanism for clearing neurotoxic waste. The glymphatic system is intimately tied to the sleep cycle and circadian dynamics. However, glymphatic dysfunction and sleep disturbances are nearly ubiquitous in the acute period after concussion injury. Because of this, sleep optimization via circadian therapy is a time-sensitive and critical tool in acute concussion management.

The Impact of the COVID-19 Pandemic on Concussion Symptoms and Recovery Times in Adolescents

After the event of a concussion, patients may experience a combination of cognitive, physical, and affective symptoms that impact their daily life. Management of concussion should consider the various personal histories and external stressors that contribute to a patient’s symptom burden and recovery. The aim of this study is to quantify the impact of the COVID-19 pandemic on concussion symptoms and recovery time in a cohort of adolescents. The study is a secondary data analysis of ImPACT Concussion Test symptom scores and electronic health records from a cohort of adolescents between the ages of 12-18, pre-pandemic (January 1, 2015 - March 20, 2020) and pandemic (March 21, 2020 - April 1, 2022). Symptom prevalence of trouble falling asleep, irritability, nervousness, sadness, feeling more emotional, headache, nausea, balance problems, dizziness, sensitivity to noise, sensitivity to light and visual problems were recorded. Recovery times were pulled from patient records on return to full competition. A total of pre-pandemic non-concussed (n =2104), pre pandemic concussed (n=437), pandemic non- concussed (n = 492) and pandemic concussed (n=71) were included in the final analysis. Adolescents concussed during the pandemic experienced statistically significantly more irritability (p=0.0008), nervousness (p=0.0048), sadness (p=0.0018), feeling more emotional (p=0.0060), balance problems (p=0.0310), and visual problems (p=0.0002) than adolescents concussed before the pandemic. Owing to multiple biopsychosocial considerations, return to activity was prolonged in adolescents concussed during the pandemic as compared to before. Affective symptoms increased during the pandemic in the general pediatric population, however this study demonstrates the additional burden the pandemic had on adolescents with concussion. These findings suggest that affective symptoms place burden on somatic healing from injury, and further encourages a biopsychosocial approach to injury management, in which social and emotional challenges of a patient's life are considered.

Development of a Measure of Parent Concussion Management Knowledge and Self-Efficacy.

Abstract Assessing parent readiness to support their child's post-concussion management requires valid and reliable measures. Therefore, the objective of this study was to develop and conduct preliminary tests of reliability and validity of survey measures of parent concussion management knowledge and self-efficacy. Additionally, we tested the hypothesis that among parents of youth who had sustained a concussion, higher scores on measures of knowledge and self-efficacy would predict greater likelihood of engaging in recommended concussion management behaviors during their child's recovery. Measure development occurred with reference to parenting behaviors included in the Center for Disease Control and Prevention's Pediatric Mild Traumatic Brain Injury (mTBI) Management Guidelines. A multi-stage mixed- methods approach was employed, including expert review, cognitive interviews with parents, quantitative item reduction, and tests of reliability and validity. All participants were English-speaking parents of school-aged children in the United States. A stepwise measure development process was followed, with different participant groups across steps (including opt-in web-based survey panels and in-person recruitment from the population of parents of pediatric patients seen in a large pediatric emergency department). In total, 774 parents participated in study activities. The final knowledge index had 10 items, and the final self-efficacy scale had 13 items across four subscales (emotional support, rehabilitation support, monitoring, and external engagement). Internal consistency reliability was 0.63 for the knowledge index and 0.79-0.91 for self-efficacy sub-scales, and validation tests were in the hypothesized directions. In a test of predictive validity, we observed that among parents of youth patients with recent concussion, higher self-efficacy scores at the time of discharge from the pediatric emergency department were positively correlated (r = 0.12) with greater likelihood of engaging in recommended support behaviors at 2-week follow-up. There was no association between concussion management knowledge at discharge and parenting behaviors at follow-up. Parents have the potential to play an important role in concussion management. The measures of knowledge and self-efficacy developed in this study can help identify parent needs and evaluate interventions aiming to support parenting post-concussion.

An at-home, virtually administered graded exertion protocol for use in concussion management: Preliminary evaluation of safety and feasibility in healthy youth and children with subacute concussion.

Graded exertion testing (GXT) is an important tool for concussion management, as it is used to personalize post-concussion exercise prescription and return athletes to sport. However, most GXT requires expensive equipment and in-person supervision. Our objective was to assess the safety and feasibility of the Montreal Virtual Exertion (MOVE) protocol, a no-equipment, virtually compatible GXT, in healthy children and children with subacute concussion. Cross-sectional. The MOVE protocol consists of seven stages of bodyweight and plyometric exercises performed for 60 seconds each. Twenty healthy (i.e., non-concussed) children completed the MOVE protocol virtually over Zoom Enterprise. Next, thirty children with subacute concussion (median: 31.5 days post-injury) were randomized to the MOVE protocol or Buffalo Concussion Treadmill Test (BCTT), which increases the incline or speed of the treadmill every minute until maximum exertion. Out of an abundance of caution, all concussed participants completed the MOVE protocol in an in-person clinical space. However, the test evaluator was stationed in a different room within the clinic and administered the MOVE protocol using Zoom Enterprise software to mimic telehealth conditions. Safety and feasibility outcomes were recorded throughout GXT, including heart rate, rate of perceived exertion (RPE), and symptom outcomes. No adverse events were recorded, and all feasibility criteria were successfully met in healthy youth and youth with concussion. Among concussed youth, increases in heart rate (MOVE: 82.4  17.9 bpm, BCTT: 72.1  23.0 bpm; t(28)=1.36, p=0.18), RPE (MOVE: 5.87  1.92, BCTT: 5.07  2.34, t(28)=1.02, p=0.32), and overall symptom presentation were similar between the MOVE and BCTT protocols. The MOVE protocol is a safe and feasible GXT that in healthy youth and youth with subacute concussion. Future studies should assess the fully virtual administration of the MOVE in children with concussion, MOVE protocol tolerability in children with acute concussion, and whether the MOVE protocol can be used to guide individualized exercise prescription.

A-59 Sport-related concussion in para athletes: A scoping review of concussion assessment and management

Abstract Purpose Current guidelines have lagged in addressing sport-related concussion (SRC) in athletes with disabilities, or para athletes. Concussion assessments may not accurately capture symptoms in para athletes or be appropriately accessible, resulting in challenges managing SRCs in these athletes. The objective of this scoping review was to summarize the current literature on SRC in para athletes, including assessment procedures and management of SRC. Data Selection 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 inception to 02/01/2023. Articles selected examined SRC assessment and management in adaptive sports. Data Synthesis Reviewers screened 202 title-abstracts and 32 articles qualified for full-text review, with 9 articles qualifying for data extraction for information on SRC assessment and management. Most articles addressed baseline assessment (N=6), some addressed both assessment and management (N=2), and only one article addressed SRC management (N=1). Results identified discrepancies in the results of baseline data in para athletes. Differences in baseline composite scores and symptom reporting in para vs. non-adaptive athletes were also found. The literature acknowledged lack of validated assessment tools and SRC management guidelines for para athletes. Conclusions There is limited literature on the assessment and management of SRC in para athletes at both elite and non-elite levels, indicating a lag in research on para athletes as compared to non-adaptive athletes. Development or standardization of current baseline assessment procedures for SRC and subsequent management guidelines for para athletes is needed.

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-69 The Impact of Sleep Disturbance on Depression and Anxiety Post-Concussion Among High School Athletes

Abstract Purpose This study aims to explore the relationship between concussion-related sleep symptoms and affective symptoms in high school athlete. Methods A retrospective analysis of the Maine Concussion Management Initiative (MCMI) Immediate Post-concussion Assessment Tool ™ (ImPACT™) database was conducted to investigate the relationship between sleep and affective symptom scores in high school athletes (14-18 years) within 7 days of sustaining a concussion. The Post-Concussion Symptom Scale (PCSS) was completed by each athlete as part of their post-injury ImPACT™ testing battery. Sleep-related symptoms and affective/mood related symptoms from the PCSS were summed to create a sleep and affective symptom score, respectively. Results The final sample included 548 adolescents (M=15.94±1.06 years old; 50.4% female) were evaluated 3.16±1.85 days after injury. The results of a simple linear regression revealed a significant relationship between sleep and affective symptoms (F(1,546)=142.60, p&amp;lt;.001), and the model explained 20.7% of the total variance of affective symptom scores. Additionally, there was an association between gender and affective symptoms (Χ2(1)=6.39, p=.01), with females 1.6 times more likely to report at least one affective symptom. Females (M=3.62±4.33) had significantly higher affective symptom scores compared to their male (M=2.35±3.46) counterparts (t(546)=3.79, p&amp;lt;.001). Conclusions This study provides evidence of a significant relationship between sleep disturbance and affective symptoms in high school-aged athletes following concussion. Female athletes reported higher affective symptom scores.

A-08 Understanding the relationship between knowledge, beliefs, actions and confidence surrounding concussions among youth hockey coaches

Abstract Purpose To investigate the effectiveness of mandatory concussion education among youth hockey coaches and to understand if increased knowledge correlates with confidence. Identification of facilitators and barriers to coaches’ beliefs and actions were also assessed. Methods Prospective, cross-sectional descriptive pilot study using an electronic survey via REDCap sent to youth coaches within the Minnesota Hockey organization. Quantitative questions were used to investigate knowledge and attitudes, while qualitative questions explored the facilitators and barriers to concussion management in youth hockey. Results 98.8% of the 177 participants (M=150; F=22, NB=5), aged 18–65+ years completed the mandatory concussion training, with majority completing it in the last year (79%). 95% endorsed concussion education as beneficial with only 8 coaches reporting it was not helpful and 10 coaches requesting more educational materials. Over half of the participants (96; 54%) denied legislation impacting their attitude toward concussion. Confidence in concussion knowledge (3.07±1.09; 77%) and attitudes towards concussions (7.62±1.63; 85%) were positive. 39 (26%) coaches considered athlete and parent input most valuable for return to play. This may be related 72% of participants who reported no trained medical staff were present at games or practices. Concerningly, 20% of coaches may not encourage an athlete with loss of consciousness to seek emergent care. Conclusions Current mandatory concussion education produces increased knowledge, confidence, and appropriate action among majority of youth coaches. Coach reliance on athlete and parent report for clearance to play increases with no medical staff present for practices and games, which could have negative consequences.

A-53 Co-Occurring Depression and Anxiety Increases Prospective Risk for Concussion

Abstract Purpose There is limited research examining whether mental health concerns increase risk for future concussion, despite these difficulties being highly prevalent in college-age populations and student-athletes. This study investigates whether affective disturbance at baseline increases the risk for prospective concussion. We predict that athletes with co-occurring depression/ anxiety will incur the greatest risk for injury. Methods 886 collegiate athletes completed baseline neuropsychological testing and were prospectively followed as part of a sports concussion management program. Athletes were separated into 4 groups (HCs, Depression Alone, Anxiety Alone, Co-Occurring Depression/Anxiety) based on self-reported anxiety and depression at baseline. Of the 886 athletes, 96 sustained future concussion. Logistic regression was conducted with prospective concussion (yes/no) as the outcome, and affective group as the predictor. Sex and sport were examined as covariates. Results After controlling for sport, athletes in the Co-Occurring Depression/Anxiety group were more than twice as likely to sustain prospective concussion compared to HCs, p=.03, OR=2.18, 95% CI [1.10,4.33]. Though not statistically significant, athletes in the Co-Occurring Depression/Anxiety showed a 59% and 56% increased risk for prospective concussion compared to the Depression Alone and Anxiety Alone groups, respectively. Athletes in the Depression Alone and Anxiety Alone groups both showed a 31% increased risk for prospective concussion compared to HCs. Conclusions Athletes with co-occurring depression/anxiety at baseline show a notably increased risk for sustaining future concussion, even after controlling for sport. These findings highlight the importance of screening for depression and anxiety at baseline to provide treatment for these athletes, improve well-being, and reduce concussion risk.