Concussion Rates Research Articles

Salt diet Induces Neuroinflammatory Response, Microbiome Dysregulation and Associated with Long-term Anxiety Following Repetitive Closed Head Injury. (S28.003)

<h3>Objective:</h3> Investigate the effects of salt diet on neuroinflammatory response, behavior, and microbiome dysregulation following repetitive closed head injury model. <h3>Background:</h3> Concussions continue to be a prominent public health concern, with an estimated 1.6–3.8 million incidences annually in the United States. Younger populations are experiencing the highest rates of concussion and nearly all athletic endeavors have some risk of concussive injury. Concerns surrounding the potential risks of long-term cognitive and medical outcomes made adolescent traumatic brain injury (TBI) a central focus of public attention. Coupled to these events, recent clinical studies have shown that lifestyle factors, including salt diet, constitute additional risk affecting TBI consequences and neuropathophysiological outcomes. However, the impact of salt diet on the pathophysiology of TBI and whether it exacerbates post-injury outcomes is still largely unknown. <h3>Design/Methods:</h3> We investigated if the exposure to a high salt diet (HSD) would alter hemodynamics, behavior, innate immune response and microbiome diversity after repetitive mild closed head injury in adolescent mice. Mice were injured with a three hit model (3HD) and then maintained on a HSD or standard diet (STD) for 12 weeks. <h3>Results:</h3> We found that HSD didn’t change systolic and diastolic blood pressure, and heart rate compared with STD group. HSD group was associated with worsening anxiety-like behavior at 12 weeks post diet administration. HSD induced microgliosis and proinflammatory microglial transcriptomic signature including upregulation in interferon gamma, Interferon beta, T cells proliferation pathways. Consistently, we found upregulation of proinflammatory Tumor necrotic factor (TNF) in brain compared to Sham-HSD and TBI-STD groups. HSD was the main driver of microbiome dysregulation in both TBI and Sham groups. We found that Eubacterium xylanophilum and Lachnospiraceae bacterium associated with an anxiety phenotype following injury at 12 weeks post diet administration. <h3>Conclusions:</h3> Salt diet associated with increasing risk of worsening anxiety and exacerbating chronic neuroinflammation post repetitive head injury. <b>Disclosure:</b> Dr. Izzy has received publishing royalties from a publication relating to health care. Taha Yahya has nothing to disclose. Dr. Cao has nothing to disclose. Mr. Albastaki has nothing to disclose. Dr. Waed has nothing to disclose. Ms. Chopra has nothing to disclose. Miss EKWUDO has nothing to disclose. Miss Kurdeikaite has nothing to disclose. Ms. Moraes Verissimo has received personal compensation for serving as an employee of Brigham and Women’s Hospital. Ms. Moraes Verissimo has received personal compensation for serving as an employee of Brigham and Women’s Hospital and Harvard Medical School. Ms. Moraes Verissimo has received personal compensation for serving as an employee of Von Medical, Inc.. Ms. Moraes Verissimo has received personal compensation for serving as an employee of Nova Southeastern University. Ms. Moraes Verissimo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Montachem Company. Dr. Cox has received personal compensation for serving as an employee of Anaerobe Systems. The institution of Dr. Cox has received research support from Infectious Disease Society. The institution of Dr. Cox has received research support from BrightFocus Foundation. Dr. Cox has received intellectual property interests from a discovery or technology relating to health care. Dr. Zafonte has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MYOMO. Dr. Zafonte has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kisbee. Dr. Zafonte has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers in Neurology. The institution of Dr. Zafonte has received research support from NIDILRR. The institution of Dr. Zafonte has received research support from NIH. The institution of Dr. Zafonte has received research support from FPHS study. Dr. Zafonte has received publishing royalties from a publication relating to health care. Michael J. Whalen has nothing to disclose.

Epidemiological analysis of pediatric baseball and softball concussions in United States emergency departments

PurposeTo evaluate the epidemiology of concussions in pediatric baseball and softball players. We hypothesized that head-to-ball injuries would be the most common cause of concussions. MethodsThe National Electronic Injury Surveillance System (NEISS) database was used to gather data. Concussions occurring during baseball and softball participation in pediatric patients (4–17 years old) from 2012 to 2021 was gathered. Concussion mechanisms were grouped into 5 categories: head-to-player, head-to-ball, head-to-surface (ground, walls, railings), head-to-bat, and unknown. Linear regression models were used to assess changes in yearly concussion rates over the study period. Results from these models were reported using parameter estimates and the estimated Pearson correlation coefficient. ResultsA weighted total of 54,978 baseball and softball related concussion injuries were analyzed. The average weighted age of our cohort at the time of injury was 13.1 years, with 54.1% (n = 29,761) of concussions occurring in males. The national estimated incidence of concussion injuries decreased non-significantly over the study period (slope estimate = −311 concussions/year, r = −0.625, p-value = 0.054). The majority of weighted national estimate concussions were due to head-to-ball injuries (n = 34,650; 63.0%), followed by head-to-player (n = 8501; 15.5%), head-to-surface (n = 5347; 9.7%), and head-to-bat (n = 5089; 9.3%). On sub-analysis, individuals were grouped into 3 age brackets: 4–8, 9–13, and 14–17 years. The most common mechanism of concussions in children of all ages was head-to-ball. The incidence of head-to-player and head-to-surface injuries increased throughout each age group, while head-to-bat decreased. ConclusionThe incidence of concussions in pediatric baseball and softball athletes has been decreasing non-significantly over our 10-year study period. The most common mechanism of concussions in our study was head-to-ball injuries.

School-level determinants of incidence of sports-related concussion: Findings from the CARE Consortium.

Epidemiologic research on sports-related concussion (SRC) has focused on individual risk factors, with limited research on institutional risk factors and variability in concussion rates. This study used data from 53,822 athletes-seasons collected at 30 United States sites (26 civilian institutions and 4 military service academies), from 2014/15 to 2018/19 academic years, by the Concussion Assessment, Research, and Education Consortium. School-level risk factors included competitive division (DI, DII, DIII), school type (military/civilian) and a Sport Risk Index (SRI; Low, Medium, High). For comparability between civilian institutions and military academies, only NCAA athletes and concussions in sports games and practices were included. Random intercepts log-binomial regression was used to estimate Risk Ratios (RRs) and model variability in SRC risk. A total of 2,503 SRCs were observed during the study period, including 829 competition SRCs (33%) and 1,674 practice SRCs (67%). Most variability in SRC risk was at the level of athlete or team (within-school), rather than at the school-level. Specifically, across the three SRC outcomes (all [competition and practice combined], competition-only, and practice-only), within-school variability was 5 to 7 times greater than between-school variability. Three school-level risk factors (Division, School Type, and SRI) accounted for over one-third (36%) of between-school variability. SRI was the strongest school-level predictor of SRC risk (RR = 5.7; 95%CI: 4.2, 7.6 for High vs. Low). SRC risk was higher for Division I compared to Divisions II/III (RR = 1.6; 95%CI: 0.9, 2.9 for DI vs. DIII), and military academies had a moderately elevated risk of SRC (RR = 1.4; 95%CI: 0.7, 2.7). A large portion of the apparent variability between schools was attributable to structural factors (sport risk and competitive level), suggesting that there were minimal systemic differences in concussion identification between schools. While most variability is within-school, understanding school-level determinants of concussion risk may still be important in providing the implementation science context for individual-level interventions.

Validity of Research Based on Publicly Obtained Data in Sports Medicine: A Quantitative Assessment of Concussions in the National Football League.

Numerous researchers have leveraged publicly available internet sources to publish clinical research concerning incidence and recovery from injuries in National Football League (NFL) players. This study aims to (1) provide a comprehensive systematic review of all publicly obtained data studies (PODS) regarding concussions in NFL athletes and (2) quantify the percentage of injuries identified by these studies in comparison with published concussion data from the NFL injury database. A systematic review was conducted in accordance with PRISMA guidelines to identify all published studies utilizing publicly obtained data regarding concussions in NFL athletes. Systematic review. Level 4. Manuscript details, factors related to the athletes of interest (eg, study period, positions included), and results (eg, concussion rate, number of total concussions, return-to-play data) were extracted independently by 2 authors. Results were compared with incident concussions reported from 2015 to 2019 by each medical staff member to the NFL database linked to the League's electronic health record (EHR). A total of 20 concussion-focused manuscripts based on PODS were identified from 2014 to 2020. PODS captured between 20% and 90% of concussions (mean, 70%) reported by medical staff to the injury database. PODS reported that 55% of concussions occurred on offensive plays, 45% on defensive plays and <1% occurred during special teams plays, compared with 44%, 37%, and 18%, respectively, as indicated by published data from the NFL injury database. When analyzed by position groups, running backs and quarterbacks comprised the most over-represented positions concussed in PODS, while offensive linemen, defensive backs, and linebackers comprised the most under-represented positions. PODS captured approximately 70% of concussions reported by NFL medical staff to the NFL injury database. There is heterogeneity in the degree to which PODS were able to identify concussions, with a bias toward concussions among players at higher profile positions.

Examining the Risk of Concussion in Children With Facial Fractures: A Large Emergency Department-Based Analysis

Background: Children who sustain injuries resulting in facial fractures are at risk for concomitant concussion. Prompt diagnosis and appropriate management of concussions are crucial in preventing neurocognitive impairment. The goal of this study is to examine the relationships between distinct craniofacial fracture patterns, injury mechanism, and concussion in pediatric patients. Methods: A retrospective review of 3334 patients &lt;18 years of age who were evaluated at a pediatric level I trauma center from 2006 to 2021 for facial fractures was performed. Data collected included patient demographics, mechanism of injury, documentation of concussion, and facial fracture type. Patients with an intracranial injury were excluded. Results: Two hundred twenty-seven patients met inclusion criteria (67.9% male), mean age at injury was 12.3 ± 4.3 years. Overall, concussions were more common in children &gt;12 years old (54.2%), with sports as the most common cause of injury (32.5%). In patients &lt;12 years, motor vehicle accidents were the main cause of injury (30.6%, P &lt; .001). Zygomaticomaxillary complex and maxillary fractures were associated with higher rates of concomitant concussion. Patients with a history of prior concussion were 3.4 times more likely to present with another concussion (odds ratio, 3.4; 95% Cl, 1.7-6.9). Conclusions: Nearly 7% of pediatric patients with facial fractures in this retrospective series were diagnosed with a concomitant concussion. The results suggest that a higher index of suspicion for concussions should be maintained for patients with midface fractures and those with a previous history of concussions.

Concussion in Canadian Youth Ice Hockey: What Is Needed to Decrease the Burden?

Concussion in Canadian Youth Ice Hockey: What Is Needed to Decrease the Burden?

144 Sports Participation and Sports-Related Neurologic Injuries in Pediatric Patients With Chiari I Malformation

INTRODUCTION: Currently, there is no consensus recommendation regarding the safety of sports participation for pediatric patients with Chiari I malformation (CM-I). METHODS: A prospectively administered survey was given to 744 pediatric neurosurgery clinic patients at the University of Michigan between December 2010 and December 2021. Data were recorded on demographic information, imaging characteristics, treatment, sports participation, and presence of sports-related neurologic injury. Patients with incomplete survey data were called. Two hundred and seven patients completed at least 1 subsequent survey and were prospectively followed for a mean of 1.56 years. A season was defined as 3 months of sports play. RESULTS: Of the 744 patients with completed surveys, 462 patients participated in sports. Patients who participated in sports were more likely to be older at presentation (p &lt; 0.001) and have rounded cerebellar tonsil morphology (p &lt; 0.001). A cumulative total of 6,854.67 seasons of sports were played (5,918.67 prior to CM-I decompression (CMD) and 936 after). There were 84 sports-related concussions among 55 patients; 79 prior to CMD and 5 after CMD. The concussion rate was 12.25 per 1,000 seasons of all sports, 9.16 per 1,000 seasons of limited-contact sports and 13.76 per 1,000 of contact sports. The concussion rate after CMD was 5.34 per 1,000 seasons of all sports, 9.19 per 1,000 seasons of limited-contact sports and 7.09 per 1,000 seasons of contact sports. There were no reports of long-lasting neurologic issues post-concussion or of permanent spinal cord injury. CONCLUSIONS: There were no permanent or catastrophic sports-associated neurologic injuries reported in this study. The concussion rate in CM-1 patients before and after CMD were low and therefore sports participation in this population should not be counseled against.

Changes in sport-related concussion and traumatic brain injury in New Zealand during the first two years of the COVID-19 pandemic.

To quantify changes in sport-related concussion and traumatic brain injury claims in New Zealand during the first two years of the COVID-19 pandemic (i.e., 2020 and 2021). Population-based cohort study. This study included all new sport-related concussion and traumatic brain injury claims that were registered with the Accident Compensation Corporation in New Zealand during 1 January 2010 to 31 December 2021. Annual sport-related concussion and traumatic brain injury claim rates per 100,000 population from 2010 to 2019 were used to fit autoregressive integrated moving average models, from which forecast estimates with 95 % prediction intervals for 2020 and 2021 were derived and compared against corresponding observed values to obtain estimates of absolute and relative forecast errors. Sport-related concussion and traumatic brain injury claim rates were 30 % and 10 % lower than forecasted in 2020 and 2021, respectively, equating to an estimated total of 2410 fewer sport-related concussion and traumatic brain injury claims during the two-year period. There was a large reduction in sport-related concussion and traumatic brain injury claims in New Zealand during the first two years of the COVID-19 pandemic. These findings highlight the need for future epidemiological studies examining temporal trends of sport-related concussion and traumatic brain injury to account for the impact of the COVID-19 pandemic.

767 Electrophysiological Analysis of Traumatic Optic Neuropathy in Patients with Suspected Traumatic Brain Injury: A Prospective Cohort Study

INTRODUCTION: Traumatic optic neuropathy (TON) can cause persistent visual deficits and is a known sequala of traumatic brain injury (TBI). Little is known regarding appropriate diagnosis, management, and treatment. METHODS: We performed a prospective cohort study with 356 active military personnel using electrophysiological visual evoked potential (VEP) testing for TON in the context of known or suspected TBI. We utilized a new VEP protocol that included kinetic and static visual field testing to uncover occult cases of TON previously missed in the current disability examination. This was done to incorporate patients with borderline concussive cases that do not meet current diagnosis of mild, moderate, or severe TBI by the Veteran’s Disability Exam. RESULTS: 80 patients were diagnosed with TON. Average age of TON patients was 37.4 years, with most patients being male. Of those patients with TON, 45% had reported TBI, whereas an additional 54% had suspected history of concussion. Patients presented with bilateral TON (65.8%, n = 52), while unilateral TON cases occurred less frequently (35.4%, n=28). Visual field defects were apparent in both static and kinetic visual field testing in 54% of cases. VEP sensitivity in our study was 88%. Military parachute jumpers (paratroopers) represented the highest risk group for undiagnosed TBI and TON. CONCLUSIONS: We recommend periodic static and kinetic visual field testing in high-risk individuals working in fields with high concussion rates. This allows implementation of treatment early to avoid decrements in visual acuity. By instituting our protocol, we can detect visual deficits early in our TBI patients and direct to appropriate treatment centers.

Sports Participation and Neurological Injuries in Pediatric Patients With Chiari I Malformation.

Currently, there is no consensus recommendation regarding the safety of sports participation for pediatric patients with Chiari I malformation (CM-I). To prospectively survey the treated and untreated patients with CM-I to define the risk of sports-associated neurological injury. A prospective survey was administered to 744 pediatric patients at one neurosurgery clinic between 2010 and 2021. Data were recorded on demographic information, imaging characteristics, treatment, sports participation, and presence of sports-related neurological injury. Patients with incomplete data were called. Two hundred seven patients completed at least 1 subsequent survey and were prospectively followed (mean 1.6 years). Of 744 patients with completed surveys, 462 participated in sports. Sports participants were more likely to be older at presentation ( P < .001) and have rounded cerebellar tonsil morphology ( P < .001). Seasons of sports played before and after CM-I decompression (CMD) totaled 5918.7 and 936, respectively. There were 84 sports-related concussions among 55 patients; 79 in untreated patients and 5 after CMD. For all sports participants, the concussion rate was 12.3/1000 seasons of all sports, 9.2/1000 seasons of limited-contact sports, and 13.8/1000 of contact sports. The concussion rate after CMD was 5.3/1000 seasons of all sports, 9.2/1000 seasons of limited-contact sports, and 7.1/1000 seasons of contact sports. There were no reports of long-lasting neurological issues postconcussion or of permanent spinal cord injury. No permanent or catastrophic sports-associated neurological injuries were reported. The concussion rates in treated and untreated patients with CM-I were low. Therefore, sports participation in this population should be permitted in most cases.

Protective equipment in youth ice hockey: are mouthguards and helmet age relevant to concussion risk?concussionfor mouthguard wearers

ObjectivesTo compare the incidence rates and odds of concussion between youth ice hockey players based on mouthguard use and helmet age.Materials and methodsWithin a 5-year longitudinal cohort (2013/2014 to 2017/2018)...

Surfing injuries: A US epidemiological study from 2009–2020

BackgroundThe sport of surfing has grown exponentially. Early studies of surfing injuries are outdated as newer and more accessible surf technology has become available. This study's goal was to describe surfing injury patterns, incidence, and disposition of pediatric and adult surfers. Study designA retrospective review of surfing injuries from 2009 to 2020 of adult (>18 years of age) and pediatric (<18 years of age) patients was performed using the National Electronic Injury Surveillance System (NEISS) database. The consumer product code 1261 (Surfing) was used to identify injury patterns. Chi-squared test was performed on all categorical variables. Logistic regression was used on significant variables from the frequency tables. All analysis was performed with R-statistical programming software. ResultsThere was an overall decreasing trend of surfing injuries over time. Injuries for both adult and pediatric patients tended to occur most within the summer season (p<0.001). The odds of an adult surfing injury victim being male is 2.89 (95% CI 1.87–4.44). The head/neck/face were the most injured body part in both groups. The pediatric group had a significantly higher rate of concussions at 6.5% compared to the adult group at 3.2%. Overall, the most common injury type was to the skin (p<0.001). Disposition between groups were similar with most patients being discharged home. Mortality was rare with three reported fatalities in the adult group and none in the pediatric group. ConclusionThe incidence of surfing injuries is continuing to decline despite more people surfing, revealing the improved safety of the sport over the last decade. Head/neck/face injuries are common injury locations, and pediatric surfers are particularly at increased risk of concussions. Continued education, usage of safety equipment such as protective headgear, and awareness of injury patterns, could further lessen potential injuries.

INCIDENCE AND CLINICAL MANIFESTATIONS OF CONCUSIONS IN ADOLESCENT AND PRE-ADOLESCENT ATHLETES PRACTICING OLYMPIC SPORTS

Background: Concussion is a frequent and sometimes severe complication of sport activity. The incidence in the USA is estimated at 538/100.000 person/year, while in Brazil there is no published estimate at that regard. The aim of our study was to evaluate the concussion incidence rate in adolescents and preadolescents athletes who practice different types of Olympic sports. Methods: This is a cross-sectional, retrospective study, which included volleyball, basketball, artistic gymnastics and judo adolescents (15-19 years old) and preadolescent (11-15 years old) athletes. An on line survey was sent to them by their coaches, and they were free to answer or not the questions. The central question was if they have had Traumatic Brain Injury/concussion in the last 12 months. If the answer was yes, then they had to respond to a questionnaire with several additional questions related to this concussion. Results: 66 athletes answered the survey; 23 out of 66 reported a concussion in the last 12 months. The overall incidence of concussion was 34.8%. The incidence per type of sport was 31,5% for volleyball, 20% for basketball, 57,1% for judo and 66,6% for artistic gymnastic. Those differences were not statistically significant, although there was a clear trend indicating the risk is higher for gymnastic and judo. There was no difference regarding the incidence according to gender or age distribution (adolescent versus preadolescents). The most frequent post-concussion symptoms were headache/migraine (73.9%), head pressure (26.1%), dizziness (13%), neck pain (13%) and changes in balance (13%). 12 out of the 23 (52.2%) athletes reporting a concussion had two or more symptoms (up to 8 symptoms). Conclusion: Our study showed that the incidence rate of sport concussions in our country is very high, at least in the universe of adolescent and preadolescent athletes. To our knowledge, this is the first report of concussion incidence in Brazil. It indicates that educational and medical measures should be employed as soon as possible, possibly under the lead of sport medicine specialists, in order to prevent or to deal with this complication in a standardized way.

Epidemiological analysis of concussions in youth ice hockey players: A national emergency department database study

PurposeTo evaluate the epidemiology of concussions in youth ice hockey players. MethodsThe National Electronic Injury Surveillance System (NEISS) database was used to gather data. Concussions occurring during ice hockey participation in youth patients (4–21 years old) from 2012 to 2021 was gathered. Concussion mechanisms were grouped into 7 categories: head-to-player, head-to-puck, head-to-ice, head-to-board/glass, head-to-stick, head-to-goal post, and unknown. Hospitalization rates were also tabulated. Linear regression models were used to assess changes in yearly concussion and hospitalization rates over the study period. Results from these models were reported using parameter estimates [with 95% confidence intervals (CI)] and the estimated Pearson correlation coefficient. Additionally, logistic regression was used to model the risk of hospitalization across the different cause categories. ResultsA total of 819 ice hockey related concussions were analyzed between 2012 and 2021. The average age of our cohort was 13.4 years, with 89.3% (n = 731) of concussions occurring in males. The incidence of head-to-ice, head-to-board/glass, head-to-player, and head-to-puck concussion mechanisms decreased significantly over the study period (slope estimate = −2.1 concussions/year [CI: (−3.9, −0.2)], r = −0.675, p = 0.032), (slope estimate = −2.7 concussions/year [CI: (−4.3, −1.2)], r = −0.816, p = 0.004), (slope estimate = −2.2 concussions/year [CI: (−3.4, −1.0)], r = −0.832, p = 0.003), and (slope estimate = −0.4 concussions/year [CI: (−0.62, −0.09)], r = −0.768, p = 0.016), respectively. Majority of patients were discharged from the emergency department (ED) to their home, as only 20 people (2.4%) were hospitalized over our study period. The majority of concussions were due to head-to-ice (n = 285, 34.8%), followed by head-to-board/glass (n = 217, 26.5%) and head-to-player (n = 207, 25.3%). The most common cause for hospitalizations due to concussions was head-to-board/glass (n = 7, 35%), followed by head-to-player (n = 6, 30%) and head-to-ice (n = 5, 25%). ConclusionThe most common mechanism of youth ice hockey concussions was head-to-ice in our 10-year study period, while head-to-board/glass was the most common cause of hospitalizations. IRBThis project did not require review by the institutional review board.

Sports-Related Concussion Affects Cognitive Function in Adolescents: A Systematic Review and Meta-analysis

Background: Rates of sports-related concussion (SRC) are high in adolescents. Ambiguity exists regarding the effect of SRC on cognitive function in adolescents. Purpose: To rigorously examine adolescents’ cognitive function after SRC. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: Web of Science, Scopus, and PubMed were searched from database inception until September 2021. Studies were included if participants were adolescents aged 13 to 18 years, if the definition of SRC was fully consistent with the Berlin Consensus Statement on Concussion in Sport, if the study included a control group or in-group baseline test, and if the study reported cognitive outcomes (eg, visual memory, processing speed) that could be separately extracted. Results: A total of 47 studies were included in the systematic review, of which 31 were included in the meta-analysis, representing 8877 adolescents with SRC. Compared with individuals in the non-SRC group, individuals with SRC had worse performance in cognitive function and reported more symptoms not only in the acute phase but also in the prolonged phase (1-6 months after injury) (visual memory: d = −0.21, 95% CI, −0.37 to −0.05, P = .012; executive function: d = −0.56, 95% CI, −1.07 to −0.06, P = .028; and symptoms: d = 1.17, 95% CI, 0.13 to 2.22, P = .028). Lower scores in most of the outcomes of cognitive function were observed at <3 days and at 3 to 7 days, but higher scores for verbal memory (d = 0.10; 95% CI, 0.03 to 0.17; P = .008) and processing speed (d = 0.17; 95% CI, 0.10 to 0.24; P < .001) were observed at 7 to 14 days after SRC relative to baseline. The effects of SRC on cognitive function decreased over time (100% of the variance in reaction time, P < .001; 99.94% of the variance in verbal memory, P < .001; 99.88% of the variance in visual memory, P < .001; 39.84% of the variance in symptoms, P = .042) in control group studies. Study design, participant sex, measurement tools, and concussion history were found to be modulators of the relationship between cognitive function and SRC. Conclusion: This study revealed that adolescent cognitive function is impaired by SRC even 1 to 6 months after injury. Results of this study point to the need for tools to measure cognitive function with multiple parallel versions that have demographically diversiform norms in adolescents. Effective prevention of SRC, appropriate treatment, and adequate evaluation of cognitive function before return to play are needed in adolescent SRC management. Moreover, caution is warranted when using the baseline-to-postconcussion paradigm in return-to-play decisions.

Higher rates of concussion following COVID-19 infection in high school athletes

ObjectiveTo compare concussion rates (CRs) over one academic year in high school athletes with and without a COVID-19 infection prior to concussion.MethodsIllness and concussion were prospectively reported for male and...

A Helmet of Her Own?: A Qualitative Study of Key Stakeholder Perspectives on Headgear in Girls’ Lacrosse

Despite the high incidence rate of concussions in women's lacrosse, there is substantial push back against the use of helmets at the secondary educational and collegiate levels in the U.S. This study examines the social factors influencing the controversy surrounding the use of protective headgear and how the recent development of headgear specific to the women's game has shaped ongoing debates. Purposeful sampling was used to recruit interviewees with research knowledge or firsthand experience with injury and protective headgear in girls' lacrosse. Semistructured interviews were conducted and subsequently coded using qualitative research software to identify key themes and patterns. Sixteen respondents participated in this study; 4 players, 4 coaches, 3 researchers, and 5 administrators were represented in this sample. Overarching themes identified across these interviews included playing through pain, health consequences of concussions, concussion prevention strategies and the potential role of headgear, symbolism of headgear, gender dynamics, autonomy, and decision making. This qualitative study shows the importance of attention to the unique history of girls' lacrosse and current narratives surrounding headgear in the sport. There is a need for greater collaboration and consensus between all relevant groups to ensure that headgear best addresses the concerns of the people who will ultimately be using it. Future qualitative research should build on this preliminary study with a larger and more diverse sample to follow up on key themes and ultimately inform effective safety measures to protect athletes.

A systematic review and meta-analysis of factors influencing ImPACT concussion testing in high school and collegiate athletes with self-reported ADHD and/or LD.

Sport concussion is a common injury, and athletes with attention-deficit/hyperactivity disorder (ADHD) and/or learning disorder (LD) are at increased risk and require specialized attention in clinical settings. Although systematic reviews of the relationship between ADHD/LD and concussion are reported in the literature, these reviews do not include quantitative syntheses. Additionally, no reviews have focused on the most commonly utilized concussion assessment, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). The current review provides an update of sport concussion assessment in athletes with ADHD and/or LD from 2000 to 2021 on these topics: baseline and postconcussion performance on ImPACT, baseline and postconcussion symptom reporting using the Postconcussion Symptom Scale, invalid baseline classification on ImPACT, and self-reported history of concussion. Meta-analyses were conducted on baseline ImPACT performance, symptom reporting, invalid baseline classification, and concussion rates. Thirty-four studies were included in systematic review and 19 were included in meta-analyses. Decreased baseline performance was found for athletes with ADHD (trivial to small effects), LD (small-to-medium effects), and ADHD/LD (small-to-medium effects). Increased baseline symptom reporting was found for athletes with ADHD (small effect). Increased odds of invalid baseline performance (trivial effect) and self-reported concussion history (small effect) were found in ADHD. These results provide the first quantitative synthesis of the literature in this area. It is recommended that future research further examines these topics in athletes with LD and co-occurring ADHD/LD (given the focus on ADHD), as well as the effects that all of these conditions may have on concussion recovery and return-to-play decision-making. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Self-reported concussion history among midwestern skiers and snowboarders.

To assess the rate of self-reported concussion in midwestern skiers and snowboarders. Recreational skiers and snowboarders between the ages of 14 and69 yearsduring a single winter ski season (2020-2021) at a ski area in Wisconsin, USA. Survey study. Among this survey population (n=161), 9.32 and 19.25% reported one or more diagnosed concussion and suspected concussion respectively as a result of a skiing- or snowboarding-related incident. Skiers and snowboarders that self-identified as advanced, those who utilized terrain park features, and those that participated in freestyle competition had significantly higher self-reported rates of concussion. Self-reported concussion history indicates a concussion prevalence that is higher than expected based on previous studies. Participants reported significantly more suspected concussions than diagnosed concussions, indicating a possible issue with underreporting in this population.

It Takes Two to Tango: High Rates of Injury and Concussion in Ball Carriers and Tacklers in High School Boys' Rugby.

To examine injury and concussion rates, mechanisms, locations, and types of injury in Canadian high school male rugby. Prospective cohort study. High school male rugby. A total of 429 high school players (2018: n = 225, 2019: n = 256) were recruited from 12 teams in 7 schools in Calgary, Canada. None. Injury surveillance included baseline questionnaires, weekly exposure, and injury reports. Injuries included those requiring medical attention, resulted in time loss and/or inability to complete a session. Concussion was defined as per the fifth Consensus on Concussion in Sport, and all players with a suspected concussion were referred to a study sport medicine physician. A total of 134 injuries were captured, leading to an injury incidence rate (IR) of 57.9/1000 hours [95% confidence intervals (CIs): 45.4-73.8]. Median time loss was 6 days (range: 0-90). Injuries to the head were the most common (40%), followed by shoulder (12%) and ankle (10%). The concussion IR was 22.0/1000 hours (95% CIs: 15.9-30.4), which was the most common injury type (38%), followed by sprain (20%) and strain (15%). Sixty-five percent of injuries occurred in the tackle (ball carrier 35%, tackler 30%) and 76% of concussions (ball carrier 41%, tackler 35%). The rate of injury and concussion in Canadian youth high school male rugby is high, with tackle-related injuries and concussions the most common. Given this, there is a critical need for implementation of prevention strategies, in particular targeting concussion and the tackle event (eg, neuromuscular, tackle training, and law changes).