Previous literature on sport-related concussion (SRC) knowledge and reporting behaviors has been limited to high school and National Collegiate Athletic Association collegiate athletes; however, ...knowledge regarding collegiate club-sport athletes is limited.
To determine the level of SRC knowledge and reporting behaviors among collegiate club-sport athletes and to investigate differences between athletes in traditional and nontraditional sports.
Cross-sectional study.
Survey.
A total of 410 athletes (247 males, 163 females) involved in traditional (n = 244) or nontraditional (n = 165) collegiate club sports.
The survey consisted of demographics, recognition of SRC signs and symptoms, general SRC knowledge, and reasons why athletes would not report SRCs. The independent variable was sport type. Sport-related concussion signs and symptoms and general knowledge were assessed by the frequency of correct answers to SRC signs and symptoms and general knowledge questions. Sport-related concussion-reporting behavior frequencies were evaluated by asking participants to indicate reasons why they did not or would not report an SRC.
The SRC signs and symptoms knowledge score was 23.01 ± 3.19 and general SRC knowledge score was 36.49 ± 4.16 (maximal score = 43). No differences were present for SRC signs and symptoms knowledge ( F
= 1.99, P = .16) or general SRC knowledge ( F
= 3.28, P = .07) between athletes in traditional and nontraditional collegiate club sports. The most common reason for not reporting an SRC was not recognizing it as a serious injury (n = 165, 40.3%). Chi-square tests demonstrated significant relationships between sport type and 5 reasons for not reporting an SRC.
The participants displayed moderate to high levels of knowledge of SRCs but indicated they had failed to or would fail to report SRCs for a variety of reasons. The lack of sports medicine coverage and disconnect between knowledge and injury recognition may make collegiate club-sport athletes more likely to participate while concussed.
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.
Approximately 1.6 to 3.8 million recreational and sports-related concussions (SRC) occur each year in the Unites States. Research suggest that female athletes are at a greater risk for a SRC compared ...to male athletes competing in comparable sports (i.e., soccer, basketball). Moreover, female athletes have reported more total symptoms and greater neurocognitive impairments following a SRC. Female athletes have been found to report greater symptom provocation as measured by the Vestibular/Ocular Motor Screening (VOMS), and increased brain activation compared to males. There is a scarcity of research on long-term effects of SRC in male and female athletes. Therefore, the aim of this review article is to summarize the existing literature on sex differences in acute and sub-acute SRC outcomes.
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•Concussion knowledge of parents and youth athletes were generally favorable.•Knowledge deficits were found regarding emotion-related signs and symptoms.•25% of youth athletes thought it was safe to ...return to play with concussion symptoms.•Age and medical occupation were related to higher parent concussion knowledge.•Youth athlete concussion knowledge was significantly influenced by numerous factors.•More concussion awareness resources are needed at the youth sport level.
Introduction: On-site health care providers are not routinely present at all youth sport events. Therefore, parents and youth athletes are often responsible for identifying and making appropriate immediate care decisions regarding concussions, which may be influenced by their injury health literacy. Previous studies have investigated the level of concussion knowledge of parents and athletes, but few have investigated factors associated with greater awareness at the youth sport level specifically. Method: A total of 466 parents and 390 youth contact sport athletes from Pennsylvania and Michigan completed separate surveys of concussion knowledge and personal and family demographic information. Results: Parents had a mean concussion knowledge score of 39.3 ± 4.6 out of a possible 47 points. Having a medical occupation (p = .04) and being older in age (p = .03) were associated with higher concussion knowledge scores in parents (R2 = 0.018; 95% CI = 32.77–38.99). Youth athletes had a mean concussion knowledge score of 35.0 ± 5.7 out of 47. Having learned about concussion previously (p < .001), having a history of diagnosed concussion(s) (p = .01), sport type (relative to girls’ ice hockey, p < .001), older age (p < .001), and parent concussion knowledge (p = .04) were associated with higher youth athlete concussion knowledge (R2 = 0.176; 95% CI = 19.08–31.72). Conclusions: More evidence-based concussion awareness resources are needed at the youth sport level. While it did not significantly influence concussion knowledge for parents, concussion education is a modifiable factor that may be essential for improving concussion knowledge of youth athletes, thus warranting further study into effective awareness strategies for this population. Practical Applications: The factors found to influence concussion knowledge in this study could be considered in future educational concussion initiatives for youth athletes and their parents in order to increase awareness regarding the potential dangers of participating in sport while concussed.
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Background:
Sports-related concussion (SRC) injury rates are well established in collegiate athletics through epidemiological studies using the National Collegiate Athletic Association Injury ...Surveillance System. However, few studies have examined sex differences, time loss, and missed school days in high school athletes, especially at the state level.
Purpose:
To identify sex differences in the clinical incidence of SRCs, missed school days, and time loss in high school student-athletes.
Study Design:
Descriptive epidemiological study.
Methods:
A total of 193,757 (116,434 male and 77,323 female) student-athletes (10th grade ± 1.1) participating in Michigan High School Athletic Association (MHSAA)–sponsored athletic activities were recorded in the Head Injury Reporting System. Certified athletic trainers, school athletic administrators, and coaches from MHSAA high schools reported SRC data and overall participation for the 2015-2016 academic year. Total concussive injuries, as well as missed school days and time loss for each concussive injury, were reported. The clinical incidence was calculated by dividing the number of SRCs in a particular category by the number of participants in that category and presented with 95% CIs. Relative risk ratios (RRs) were determined for sex-comparable sports.
Results:
The overall clinical incidence for all sports was 1.7 per 100 player-seasons (95% CI, 1.6-1.8) and 1.9 (95% CI, 1.8-2.0) for male sports and 1.5 (95% CI, 1.4-1.6) for female sports. Female athletes were at a 1.9 (95% CI, 1.8-2.2) times greater risk for enduring SRCs than male athletes in sex-comparable sports, with a greater risk in baseball/softball (RR, 2.7 95% CI, 1.9-3.8), basketball (RR, 2.5 95% CI, 2.1-2.9), and soccer (RR, 1.6 95% CI, 1.4-1.9). Female student-athletes had significantly longer time loss than male student-athletes (P < .001). The mean number of missed school days did not differ between sexes (P = .70).
Conclusion:
High school female student-athletes have a higher risk for an SRC in all sex-comparable sports except lacrosse. This may be because of biomechanical differences of the head-neck segment, hormonal differences, and the fact that female athletes are more likely to report symptoms after a suspected SRC.
Clinical Relevance:
Despite sex differences in the clinical incidence of SRCs and time loss from participation in high school sports, the numbers of missed school days are relatively similar between sexes.
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Football continues to demonstrate the highest rate of sport-related concussion (SRC) in high school athletics. To mitigate the SRC risk, the Michigan High School Athletic Association (MHSAA) ...implemented rules aimed at reducing the number of collisions occurring in practices.
To estimate the rates of SRC in MHSAA football programs and evaluate progressive limitations to collision practices over 5 consecutive seasons.
Retrospective cohort study.
Michigan high school football.
High school (9th-12th grade) football athletes (>99% male) participating in MHSAA-sanctioned events.
Designated administrators at each school recorded the total number of participating athletes and SRCs (defined as head injuries resulting from athletic participation that required the student-athletes to be withheld from activity after exhibiting signs, symptoms, or behaviors consistent with an SRC) in the MHSAA injury-surveillance system each season (2015-2016 through 2019-2020). Progressive limitations to collision practices occurred across the study period. We estimated athlete-exposures (AEs) as the total number of players multiplied by the total number of possible practices (11 weeks, 4 days each) or competitions (9 weeks, 1 day each) during each season. Incidence rates and rate ratios (RRs) with 95% CIs were used to compare practice and competition SRCs and each season with the most recent season.
A total of 7755 football SRCs were diagnosed across the 5-year period. The overall SRC rate was 8.03 per 10 000 AEs (95% CI = 7.85, 8.21). The competition SRC rate (30.13/10 000 AEs) was higher than the practice rate (3.51/10 000 AEs; RR = 8.58; 95% CI = 8.19, 9.00). The practice SRC rate was lower in 2017-2018 (RR = 0.86; 95% CI = 0.77, 0.97), 2018-2019 (RR = 0.89; 95% CI = 0.79, 1.0), and 2019-2020 (RR = 0.83; 95% CI = 0.74, 0.94) relative to 2015-2016.
We found that the progressive limitations to collision practices were protective against SRCs, as the rate of SRC was lower in the 3 most recent seasons relative to 2015-2016.
Because of the negative consequences of concussion, considerable research efforts have been directed toward understanding the risk factors for sport-related concussion (SRC) and its outcomes to ...better inform strategies for risk reduction. Girls are suggested to have an increased risk of concussion, warranting exploration into sex-dependent variations in concussion presentation and management, with the potential that this information might inform sex-specific rules directed toward risk reduction within sports.
To compare sex-associated differences in epidemiology and concussion management in adolescent soccer players within a prospective, longitudinal high school injury surveillance project.
This prospective, longitudinal cohort study assessed male and female soccer athletes from all high schools in the Michigan High School Athletic Association (MHSAA) during academic years 2016-2017 to 2018-2019.
Sport-related concussion captured in the MHSAA Head Injury Reporting System.
Outcomes included details regarding each documented SRC event, including injury mechanism, immediate management, and return-to-play time. Multiple comparisons were made between male and female athletes regarding SRC risk, mechanism, short-term management, and outcomes.
A total of 43 741 male and 39 637 female soccer athletes participated in MHSAA soccer during the 3 consecutive academic years of study (2016-2017: n = 751 schools; 2017-2018: n = 750 schools; and 2018-2019: n = 747 schools). During the 3 years of surveillance, 1507 of the 83 378 soccer athletes (1.8%) were reported to have SRC during soccer participation, including 557 boys (37.0%) and 950 girls (63.0%). Documented SRC risk in female soccer participants was greater than in male soccer participants (risk ratio, 1.88; 95% CI, 1.69-2.09; P < .001). Male soccer athletes most often sustained SRC from contact with another player (48.4%), whereas SRCs in female soccer players recorded in the Head Injury Reporting System were most often from nonplayer contact events (41.9%; P < .001). Adolescent male soccer players with a documented SRC were more likely to be removed from play on the day of injury (odds ratio, 1.54; 95% CI, 1.15-2.06; P = .004). Although the overall median time to return to play was 11 days (interquartile range IQR, 7-15 days), male athletes typically returned 2 days earlier than female athletes (median, 10 IQR, 7-14 days vs 12 IQR, 7-16 days; Peto test P < .001).
In this cohort study, sex-associated differences were revealed among adolescent soccer athletes in SRC risk, mechanism of injury, immediate management, and outcomes in injuries documented in a statewide injury reporting system. Thus, consideration might be given to sex-specific approaches to participation and concussion management in the sport.
Despite the clinical utility of baseline comparisons during concussion assessments, little evidence exists on long-term test-retest reliability of baseline tests in youth athletes. In addition, sex ...differences in baseline performance are inconsistent in youth athletes, warranting further research. The purpose was to examine sex differences, prevalence of false-positive scores, and long-term test-retest reliability of the King-Devick (KD) test. Healthy youth athletes (23 males, 28 females) completed the KD test prior to the Spring 2016 and Fall 2017 seasons. Two-way random-effects intraclass correlation coefficients (ICCs) were utilized to determine test-retest reliability. A mixed between-within ANOVA with post-hoc t-tests were used to identify the interaction between sex and season, and frequencies were used to determine abnormal test score prevalence. The KD test demonstrated good test-retest reliability (0.7795% CI, 0.43–0.89), with 11.8% of youth athletes having clinically meaningful improvements between Season 1 to Season 2. There was a significant sex*season interaction (F(1,49) = 4.67, p = .04), with significantly greater improvements between seasons in male youth athletes compared to female youth athletes. However, 33–35% of youth athletes displayed abnormal test scores in Season 2 relative to Season 1. The KD test demonstrated good reliability and only a small percentage had clinically meaningful changes, however a high prevalence of false-positive scores were observed in this sample.
•Youth soccer athletes demonstrated good long-term test-retest reliability on the King-Devick (KD) test.•33-35% of youth athletes displayed abnormal KD test scores at a retest 1.5 seasons following first baseline administration.•Overall, females demonstrated faster KD test times; however, males had significantly faster improvements at retest compared to females.
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Understanding time loss resulting from sport-related concussion (SRC) within individual sports allows high school athletic trainers to provide accurate and evidence-based clinical information. ...Currently, research regarding patterns of clinical recovery outcomes in high school student-athletes across sports is lacking.
To describe the time to authorized unrestricted return to participation (RTP) after SRC in a large cohort of high school student-athletes in a variety of sports using a time-to-event analysis.
Descriptive epidemiology study.
Aggregate injury and player exposure data from the Michigan High School Athletic Association Head Injury Reporting System.
High school student-athletes.
Dates for SRC injury events and authorized unrestricted RTP were entered into the Head Injury Reporting System for each case and were used to calculate time to unrestricted RTP. Survival analysis indicated the time to authorized RTP for males and females in weekly increments across sports and academic years. Separate Kaplan-Meier analyses adjusted for SRC cases with a history of concussion also identified the proportions of student-athletes who obtained authorized medical clearance in weekly increments.
A total of 15 821 SRCs, 10 375 (65.6%) in males and 5446 (34.4%) in females, were reported during the 2015-2016 through 2018-2019 academic years. The median time to authorized unrestricted RTP was 11 days for all patients. Approximately 30% of concussed student-athletes were not cleared for unrestricted RTP by 14 days after their SRC diagnosis, with 13% taking longer than 21 days to return to unrestricted RTP after SRC.
The results from this multisite, state-based injury surveillance system indicated that it is not abnormal for high school student-athletes to take longer than 14 days to fully recover from an SRC. This information may be useful for educating high school student-athletes and sport stakeholders, normalizing SRC recovery trajectory perceptions, and establishing realistic RTP timeline expectations.
Background:
The current evidence for acute management practices of sport-related concussion (SRC) is often limited to in-clinic visits, with limited studies identifying professionals in early SRC ...care and the association with prolonged recovery outcomes.
Purpose:
To describe acute SRC management practices (ie, the personnel in the initial evaluations, removal from activity) and test the association with prolonged return to sport (RTS) time.
Study Design:
Descriptive epidemiology study.
Methods:
We conducted a retrospective cohort study of 17,081 high school SRCs accrued between the 2015-2016 and 2020-2021 academic years. We reported acute management practices and RTS time as frequencies stratified by sex, sport, and event type and compared athletic trainer (AT) access in initial evaluation with chi-square tests (P < .05). Separate logistic regressions estimated odds ratios (ORs) and 95% CIs for removal from activity and prolonged RTS >21 days by acute management practices.
Results:
Most SRCs (n = 12,311 72.1%) had complete initial evaluation by an AT. Boys had an AT evaluation in 75.5% (n = 2860/3787) of practice-related and 74.8% (n = 5551/7423) of competition-related events. Girls had an AT evaluation in 61.3% (n = 1294/2110) of practice-related and 69.3% (n = 2606/3761) of competition-related events. In sex-comparable sports (n = 6501), there was no difference between boys (n = 1654/2455 67.4%) and girls (n = 2779/4046 68.7%) having an AT involved in the first evaluation (χ2 = 1.21; P = .27). Notably, 25.3% of girls’ SRCs were evaluated by a coach alone, and we observed differences in personnel in initial evaluations by sport. The odds of immediate removal were higher when an AT made the initial evaluation (OR, 2.8 95% CI, 2.54-3.08). The odds of prolonged RTS >21 days was lower for those with an AT in the initial evaluation (OR, 0.74 95% CI, 0.65-0.84) adjusting for significant factors from univariate analyses, boys relative to girls (OR, 0.85 95% CI, 0.76-0.96), specialty care relative to PCP (OR, 2.16 95% CI, 1.90-2.46), specialty care relative to urgent or ready care (OR, 0.99 95% CI, 0.82-1.22) concussion history (OR, 1.41 95% CI, 1.22-1.63), and removal from activity (OR, 0.90 95% CI, 0.78-1.05).
Conclusion:
This study found variability in personnel involved in initial SRC evaluations, with higher percentages of athletes with SRCs having ATs make the initial evaluation during competitive events. There was no association between sex and AT involvement in comparable sports. There was an association between prolonged RTS and AT involvement, sex, concussion history, and location of follow-up care.
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