State of play on sports-related brain injuries

Organisation: Position: Deadline Date: Location:

Sports-related concussion (also known as mild traumatic brain injury or TBI) and possible sequelae such as CTE (chronic traumatic encephalopathy) are hot topics that can be found daily in news outlets and often as story lines in movies and TV shows, EurekAlert reports.

In March, the NFL (National Football League) conceded a link between football and CTE, and The New York Times reported a connection between the NFL and earlier faulty research on concussion.

Most symptoms of concussion – headaches, confusion, dizziness, amnesia, temporary loss of consciousness etc – are mild and short lived. However, some concussions or series of concussions are accompanied by sequelae such as post-concussion syndrome (prolongation of symptoms), second impact syndrome (rapid, severe [and sometimes fatal] brain swelling brought about by a second concussion sustained before the first concussion has healed), and CTE (a neurodegenerative disease whose symptoms may not appear until years after the last injury).

Although most accounts focus on professional athletes, a far greater number of people affected by sports-related concussions are found closer to home – down the street, next door or upstairs. Heightened press interest in concussions and their sequelae has stirred worry in the parents of young athletes and suspicion in the minds of citizens who don’t know whose spin to believe. There is a lot of information and misinformation about concussion, and it is up to medical science to provide accurate reports.

The April issue of Neurosurgical Focus offers 12 articles presenting the most up-to-date knowledge of what constitutes sports-related concussion and more severe TBIs, the latest diagnostic assessment tools, the neuropathology underlying symptoms, complications that may arise, prevention, and case management strategies.

Two articles examine statistics on patients admitted to the hospital for TBIs sustained while participating in five sport categories: fall and interpersonal contact sports, skiing/snowboarding, roller skates/skateboards, equestrian sports, and aquatic sports. These articles describe the incidence of injuries associated with these sports and characterize predictors of outcomes in patients of all ages:

  • “Adult sports-related traumatic brain injury in United States trauma centers” by Winkler et al.
  • “Pediatric sports-related traumatic brain injury in United States trauma centers” by Yue et al.

A review article follows, providing details on the diagnosis of concussion based on symptoms and discussing the potential for neuroimaging as a diagnostic tool in the future. The authors describe associated injuries such as axonal injury, brain contusion, and intracranial hemorrhage, as well as complications such as skull fracture, cervical spine injury, and eye injury. Treatment strategies are reviewed; and current knowledge about the pathological characteristics of concussion, post-concussion syndrome, second impact syndrome, and CTE is included.

  • “Sports related concussions: diagnosis, complications, and current management strategies” by Hobbs et al.

These subjects are taken up in other articles as well.

Two articles provide information on assessment tools used to diagnose concussion on the sideline during a game and in the clinical setting.

  • “The Sport Concussion Assessment Tool: a systematic review” by Yengo-Kahn et al.
  • “Clinical evaluation of concussion: the evolving role of oculomotor assessments” by Sussman et al.

The difficult decision of when young athletes must be advised to retire from play to prevent further injury is described. Variables indicating this eventuality are discussed and illustrative cases are provided.

  • “Retirement-from-sport considerations following pediatric sports-related concussion: case illustrations and institutional approach” by Ellis et al.

Relationships between TBIs and pre-existing brain disorders as well as cervical spine injuries are discussed, based on systematic reviews and analyses of pertinent scientific literature. Although not a TBI, a cervical spine injury can also result from a hit to the head during play.

  • “Sport-related structural brain injury associated with arachnoid cysts: a systematic review and quantitative analysis” by Zuckerman et al.
  • “Cervical spine surgery in professional athletes: a systematic review” by Joaquim et al.

Traumatic brain injuries associated with cricket and rugby are discussed in light of helmets. Although so far no helmet has been developed to prevent concussion from occurring, developments in helmet shells and padding have prevented many more serious TBIs. Unfortunately, some players may place too much trust in helmets, leading them to play more aggressively while wearing them.

  • “Craniofacial injuries in professional cricket: no more a red herring” by Tripathi et al.
  • “Rugby headgear and concussion prevention; misconceptions could increase aggressive play” by Menger et al. [accompanied by a podcast]

Last, two sequelae of concussion are discussed: post-concussion syndrome and CTE. Authors found five factors in college athletes that heighten their risk of developing post-concussion syndrome. With respect to CTE, one article examines the pathology of sports-related TBI and CTE, and the potential of various neuroimaging modalities and biological markers in their diagnosis. So far, a diagnosis of CTE has only been possible at autopsy. The other article discusses common questions about CTE and proposes directions for new research.

  • “Predictors of postconcussion syndrome in collegiate student-athletes,” by Zuckerman et al.
  • “Sports-related brain injuries: connecting pathology to diagnosis” by Pan et al.
  • “The science and questions surrounding chronic traumatic encephalopathy,” by Ban et al.

“Sports-related traumatic brain injury (TBI) is an important public health concern estimated to affect 300,000 to 3.8 million people annually in the United States. . . . Approximately 70%-90% of all TBIs are comparatively mild and frequently given the colloquial term ‘concussion’. – Winkler et al., Neurosurg Focus 40:E4, April 2016

Link to Neurosurgical Focus

 

ARTICLES AND ABSTRACTS

1- “Adult sports-related traumatic brain injury in United States trauma centers”
Ethan A. Winkler, John K. Yue, John F. Burke, Andrew K. Chan, Sanjay S. Dhall, Mitchel S. Berger, Geoffrey T. Manley and Phiroz E. Tarapore
Abstract

Sports-related traumatic brain injury (TBI) is an important public health concern estimated to affect 300,000 to 3.8 million people annually in the United States. Although injuries to professional athletes dominate the media, this group represents only a small proportion of the overall population. Here, the authors characterize the demographics of sports-related TBI in adults from a community-based trauma population and identify predictors of prolonged hospitalization and increased morbidity and mortality rates.

METHODS: Utilizing the National Sample Program of the National Trauma Data Bank (NTDB), the authors retrospectively analyzed sports-related TBI data from adults (age ≥ 18 years) across 5 sporting categories—fall or interpersonal contact (FIC), roller sports, skiing/snowboarding, equestrian sports, and aquatic sports. Multivariable regression analysis was used to identify predictors of prolonged hospital length of stay (LOS), medical complications, inpatient mortality rates, and hospital discharge disposition. Statistical significance was assessed at α < 0.05, and the Bonferroni correction for multiple comparisons was applied for each outcome analysis.

RESULTS: From 2003 to 2012, in total, 4788 adult sports-related TBIs were documented in the NTDB, which represented 18,310 incidents nationally. Equestrian sports were the greatest contributors to sports-related TBI (45.2%). Mild TBI represented nearly 86% of injuries overall. Mean (± SEM) LOSs in the hospital or intensive care unit (ICU) were 4.25 ± 0.09 days and 1.60 ± 0.06 days, respectively. The mortality rate was 3.0% across all patients, but was statistically higher in TBI from roller sports (4.1%) and aquatic sports (7.7%). Age, hypotension on admission to the emergency department (ED), and the severity of head and extracranial injuries were statistically significant predictors of prolonged hospital and ICU LOSs, medical complications, failure to discharge to home, and death. Traumatic brain injury during aquatic sports was similarly associated with prolonged ICU and hospital LOSs, medical complications, and failure to be discharged to home.

CONCLUSIONS: Age, hypotension on ED admission, severity of head and extracranial injuries, and sports mechanism of injury are important prognostic variables in adult sports-related TBI. Increasing TBI awareness and helmet use—particularly in equestrian and roller sports—are critical elements for decreasing sports-related TBI events in adults.

“Adult sports-related traumatic brain injury in United States trauma centers”

2- “Pediatric sports-related traumatic brain injury in United States trauma centers”

John K. Yue, Ethan A. Winkler,  John F. Burke, Andrew K. Chan, Sanjay S. Dhall, Mitchel S. Berger, Geoffrey T. Manley and Phiroz E. Tarapore

 Abstract
 Traumatic brain injury (TBI) in children is a significant public health concern estimated to result in over 500,000 emergency department (ED) visits and more than 60,000 hospitalizations in the United States annually. Sports activities are one important mechanism leading to pediatric TBI. In this study, the authors characterize the demographics of sports-related TBI in the pediatric population and identify predictors of prolonged hospitalization and of increased morbidity and mortality rates.

METHODS: Utilizing the National Sample Program of the National Trauma Data Bank (NTDB), the authors retrospectively analyzed sports-related TBI data from children (age 0–17 years) across 5 sports categories: fall or interpersonal contact (FIC), roller sports, skiing/snowboarding, equestrian sports, and aquatic sports. Multivariable regression analysis was used to identify predictors of prolonged length of stay (LOS) in the hospital or intensive care unit (ICU), medical complications, inpatient mortality rates, and hospital discharge disposition. Statistical significance was assessed at α < 0.05, and the Bonferroni correction (set at significance threshold p = 0.01) for multiple comparisons was applied in each outcome analysis.

RESULTS: From 2003 to 2012, in total 3046 pediatric sports-related TBIs were recorded in the NTDB, and these injuries represented 11,614 incidents nationally after sample weighting. Fall or interpersonal contact events were the greatest contributors to sports-related TBI (47.4%). Mild TBI represented 87.1% of the injuries overall. Mean (± SEM) LOSs in the hospital and ICU were 2.68 ± 0.07 days and 2.73 ± 0.12 days, respectively. The overall mortality rate was 0.8%, and the prevalence of medical complications was 2.1% across all patients. Severities of head and extracranial injuries were significant predictors of prolonged hospital and ICU LOSs, medical complications, failure to discharge to home, and death. Hypotension on admission to the ED was a significant predictor of failure to discharge to home (OR 0.05, 95% CI 0.03–0.07, p < 0.001). Traumatic brain injury incurred during roller sports was independently associated with prolonged hospital LOS compared with FIC events (mean increase 0.54 ± 0.15 days, p < 0.001).

CONCLUSIONS: In pediatric sports-related TBI, the severities of head and extracranial traumas are important predictors of patients developing acute medical complications, prolonged hospital and ICU LOSs, in-hospital mortality rates, and failure to discharge to home. Acute hypotension after a TBI event decreases the probability of successful discharge to home. Increasing TBI awareness and use of head-protective gear, particularly in high-velocity sports in older age groups, is necessary to prevent pediatric sports-related TBI or to improve outcomes after a TBI.

“Pediatric sports-related traumatic brain injury in United States trauma centers”
 3- “Sports-related concussions: diagnosis, complications, and current management strategies”

Jonathan G. Hobbs, Jacob S. Young and Julian E. Bailes

Abstract

Sports-related concussions (SRCs) are traumatic events that affect up to 3.8 million athletes per year. The initial diagnosis and management is often instituted on the field of play by coaches, athletic trainers, and team physicians.

SRCs are usually transient episodes of neurological dysfunction following a traumatic impact, with most symptoms resolving in 7–10 days; however, a small percentage of patients will suffer protracted symptoms for years after the event and may develop chronic neurodegenerative disease. Rarely, SRCs are associated with complications, such as skull fractures, epidural or subdural hematomas, and edema requiring neurosurgical evaluation.

Current standards of care are based on a paradigm of rest and gradual return to play, with decisions driven by subjective and objective information gleaned from a detailed history and physical examination. Advanced imaging techniques such as functional MRI, and detailed understanding of the complex pathophysiological process underlying SRCs and how they affect the athletes acutely and long-term, may change the way physicians treat athletes who suffer a concussion.

It is hoped that these advances will allow a more accurate assessment of when an athlete is truly safe to return to play, decreasing the risk of secondary impact injuries, and provide avenues for therapeutic strategies targeting the complex biochemical cascade that results from a traumatic injury to the brain.

“Sports-related concussions: diagnosis, complications, and current management strategies”
 4- “The Sport Concussion Assessment Tool: A systematic review”

Aaron M. Yengo-Kahn, Andrew T. Hale, Brian H. Zalneraitis, Scott L. Zuckerman, Allen K. Sills and Gary S. Solomon

Abstract

Over the last 2 decades, sport-related concussion (SRC) has garnered significant attention. Even with increased awareness and athlete education, sideline recognition and real-time diagnosis remain crucial. The need for an objective and standardized assessment of concussion led to the eventual development of the Sport Concussion Assessment Tool (SCAT) during the Second International Conference on Concussion in Sport in 2004, which is now in its third iteration (SCAT3). In an effort to update our understanding of the most well-known sideline concussion assessment, the authors conducted a systematic review of the SCAT and the evidence supporting its use to date.

METHODS: English-language titles and abstracts published between 1995 and October 2015 were searched systematically across 4 electronic databases and a review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines adapted for the review of a heterogeneous collection of study designs. Peer-reviewed journal articles were included if they reported quantitative data on any iteration of the SCAT, Standardized Assessment of Concussion (SAC), or modified Balance Error Scoring System (mBESS) data at baseline or following concussion in an exclusively athlete population with any portion older than 13 years of age. Studies that included nonathletes, only children less than 13 years old, exclusively BESS data, exclusively symptom scale data, or a non–SCAT-related assessment were excluded.

RESULTS: The database search process yielded 549 abstracts, and 105 full-text articles were reviewed with 36 meeting criteria for inclusion. Nineteen studies were associated with the SAC, 1 was associated with the mBESS exclusively, and 16 studies were associated with a full iteration of the SCAT. The majority of these studies (56%) were prospective cohort studies. Male football players were the most common athletes studied. An analysis of the studies focused on baseline differences associated with age, sex, concussion history, and the ability to detect an SRC.

CONCLUSIONS: Looking toward the upcoming Concussion in Sport Group meeting in fall 2016, one may expect further revision to the SCAT3. However, based on this systematic review, the authors propose further, in-depth study of an already comprehensive concussion test, with acute, diagnostic, as well as long-term use.

The Sport Concussion Assessment Tool: A systematic review

5- “Clinical evaluation of concussion: The evolving role of oculomotor assessments”Eric S. Sussman, Allen L. Ho, Arjun V. Pendharkar and Jamshid Ghajar

Abstract

Sports-related concussion is a change in brain function following a direct or an indirect force to the head, identified in awake individuals and accounting for a considerable proportion of mild traumatic brain injury. Although the neurological signs and symptoms of concussion can be subtle and transient, there can be persistent sequelae, such as impaired attention and balance, that make affected patients particularly vulnerable to further injury.

Currently, there is no accepted definition or diagnostic criteria for concussion, and there is no single assessment that is accepted as capable of identifying all patients with concussion. In this paper, the authors review the available screening tools for concussion, with particular emphasis on the role of visual function testing. In particular, they discuss the oculomotor assessment tools that are being investigated in the setting of concussion screening.

“Clinical evaluation of concussion: The evolving role of oculomotor assessments”
6- “Retirement-from-sport considerations following pediatric sports-related concussion: Case illustrations and institutional approach”

Michael J. Ellis, Patrick J. McDonald, Dean Cordingley, Behzad Mansouri, Marco Essig and Lesley Ritchie

Abstract

The decision to advise an athlete to retire from sports following sports-related concussion (SRC) remains a persistent challenge for physicians. In the absence of strong empirical evidence to support recommendations, clinical decision making must be individualized and should involve a multidisciplinary team of experts in concussion and traumatic brain injury. Although previous authors have advocated for a more conservative approach to these issues in child and adolescent athletes, there are few reports outlining considerations for this process among this unique population.

Here, the authors use multiple case illustrations to discuss 3 subgroups of clinical considerations for sports retirement among pediatric SRC patients including the following: those with structural brain abnormalities identified on neuroimaging, those presenting with focal neurological deficits and abnormalities on physical examination, and those in whom the cumulative or prolonged effects of concussion are suspected or demonstrated. The authors’ evolving multidisciplinary institutional approach to return-to-play and retirement decision making in pediatric SRC is also presented.

“Retirement-from-sport considerations following pediatric sports-related concussion: Case illustrations and institutional approach”

7- “Sport-related structural brain injury associated with arachnoid cysts: A systematic review and quantitative analysis”

Scott L. Zuckerman, Colin T. Prather, Aaron M. Yengo-Kahn, Gary S. Solomon, Allen K. Sills and Christopher M. Bonfield

Abstract

Arachnoid cysts (ACs) are congenital lesions bordered by an arachnoid membrane. Researchers have postulated that individuals with an AC demonstrate a higher rate of structural brain injury after trauma. Given the potential neurological consequences of a structural brain injury requiring neurosurgical intervention, the authors sought to perform a systematic review of sport-related structural-brain injury associated with ACs with a corresponding quantitative analysis.

METHODS: Titles and abstracts were searched systematically across the following databases: PubMed, Embase, CINAHL, and PsycINFO. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Peer-reviewed case reports, case series, or observational studies that reported a structural brain injury due to a sport or recreational activity (hereafter referred to as sport-related) with an associated AC were included. Patients were excluded if they did not have an AC, suffered a concussion without structural brain injury, or sustained the injury during a non–sport-related activity (e.g., fall, motor vehicle collision). Descriptive statistical analysis and time to presentation data were summarized. Univariate logistic regression models to assess predictors of neurological deficit, open craniotomy, and cystoperitoneal shunt were completed.

RESULTS: After an initial search of 994 original articles, 52 studies were found that reported 65 cases of sport-related structural brain injury associated with an AC. The median age at presentation was 16 years (range 4–75 years). Headache was the most common presenting symptom (98%), followed by nausea and vomiting in 49%. Thirteen patients (21%) presented with a neurological deficit, most commonly hemiparesis. Open craniotomy was the most common form of treatment (49%). Bur holes and cyst fenestration were performed in 29 (45%) and 31 (48%) patients, respectively. Seven patients (11%) received a cystoperitoneal shunt. Four cases reported medical management only without any surgical intervention. No significant predictors were found for neurological deficit or open craniotomy. In the univariate model predicting the need for a cystoperitoneal shunt, the odds of receiving a shunt decreased as age increased (p = 0.004, OR 0.62 [95% CI 0.45–0.86]) and with male sex (p = 0.036, OR 0.15 [95% CI 0.03–0.88]).

CONCLUSIONS: This systematic review yielded 65 cases of sport-related structural brain injury associated with ACs. The majority of patients presented with chronic symptoms, and recovery was reported generally to be good. Although the review is subject to publication bias, the authors do not find at present that there is contraindication for patients with an AC to participate in sports, although parents and children should be counseled appropriately. Further studies are necessary to better evaluate AC characteristics that could pose a higher risk of adverse events after trauma.

“Sport-related structural brain injury associated with arachnoid cysts: A systematic review and quantitative analysis”
8- “Cervical spine surgery in professional athletes: A systematic review”

Andrei F. Joaquim, Wellington K. Hsu and Alpesh A. Patel

Abstract

Cervical surgery is one of the most common surgical spinal procedures performed around the world. The authors performed a systematic review of the literature reporting the outcomes of cervical spine surgery in high-level athletes in order to better understand the nuances of cervical spine pathology in this population.

A search of the MEDLINE database using the search terms “cervical spine” AND “surgery” AND “athletes” yielded 54 abstracts. After exclusion of publications that did not meet the criteria for inclusion, a total of 8 papers reporting the outcome of cervical spine surgery in professional or elite athletes treated for symptoms secondary to cervical spine pathology (focusing in degenerative conditions) remained for analysis. Five of these involved the management of cervical disc herniation, 3 were specifically about traumatic neurapraxia.

The majority of the patients included in this review were American football players. Anterior cervical discectomy and fusion (ACDF) was commonly performed in high-level athletes for the treatment of cervical disc herniation.

Most of the studies suggested that return to play is safe for athletes who are asymptomatic after ACDF for cervical radiculopathy due to disc herniation. Surgical treatment may provide a higher rate of return to play for these athletes than nonsurgical treatment. Return to play after cervical spinal cord contusion may be possible in asymptomatic patients. Cervical cord signal changes on MRI may not be an absolute contraindication for return to play in neurologically intact patients, according to some authors. Cervical contusions secondary to cervical stenosis may be associated with a worse outcome and a higher recurrence rate than those those secondary to disc herniation. The evidence is low (Level IV) and individualized treatment must be recommended.

“Cervical spine surgery in professional athletes: A systematic review”

9- Craniofacial injuries in professional cricket: no more a red herring

Manjul Tripathi, Dhaval P. Shukla, Dhananjaya Ishwar Bhat, Indira Devi Bhagavatula and Tejesh Mishra

Abstract

The issue of head injury in a noncontact sport like cricket is a matter of great debate and it carries more questions than answers. Recent incidents of fatal head injuries in individuals wearing a helmet have caused some to question the protective value of the helmet.The authors discuss the pattern, type of injury, incidents, and location of cranio-facio-ocular injuries in professional cricket to date. They evaluate the history of usage of the helmet in cricket, changes in design, and the protective value, and they compare the efficacy of various sports’ helmets with injury profiles similar to those in cricket. The drop test and air cannon test are compared for impact energy attenuation performance of cricket helmets. A total of 36 cases of head injuries were identified, of which 5 (14%) were fatal and 9 (22%) were career-terminating events.

Batsmen are the most vulnerable to injury, bearing 86% of the burden, followed by wicketkeepers (8%) and fielders (5.5%). In 53% of cases, the ball directly hit the head, while in 19.5% of cases the ball entered the gap between the peak and the faceguard. Ocular injuries to 3 wicketkeepers proved to be career-terminating injuries. The air cannon test is a better test for evaluating cricket helmets than the drop test. Craniofacial injuries are more common than popularly believed.

There is an urgent need to improve the efficacy and compliance of protective restraints in cricket. A strict injury surveillance system with universal acceptance is needed to identify the burden of injuries and modes for their prevention.

“Craniofacial injuries in professional cricket: No more a red herring”
10- “Rugby headgear and concussion prevention: Misconceptions could increase aggressive play”

Richard Menger, Austin Menger and Anil Nanda

Abstract

Multiple studies have illustrated that rugby headgear offers no statistically significant protection against concussions. However, there remains concern that many players believe rugby headgear in fact does prevent concussions. Further investigation was undertaken to illustrate that misconceptions about concussion prevention and rugby headgear may lead to an increase in aggressive play.

METHODS: Data were constructed by Internet survey solicitation among United States collegiate rugby players across 19 teams. Initial information given was related to club, age, experience, use of headgear, playing time, whether the rugger played football or wrestling in high school, and whether the player believed headgear prevented concussion. Data were then constructed as to whether wearing headgear would increase aggressive playing style secondary to a false sense of protection.

RESULTS: A total of 122 players responded. All players were male. The average player was 19.5 years old and had 2.7 years of experience. Twenty-three of 122 players (18.9%) wore protective headgear; 55.4% of players listed forward as their primary position. Overall, 45.8% (55/120) of players played 70–80 minutes per game, 44.6% (54/121) played football or wrestled in high school, 38.1% (45/118) believed headgear prevented concussions, and 42.2% (51/121) stated that if they were using headgear they would be more aggressive with their play in terms of running or tackling. Regression analysis illustrated that those who believed headgear prevented concussions were or would be more likely to engage in aggressive play (p = 0.001).

CONCLUSIONS: Nearly 40% of collegiate rugby players surveyed believed headgear helped to prevent concussions despite no scientific evidence that it does. This misconception about rugby headgear could increase aggressive play. Those who believed headgear prevented concussion were, on average, 4 times more likely to play with increased aggressive form than those who believed headgear did not prevent concussions (p = 0.001). This can place all players at increased risk without providing additional protection. Further investigation is warranted to determine if headgear increases the actual measured incidence of concussion among rugby players in the United States.

Rugby headgear and concussion prevention: Misconceptions could increase aggressive play
11- “Predictors of postconcussion syndrome in collegiate student-athletes”

Scott L. Zuckerman, Aaron M. Yengo-Kahn, Thomas A. Buckley, Gary S. Solomon, Allen K. Sills and Zachary Y. Kerr

Abstract

Sport-related concussion (SRC) has emerged as a public health problem, especially among student-athletes. Whereas most concussions resolve by 2 weeks, a minority of patients experience postconcussion syndrome (PCS), in which symptoms persist for months. The objective of this study was to elucidate factors predictive of PCS among a sample of National Collegiate Athletic Association (NCAA) student-athletes in the academic years 2009–2010 to 2014–2015.

METHODS: The SRC data originated from the NCAA Injury Surveillance Program (ISP) in the 2009–2010 to 2014–2015 academic seasons. The NCAA ISP is a prospective database made up of a convenience sample of schools across all divisions. All SRCs are reported by certified athletic trainers.

The PCS group consisted of concussed student-athletes with concussion-related symptoms that lasted ≥ 4 weeks. The non-PCS group consisted of concussed student-athletes with symptom resolution in ≤ 2 weeks. Those with symptoms that resolved in the intermediate area of 2–4 weeks were excluded. Odds ratios (ORs) were estimated using logistic regression.

RESULTS: During the 2009–2010 to 2014–2015 seasons, 1507 NCAA student-athletes sustained an SRC, 112 (7.4%) of whom developed PCS (i.e., concussion-related symptoms that lasted ≥ 4 weeks). Men’s ice hockey contributed the largest proportion of concussions to the PCS group (28.6%), whereas men’s football contributed the largest proportion of concussions in the non-PCS group (38.6%).

In multivariate analysis, recurrent concussion was associated with increased odds of PCS (OR 2.08, 95% CI 1.28–3.36). Concussion symptoms that were also associated with increased odds of PCS included retrograde amnesia (OR 2.75, 95% CI 1.34–5.64), difficulty concentrating (OR 2.35, 95% CI 1.23–4.50), sensitivity to light (OR 1.97, 95% CI 1.09–3.57), and insomnia (OR 2.19, 95% CI 1.30–3.68). Contact level, sex, and loss of consciousness were not associated with PCS.

CONCLUSIONS: Postconcussion syndrome represents one of the most impactful sequelae of SRC. In this study of exclusively collegiate student-athletes, the authors found that recurrent concussions and various concussion-related symptoms were associated with PCS. The identification of initial risk factors for the development of PCS may assist sports medicine clinicians in providing timely interventions and treatments to prevent morbidity and shorten recovery time after SRC.

“Predictors of postconcussion syndrome in collegiate student-athletes”
12- “Sports-related brain injuries: connecting pathology to diagnosis”

James Pan, BS1,*, Ian D. Connolly, MS1, Sean Dangelmajer, BA2, James Kintzing, BS3, Allen L. Ho, MD1, and Gerald Grant, MD1

Abstract

Brain injuries are becoming increasingly common in athletes and represent an important diagnostic challenge. Early detection and management of brain injuries in sports are of utmost importance in preventing chronic neurological and psychiatric decline. These types of injuries incurred during sports are referred to as mild traumatic brain injuries, which represent a heterogeneous spectrum of disease.The most dramatic manifestation of chronic mild traumatic brain injuries is termed chronic traumatic encephalopathy, which is associated with profound neuropsychiatric deficits.

Because chronic traumatic encephalopathy can only be diagnosed by postmortem examination, new diagnostic methodologies are needed for early detection and amelioration of disease burden. This review examines the pathology driving changes in athletes participating in high-impact sports and how this understanding can lead to innovations in neuroimaging and biomarker discovery.

Sports-related brain injuries: connecting pathology to diagnosis

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