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Johnson A, Van Tubbergen M, Hashikawa A, Ichesco I, Almeida A, Kolberg K, Larson J. Differences in concussion knowledge between parents and their children in a multidisciplinary concussion clinic sample. J Pediatr Rehabil Med 2023; 16:301-309. [PMID: 36847020 DOI: 10.3233/prm-210058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
PURPOSE This study assessed concussion knowledge in concussed youth and parents treated at a multi-disciplinary concussion center. METHODS Youth (n = 50) and parents (n = 36) were approached at the beginning of a clinical visit. Participants completed a 22-item, previously published concussion knowledge survey before the visit. RESULTS Responses were compared with previously collected, published data from adolescents in a high school setting (n = 500). The patient group was divided into those with one (n = 23) vs. two or more concussions (n = 27). Chi-square analyses compared total correct responses between youth, parents, and the high school sample. T-tests assessed differences in knowledge based on prior concussions, age, and gender. All groups showed high accuracy for return-to-play guidelines (>90%) and similar knowledge of concussion-related symptoms (72.3% vs. 68.6%). Significant knowledge gaps about diagnosis, neurological consequences, and long-term risks were present across groups (19% to 68% accuracy). The patient group more often misattributed neck symptoms to concussion (X2 < 0.005). Prior concussion and gender were not significant predictors of concussion knowledge (p > 0.5). CONCLUSION Community and clinically-based educational techniques may not be effectively communicating knowledge about concussion diagnosis, symptoms, long-term risks, and neurological implications of concussion. Educational tools need to be tailored to specific settings and populations.
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Affiliation(s)
- Abigail Johnson
- University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | | | | | - Ingrid Ichesco
- University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | - Andrea Almeida
- University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Jennifer Larson
- University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
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Cross-Cultural Adaptation of the Urdu Version of Rosenbaum Concussion Knowledge and Attitude Survey—Student Version in Pakistan. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2023. [DOI: 10.1123/jcsp.2022-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Evaluating athletes’ knowledge of and attitudes toward sports-related concussions is important. However, there is limited research involving South Asian athletes, partly due to the lack of a valid and reliable tool. This study, therefore, aimed to translate and validate the Rosenbaum Concussion Knowledge and Attitude Survey—Student Version, an established tool used to measure knowledge and attitude toward concussion, into Urdu. Rosenbaum Concussion Knowledge and Attitude Survey—Student Version was translated into Urdu using the standard guidelines and then completed by 369 athletes participating in contact sports at different universities in Pakistan. Confirmatory factor analysis was performed on the Concussion Attitude Index items to examine the underlying factorial structure. Construct validity of Concussion Attitude Index factors was also investigated using convergent and discriminant validity. The results showed that the Urdu version of the Rosenbaum Concussion Knowledge and Attitude Survey—Student Version has good psychometric properties and is a valid and reliable tool for evaluating Urdu-speaking athletes’ knowledge of and attitudes toward concussions.
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Roberts SD, Schatz P, Register-Mihalik J, Wojtowicz M. Parent knowledge of and attitudes towards youth sport-related concussion and associations with child and parent factors. Concussion 2021; 6:CNC93. [PMID: 35433025 PMCID: PMC9008503 DOI: 10.2217/cnc-2021-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/11/2022] [Indexed: 11/21/2022] Open
Abstract
Aim: This cross-sectional study aimed to better understand parental knowledge and attitudes regarding pediatric sport-related concussions, and association with parent/child biopsychosocial factors. Methods: A community sample of ninety families (n = 140 children) were included. Parental concussion knowledge and attitudes, concussion history, sport participation and social risk status score (SRS) were collected. Results: Parents scored an average of 76% accuracy on factual concussion knowledge, with 74% confidence in responses. Parents endorsed a favorable attitude toward concussion reporting and management. Low SRS had higher perceived accuracy of knowledge than medium or high SRS (p = 0.003). SRS influenced over-and-underestimations of factual knowledge (p = .04). Age at first sport and sport contact level influenced factual and perceived concussion knowledge. Conclusion: These findings identify common gaps in concussion knowledge in parents.
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Affiliation(s)
| | - Phillip Schatz
- Department of Psychology, Saint Joseph's University, Philadelphia, PA 19131, USA
| | - Johna Register-Mihalik
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC 27514, USA
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Begonia MT, Knapp AM, Prabhu RK, Liao J, Williams LN. Shear-deformation based continuum-damage constitutive modeling of brain tissue. J Biomech 2021; 117:110260. [PMID: 33515903 DOI: 10.1016/j.jbiomech.2021.110260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 11/19/2022]
Abstract
Traumatic brain injury (TBI) is a leading cause of death in the United States. Depending on the severity of injury, complications such as memory loss and emotional changes are common. While the exact mechanisms are still unclear, these cognitive deficiencies are thought to arise from microstructural damages to the brain tissue, such as in diffuse-axonal injury where neuron fibers are sheared. Constitutive models can predict such damage at a microstructural level and allow for insight into the mechanisms of injury initiating at lower length scales. In this study, we developed a continuum damage model of brain tissue that is validated by experimental quasi-static stress-strain tests in tension, compression, and shear. The present work shows that damage is most present in the shear stress state, making the tissue suitable for damage modeling via shear interaction terms. Using this model, new insights into microstructural breakdown due to shear stresses and strains can be gained by application to simulations.
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Affiliation(s)
- Mark T Begonia
- Virginia Tech Helmet Lab, Institute for Critical Technology and Applied Science (ICTAS), Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, United States
| | - Alexander M Knapp
- Tissue Mechanics, Microstructure, and Modeling Laboratory, Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, United States
| | - R K Prabhu
- Center for Advanced Vehicular Systems, Research Blvd., Starkville, MS 39762, United States
| | - Jun Liao
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX 76010, United States
| | - Lakiesha N Williams
- Tissue Mechanics, Microstructure, and Modeling Laboratory, Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, United States.
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Kahan JB, Salzler M, DiCenzo D, Zink T, Radford Z, Tybor D. High School Athletic Directors Report Poor Compliance With Concussion Reporting and Medical Clearance in Massachusetts. Arthrosc Sports Med Rehabil 2020; 2:e563-e567. [PMID: 33134995 PMCID: PMC7590589 DOI: 10.1016/j.asmr.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 07/01/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To assess statewide prevalence of medical access, concussion reporting, and concussion clearance rates of high school athletic departments in Massachusetts after the implementation of state-wide concussion legislation. Methods A random sample of 50 athletic directors (ADs) from Massachusetts high schools with an enrollment of >150 students was selected. A 10-minute electronic survey about access to athletic trainers and physicians, and concussion reporting and clearance practices was administered. Responses were anonymous. Results The response rate was 80% (n = 40). In total, 90% of respondents were male. Median age and experience of respondents was 52 years old and 10 years, respectively. The median school size was 637 students, represented from all Massachusetts geographic athletic districts. ADs disclosed that on average, 12% (95% confidence interval 7%-20%) of concussions go unreported at their schools. In total, 16% of respondents reported that at least 1 in 4 of concussed athletes at their school returned to play without appropriate medical clearance, and 5% of ADs reported that not all of their coaches had undergone any form of concussion training. Overall, 55% of high schools do not have access to a full-time athletic trainer and 50% do not have a team physician; 20% have affiliations with an orthopaedic surgeon and 8% with a neurologist. Conclusions Despite new regulations in Massachusetts, high school ADs report concussion reporting and clearance that are less than 100%. Less than one half of all Massachusetts high schools report access to a full-time athletic trainer or formal relationship with a school physician. Clinical Relevance Investigating compliance with Massachusetts school athletics safety regulations could help identify a need for reform of policies designed to help schools keep student athletes safer in situations where a concussion may have occurred.
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Affiliation(s)
- Joseph B. Kahan
- Department of Orthopaedics and Rehabilitation, Yale University, New Haven, Connecticut
- Address correspondence to Joseph Kahan, M.D., M.P.H., Department of Orthopaedic Surgery, Yale University, 47 College Ave., New Haven, CT 06511.
| | - Matthew Salzler
- Tufts Medical Center, Department of Orthopaedic Surgery, Boston, Massachusetts, U.S.A
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Danielle DiCenzo
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Thomas Zink
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Zachary Radford
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - David Tybor
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
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Waterworth V, Procyk A, Canetti E, Hing W, Gough S. The influence of education in decision making concerning athlete’s return to sport following a concussion injury: A systematic review. JOURNAL OF CONCUSSION 2020. [DOI: 10.1177/2059700220941985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives Concussions have emerged as one of the most prevalent and controversial injuries sustained within the sporting context. The objective of this review was to determine the influence that education has on decision making concerning athlete’s return to sport following a concussion injury and if the risk is worth it in the eyes of the athletes. Study design Systematic review. Methods A rapid literature review was performed in PubMed, CINAHL, SPORTDiscus, Embase and Web of Science looking for articles that discussed concussions and any three of the four following search terms: (a) decision making, (b) education/knowledge, (c) sport/return to sport and (d) risk. Results Sixteen of 1243 articles were included in this review based on eligibility criteria. Ten were cohort studies, four were cross-sectional studies and two were qualitative research. There was a good agreement between the authors for all studies when determining risk of bias, presenting a Cohen’s κ of 0.901 (95% CI, 0.834, 0.968), p < 0.001. Conclusion Education can make a difference in athlete’s decision making process to return to sport; however, their awareness of the health risks that they put themselves in by returning to sport too soon is clouded by other external and internal factors. What is not fully understood is why do they put themselves at this risk? Further studies should explore athletes’ risk aversion behaviour and how it impacts their decision to return to sport following a concussion.
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Affiliation(s)
- Victoria Waterworth
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Alexander Procyk
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Elisa Canetti
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Wayne Hing
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Suzanne Gough
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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Subramaniam A, Tan RMR, Chan D, Ng ZM, Dong CY, Feng JXY, Chong SL. Assessment of the Understanding of Concussion and Care Protocols Amongst Student Athletes and Coaches: A Qualitative Study. Front Pediatr 2020; 8:526986. [PMID: 33072670 PMCID: PMC7542181 DOI: 10.3389/fped.2020.526986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Pediatric sports-induced concussions have become a topic of interest and concern in the scientific community. Already, the literature is rich with studies that have identified numerous short-term and long-term consequences of childhood sports-induced concussions. However, there are very few studies that have identified how well the students who participate in concussion-prone sports and their coaches understand these consequences and how they can be avoided. This study aimed to explore student athletes' and their coaches' understanding of the concept of concussion and how it is managed both immediately after the injury occurs and during long-term recovery. Methods: This study utilized a qualitative design. The study was conducted in local and international schools in Singapore. Participants were recruited through purposive sampling. 42 student athletes aged 13-18 who participated in rugby, softball, football, cricket, volleyball, and/or water polo were recruited. Fourteen coaches who coached these same sports were also recruited. Four focus groups and three semi-structured interviews were conducted. Data collected were then analyzed with thematic analysis. Risk factors were assessed through four domains of focus: understanding of what concussion is; attitudes toward concussion; existing protocols for treating concussion; and return-to-school and return-to-play protocols. As this is a qualitative study, outcome measures were not identified. Results: Analysis of the data revealed four themes for each group. For student-athletes these included: limited understanding of concussion; non-reporting of injuries; variable supervision of athletes; and a lack of established return-to-school and return-to-play guidelines. For coaches these included: variable understanding of concussion; insufficient formal training in concussion management; limited medical support in managing injuries; and lack of understanding and adherence to return-to-school and return-to-play protocols. Conclusions: Of the themes identified, the most pressing was a lack of clearly defined return-to-play guidelines. This is an urgent issue that needs to be jointly addressed by healthcare professionals and schools with evidence-based guidelines.
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Affiliation(s)
| | - Ronald Ming Ren Tan
- Duke-NUS Medical School, Singapore, Singapore.,Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Derrick Chan
- Duke-NUS Medical School, Singapore, Singapore.,Department of Pediatrics, Neurology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Zhi Min Ng
- Duke-NUS Medical School, Singapore, Singapore.,Department of Pediatrics, Neurology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Chao Yan Dong
- Education Office, Sengkang General Hospital, Singapore, Singapore
| | | | - Shu-Ling Chong
- Duke-NUS Medical School, Singapore, Singapore.,Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore
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Stuart S, Parrington L, Martini DN, Kreter N, Chesnutt JC, Fino PC, King LA. Analysis of Free-Living Mobility in People with Mild Traumatic Brain Injury and Healthy Controls: Quality over Quantity. J Neurotrauma 2020; 37:139-145. [DOI: 10.1089/neu.2019.6450] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Samuel Stuart
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
- Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Lucy Parrington
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
- Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Douglas N. Martini
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
- Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Nicholas Kreter
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
- Veterans Affairs Portland Health Care System, Portland, Oregon
| | - James C. Chesnutt
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
| | - Peter C. Fino
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, Utah
| | - Laurie A. King
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
- Veterans Affairs Portland Health Care System, Portland, Oregon
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Ramsay S, Dahinten S. Concussion Education in Children and Youth: A Scoping Review. SAGE Open Nurs 2020; 6:2377960820938498. [PMID: 33415292 PMCID: PMC7774435 DOI: 10.1177/2377960820938498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/01/2020] [Accepted: 06/07/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Sports-related concussions in children and youth are a significant health concern. There is increasing literature pertaining to levels of knowledge about concussion and the effects of educational interventions, but the literature has not yet been synthesized for the subpopulation of children and youth. Therefore, the purpose of this review was to identify and summarize the current state of the literature on concussion knowledge, and the effect of concussion education on the knowledge, attitudes, and behaviors of children and youth who engage in sports. METHODS A scoping review was conducted, guided by Joanna Briggs Institute methodology. Two databases, MEDLINE and CINAHL (Cumulative Index to Nursing and Allied Health Literature), and reference lists were searched to identify relevant studies that focused on children and youth less than 19 years of age who engage in sports. We also searched Google Scholar for gray literature. RESULTS Of the 21 articles that met inclusion criteria, 15 focused on levels of concussion knowledge, and 6 examined the effects of educational interventions. Children and youths' level of knowledge and exposure to prior concussion education varied, although more of the studies found a lack of concussion knowledge. Educational interventions of various types have been associated with short-term increases in knowledge and intention to report, but few of the studies found sustained effects. CONCLUSIONS Findings highlight the need for improved concussion education for children and youth engaged in sports. Findings also indicate a need for further research using more rigorous methods, and studies that examine subgroup differences in knowledge and factors that may moderate the effects of educational interventions.
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Affiliation(s)
- Scott Ramsay
- School of Nursing, University of British Columbia
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Guo D, Verweel L, Reed N. Exploring Gaps in Concussion Knowledge and Knowledge Translation Among Coaches of Youth Female Hockey. Clin J Sport Med 2019; 29:486-493. [PMID: 31688180 DOI: 10.1097/jsm.0000000000000542] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To better understand the level of concussion knowledge of youth female hockey coaches and to identify preferred methods of knowledge translation for this population. DESIGN Cross-sectional survey. SETTING Participants independently completed written surveys before in-person concussion information sessions or online surveys through link provided in emails. PARTICIPANTS Convenience sampling yielded 130 coaches of youth female hockey from Canada. MAIN OUTCOME MEASURES Knowledge level on concussion, resources from which coaches obtained information on concussion, opinions on the current level of concussion knowledge, and knowledge translation. RESULTS Coaches demonstrated adequate knowledge on concussion, achieving 84% correct on true-false questions and 92% correct on symptom identification accuracy. However, coaches showed limited awareness of concussion specific to mechanisms for injury (identification) and postconcussion symptoms. Internet resources were rated as the most used resources for concussion yet were not rated very helpful. Nonetheless, coaches indicated online courses and web sites as the most preferred method for concussion knowledge translation. CONCLUSIONS Youth female hockey coaches have overall adequate knowledge of concussion; however, gaps in knowledge do exist. Future efforts to raise the concussion knowledge among coaches of female youth hockey should include information specific to the mechanism of injury, along with sign and symptom identification, with particular attention paid to emotional symptoms. Given the reported preferences and the widespread availability of the Internet, further exploration and research validation of online courses and web sites tailored to the youth female hockey community is encouraged.
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Affiliation(s)
- David Guo
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Lee Verweel
- Rehabilitation Science Institute, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Nick Reed
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Science Institute, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
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Abstract
BACKGROUND When participating in contact sports, (mild) head trauma is a common incident-observed in both professional and amateur sports. When head trauma results in transient neurological impairment, a sports-related concussion has occurred. Acute concussion, repetitive concussions, as well as cumulative "sub-concussive" head impacts may increase the risk of developing cognitive and behavioral deficits for athletes, as well as accelerated cerebral degeneration. While this concept has been well established for classic contact sports like American Football, Rugby, or Boxing, there is still an awareness gap for the role of sports-related concussion in the context of the world's most popular sport-Soccer. METHODS Here, we review the relevance of sport-related concussion for Soccer as well as its diagnosis and management. Finally, we provide insight into future directions for research in this field. RESULTS Soccer fulfills the criteria of a contact sport and is characterized by a high incidence of concussion. There is ample evidence that these events cause functional and structural cerebral disorders. Furthermore, heading, as a repeat sub-concussive impact, has been linked to structural brain changes and neurocognitive impairment. As a consequence, recommendations for the diagnosis and management of concussion in soccer have been formulated by consensus groups. In order to minimize the risk of repetitive concussion in soccer the rapid and reliable side-line diagnosis of concussion with adoption of a strict remove-from-play protocol is essential, followed by a supervised, graduated return-to-play protocol. Recent studies, however, demonstrate that adherence to these recommendations by players, coaches, clubs, and officials is insufficient, calling for stricter enforcement. In addition, future research to solidify the pathophysiological relevance of concussion for soccer athletes seems to be needed. Advanced neuroimaging and neurochemical biomarker analyses (e.g. S100β, tau and neurofilament light (NfL)) may assist in detecting concussion-related structural brain changes and selecting athletes at risk for irreversible damage. CONCLUSION Sports-related concussion represents a genuine neurosurgical field of interest. Given the high socioeconomic relevance, neurosurgeons should get involved in prevention and management of concussion in soccer.
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The evolving landscape of policies, rules, and law in sport-related concussion. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:257-267. [PMID: 30482354 DOI: 10.1016/b978-0-444-63954-7.00025-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Beginning in 2009 with the passage of the Zackery Lystedt law in the state of Washington, all 50 states have passed concussion laws that implement a mandatory framework of care for high school and youth athletes. The structure of these laws generally shares the three primary components of the Lystedt law: (1) preseason concussion education; (2) mandatory removal from play with suspected concussion; and (3) clearance from a healthcare professional prior to return to play. These same three policy components are also found at the collegiate and professional levels of sport, either through established policy or labor contracts. This chapter explores concussion-specific legal and policy developments that currently inform concussion management practices across multiple levels of the US athletic system.
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13
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Kirk B, Pugh JN, Cousins R, Phillips SM. Concussion in University Level Sport: Knowledge and Awareness of Athletes and Coaches. Sports (Basel) 2018; 6:sports6040102. [PMID: 30241295 PMCID: PMC6315551 DOI: 10.3390/sports6040102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 11/16/2022] Open
Abstract
Using a cross-sectional survey concussion knowledge was evaluated among forty university-level athletes (n = 20, rugby union players; n = 20, Gaelic football players) and eight experienced team coaches (n = 2, rugby union; n = 2, Gaelic football; n = 1, soccer; n = 1, hockey; n = 1, netball; n = 1, basketball). Levels of knowledge of concussion were high across all participants. Coaches had higher knowledge scores for almost all areas; however, there was evidence of important gaps even in this group. Knowledge was not sufficient in identifying concussion, and when it is safe to return to play following a concussion. Impaired knowledge of how to recognise a concussion, and misunderstanding the need for rest and rehabilitation before return to play presents a hazard to health from second impact and more catastrophic brain injury. We discuss reasons for these guideline misconceptions, and suggest that attitude issues on the significance of concussion may underlie a willingness to want to play with a concussion. This suggests the current education on sport-related concussion needs to be expanded for the appropriate management of university-level contact sports.
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Affiliation(s)
- Ben Kirk
- School of Health Sciences, Liverpool Hope University, Hope Park, Liverpool L16 9JD, UK.
| | - Jamie N Pugh
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UA, UK.
| | - Rosanna Cousins
- School of Health Sciences, Liverpool Hope University, Hope Park, Liverpool L16 9JD, UK.
| | - Shaun M Phillips
- Institute for Sport, Physical Education & Health Sciences, University of Edinburgh, Scotland EH8 8AQ, UK.
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14
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Spotlight on Neurotrauma Research in Canada's Leading Academic Centers. J Neurotrauma 2018; 35:1986-2004. [PMID: 30074875 DOI: 10.1089/neu.2018.29017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Hunt C, Michalak A, Lefkimmiatis C, Johnston E, Macumber L, Jocko T, Ouchterlony D. Exploring concussion awareness in hockey with a First Nations community in Canada. Public Health Nurs 2018; 35:202-210. [PMID: 29667222 DOI: 10.1111/phn.12407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The purpose of this pilot study was twofold: (1) to begin to understand concussion in youth hockey in a First Nations community in Canada and (2) to determine the impact of a novel concussion education workshop. DESIGN A one-group quasiexperimental time series study was undertaken. SAMPLE A total of 41 participants consented, with 71% (n = 29) completing data collection at all three study time points. MEASUREMENT AND INTERVENTIONS Two nurses one from the First Nations community and one from the tertiary care center collaborated to develop and deliver the intervention on concussion specifically general, hockey and symptom knowledge. The primary outcome was Total Knowledge Score (TKS), whereby correct responses to a self-reported questionnaire were summed and then converted to a percentage. RESULTS The TKS were similar across study time points; preworkshop 71.7%, postworkshop 71.8%, and 6-month follow-up 72%. CONCLUSIONS Nurses worked collaboratively with cultural experts from a First Nations community to integrate Indigenous ways of knowing into concussion awareness and safety for First Nations youth playing hockey.
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Affiliation(s)
- Cindy Hunt
- Trauma & Neurosurgery Program, Head Injury Clinic, St. Michael's Hospital, North Bay, ON, Canada
| | - Alicja Michalak
- Trauma & Neurosurgery Program, Head Injury Clinic, St. Michael's Hospital, North Bay, ON, Canada
| | - Chrissy Lefkimmiatis
- Trauma & Neurosurgery Program, Head Injury Clinic, St. Michael's Hospital, North Bay, ON, Canada
| | | | - Leila Macumber
- Kenabutch Health Centre, Serpent River First Nation, Cutler, ON, Canada
| | - Tony Jocko
- Union of Ontario Indians, North Bay, ON, Canada
| | - Donna Ouchterlony
- Trauma & Neurosurgery Program, Head Injury Clinic, St. Michael's Hospital, North Bay, ON, Canada
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Abstract
BACKGROUND Individuals who sustain their first concussion during childhood may be at greater risk of sustaining multiple concussions throughout their lifetime because of a longer window of vulnerability. This article aims to estimate the association between age at first concussion and number of subsequent concussions. PATIENTS AND METHODS A total of 23,582 collegiate athletes from 26 universities and military cadets from three military academies completed a concussion history questionnaire (65% males, age 19.9 ± 1.4 years). Participants self-reported concussions and age at time of each injury. Participants with a history of concussion (n = 3,647, 15.5%) were categorized as having sustained their first concussion during childhood (less than ten years old) or adolescence (≥10 and ≤18 years old). Poisson regression was used to model age group (childhood, adolescence) predicting the number of subsequent concussions (0, 1, 2+). A second Poisson regression was developed to determine whether age at first concussion predicted the number of subsequent concussions. RESULTS Participants self-reporting their first concussion during childhood had an increased risk of subsequent concussions (rate ratio = 2.19, 95% confidence interval: 1.82, 2.64) compared with participants self-reporting their first concussion during adolescence. For every one-year increase in age at first concussion, we observed a 16% reduction in the risk of subsequent concussion (rate ratio = 0.84, 95% confidence interval: 0.82, 0.86). CONCLUSIONS Individuals self-reporting a concussion at a young age sustained a higher number of concussions before age 18. Concussion prevention, recognition, and reporting strategies are of particular need at the youth level.
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Nanos KN, Franco JM, Larson D, Mara K, Laskowski ER. Youth Sport-Related Concussions: Perceived and Measured Baseline Knowledge of Concussions Among Community Coaches, Athletes, and Parents. Mayo Clin Proc 2017; 92:1782-1790. [PMID: 29202937 DOI: 10.1016/j.mayocp.2017.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/19/2017] [Accepted: 10/03/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess concussion knowledge of athletes, coaches, and parents/guardians in a community setting and to understand trends/gaps in knowledge among subgroups to tailor efforts toward creating educational interventions. PARTICIPANTS AND METHODS This prospective cross-sectional study involved 262 individuals (142 [55%] female): 115 athletes participating in noncontact and contact sports (ages 13-19 years), 15 coaches, and 132 parents. Recruitment occurred from August 30, 2015, through August 30, 2016, at 3 local high schools. Participants completed a questionnaire developed by the investigators to assess concussion experience and basic knowledge. RESULTS Females, health care employees, and parents showed stronger concern for potential long-term sequelae of concussion, whereas athletes were most concerned about not being able to return to sport. Those with higher perceived concussion knowledge were slightly older (median age, 42.5 vs 33 years), more educated (college or higher: 42 [70%] vs 100 [50%]), and more likely to be health care workers (22 [37.9%] vs 34 [17.7%]) and scored higher on knowledge questions (average correct: 75.5% vs 60%). Most participants could identify potential concussion sequelae, but only 86 (34.3%) identified a concussion as a brain injury. Of the subgroups, coaches scored highest on knowledge questions. Those with a concussion history tended to consider themselves more knowledgeable but were also less concerned about sequelae. Overall, those with a concussion history scored slightly higher on knowledge questions (average correct: 69.8% vs 61.9%). Participants involved in contact sports were more likely to have had a concussion vs those in noncontact sports (57 [26%] vs 4 [10.3%]). CONCLUSION Significant differences in perceived and actual concussion knowledge across different subgroups of study participants involved in high school sports were identified.
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Affiliation(s)
- Katherine N Nanos
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN; Department of Orthopedics, Sports, and Spine, Emory University, Atlanta, GA.
| | - John M Franco
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Dirk Larson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Kristin Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Edward R Laskowski
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN; Mayo Clinic Sports Medicine, Mayo Clinic, Rochester, MN
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18
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Workewych AM, Ciuffetelli Muzzi M, Jing R, Zhang S, Topolovec-Vranic J, Cusimano MD. Twitter and traumatic brain injury: A content and sentiment analysis of tweets pertaining to sport-related brain injury. SAGE Open Med 2017; 5:2050312117720057. [PMID: 28890783 PMCID: PMC5574478 DOI: 10.1177/2050312117720057] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/16/2017] [Indexed: 11/21/2022] Open
Abstract
Objectives: Sport-related traumatic brain injuries are a significant public health burden, with hundreds of thousands sustained annually in North America. While sports offer numerous physical and social health benefits, traumatic brain injuries such as concussion can seriously impact a player’s life, athletic career, and sport enjoyment. The culture in many sports encourages winning at all costs, placing athletes at risk for traumatic brain injuries. As social media has become a central part of everyday life, the content of users’ messages often reflects the prevailing culture related to a particular event or health issue. Methods: We hypothesized that Twitter data might be useful for understanding public perceptions and misperceptions of sport-related traumatic brain injuries. We performed a content and sentiment analysis of 7483 Twitter® tweets related to traumatic brain injuries in sports collected during June and July 2013. Results: We identified five major themes. Users tweeted about personal traumatic brain injuries experiences, reported traumatic brain injuries in professional athletes, shared research about sport-related concussions, and discussed policy and safety in injury prevention, such as helmet use. We identified mixed perceptions of and sentiment toward traumatic brain injuries in sports: both an understanding that brain injuries are serious and disregard for activities that might reduce the public burden of traumatic brain injuries were prevalent in our Twitter analysis. Conclusion: While the scientific and medical community considers a concussion a form of traumatic brain injuries, our study demonstrates a misunderstanding of this fact among the public. In our current digital age, social media can provide useful insight into the culture around a health issue, facilitating implementation of prevention and treatment strategies.
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Affiliation(s)
- Adriana M Workewych
- Injury Prevention Research Office, Division of Neurosurgery, Li Ka Shing Knowledge Institute and Trauma and Neurosurgery Program, St. Michael's Hospital, Toronto, ON, Canada
| | | | - Rowan Jing
- Injury Prevention Research Office, Division of Neurosurgery, Li Ka Shing Knowledge Institute and Trauma and Neurosurgery Program, St. Michael's Hospital, Toronto, ON, Canada
| | - Stanley Zhang
- Injury Prevention Research Office, Division of Neurosurgery, Li Ka Shing Knowledge Institute and Trauma and Neurosurgery Program, St. Michael's Hospital, Toronto, ON, Canada
| | - Jane Topolovec-Vranic
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Michael D Cusimano
- Injury Prevention Research Office, Division of Neurosurgery, Li Ka Shing Knowledge Institute and Trauma and Neurosurgery Program, St. Michael's Hospital, Toronto, ON, Canada.,Faculty of Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
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19
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Factors Influencing the Underreporting of Concussion in Sports: A Qualitative Study of Minor Hockey Participants. Clin J Sport Med 2017; 27:375-380. [PMID: 28653965 DOI: 10.1097/jsm.0000000000000372] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The present study is to identify factors contributing to underreporting of concussion in adolescent athletes. DESIGN Qualitative interviews. SETTING Participants were interviewed in an office environment. PARTICIPANTS Interviews were conducted with 31 minor hockey players, 10 parents, 6 coaches, 4 trainers, 2 managers, and one game official. Players were 13 to 15 year old. With selective sampling, an inductive approach of analyzing the interviews was undertaken and themes were identified and analyzed. ASSESSMENT OF RISK FACTORS Underreporting is a complex phenomenon. A number of risk factors related to hockey culture, players, reference others, and rules of play were assessed. MAIN OUTCOME MEASURES Reasons not reporting concussion is accepted in minor hockey. RESULTS Aspects of hockey culture such as an overemphasis on winning games and upheld misperceptions about the risks associated with concussion were identified as relevant to the underreporting of concussions. Various factors relevant to the underreporting of concussions include player's motivation to win, group membership dynamics such as a player's role as the team's "enforcer," coaches' own motivation to win to further their own opportunities in the sport, and parents' personal financial interest or alternative agenda in terms of time commitments and their child's future career prospects. CONCLUSIONS Our findings indicate that underreporting of concussion among those players interviewed appears to be prevalent and associated with misconceptions about injury risk, and a culture that both reinforces and encourages underreporting with tacit or overt complicity of parents and coaches. Our findings support the need to alter the culture of violence and tough play in hockey by education, rule changes, economic measures, and changes in governance of the sport. Interviewing more stakeholders and policy makers would shed light on such potential interventions.
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20
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Hecimovich M, Marais I. Examining the psychometric properties of a sport-related concussion survey: a Rasch measurement approach. BMC Res Notes 2017; 10:228. [PMID: 28651641 PMCID: PMC5485600 DOI: 10.1186/s13104-017-2559-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 06/19/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Awareness of sport-related concussion (SRC) is an essential step in increasing the number of athletes or parents who report on SRC. This awareness is important, as there is no established data on medical care at youth-level sports and may be limited to individuals with only first aid training. In this circumstance, aside from the coach, it is the players and their parents who need to be aware of possible signs and symptoms. The aim of this study was to examine the psychometric properties of a parent and player concussion survey intended for use before and after an education campaign regarding SRC. METHODS 1441 questionnaires were received from parents and 284 questionnaires from players. The responses to the sixteen-item section of the questionnaire's 'recognition of signs and symptoms' were submitted to psychometric analysis using the dichotomous and polytomous Rasch model via the Rasch Unidimensional Measurement Model software RUMM2030. The Rasch model of Modern Test Theory can be considered a refinement of, or advance on, traditional analyses of an instrument's psychometric properties. RESULTS The main finding is that these sixteen items measure two factors: items that are symptoms of concussion and items that are not symptoms of concussion. Parents and athletes were able to identify most or all of the symptoms, but were not as good at distinguishing symptoms that are not symptoms of concussion. Analyzing these responses revealed differential item functioning for parents and athletes on non-symptom items. When the DIF was resolved a significant difference was found between parents and athletes. CONCLUSIONS The main finding is that the items measure two 'dimensions' in concussion symptom recognition. The first dimension consists of those items that are symptoms of concussion and the second dimension of those items that are not symptoms of concussion. Parents and players were able to identify most or all of the symptoms of concussion, so one would not expect to pick up any positive change on these items after an education campaign. Parents and players were not as good at distinguishing symptoms that are not symptoms of concussion. It is on these items that one may possibly expect improvement to manifest, so to evaluate the effectiveness of an education campaign it would pay to look for improvement in distinguishing symptoms that are not symptoms of concussion.
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Affiliation(s)
- Mark Hecimovich
- Division of Athletic Training, University of Northern Iowa, 003C Human Performance Center, Cedar Falls, IA USA
- School of Psychology and Exercise Science, Murdoch University, South Street, Murdoch, WA Australia
| | - Ida Marais
- University of Western Australia, Graduate School of Education, M428, 35 Stirling Highway, Crawley, WA Australia
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21
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Relationship Between Concussion History and Concussion Knowledge, Attitudes, and Disclosure Behavior in High School Athletes. Clin J Sport Med 2017; 27:321-324. [PMID: 27437911 DOI: 10.1097/jsm.0000000000000349] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Examine the association between self-reported concussion history and measures of concussion knowledge, attitude, and disclosure behavior. DESIGN Cross-sectional survey. SETTING Classroom. PARTICIPANTS A convenience sample of high school athletes (n = 167; mean age = 15.7 years) from multiple sports completed a validated survey. INDEPENDENT VARIABLES Concussion history (main predictor) was defined as the number of self-recalled concussions during participants' high school career. MAIN OUTCOME MEASURES The outcomes were recalled concussion disclosure behavior (3 measures) and scales assessing both concussion knowledge and concussion attitude. RESULTS A greater number of previous concussions was associated with worse attitude to concussion and negative concussion disclosure behavior. For every 3 additional self-recalled concussions, there was a mean decrease of 7.2 points (range of possible scores = 14-98) in concussion attitude score (P = 0.002), a 48% decrease in the self-reported proportion of concussion events disclosed (P = 0.013), and an increased prevalence of self-reported participation in games (67%) and practices (125%) while experiencing signs and symptoms of concussion (P < 0.001). Increased concussion history did not affect concussion knowledge score (P = 0.333). CONCLUSIONS Negative trends in concussion disclosure behavior were identified in youth athletes with a positive history of concussion. Improving disclosure in this subgroup will require targeted efforts addressing negative attitude to concussion.
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22
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Cusimano MD, Zhang S, Topolovec-Vranic J, Hutchison MG, Jing R. Factors affecting the concussion knowledge of athletes, parents, coaches, and medical professionals. SAGE Open Med 2017; 5:2050312117694794. [PMID: 28540042 PMCID: PMC5433676 DOI: 10.1177/2050312117694794] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/24/2017] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To determine the predictors of knowledge and awareness of concussion symptoms and outcomes through a survey of athletes, parents of players and coaches in sports settings in Canada. METHODS A cross-sectional survey of athletic communities in Canada was conducted. Respondents' concussion knowledge score consists of responses to questions about the symptoms, diagnosis, and treatment of a concussion and the timing of return-to-sport post-concussion. The percentage of correct responses was defined as the "identification rate." The extent to which participant factors affected the scores was examined by univariate and multivariate analyses. RESULTS Respondents were able to identify a mean of 80.6% of symptoms. Cognitive symptoms were most commonly known, and mental health symptoms associated with concussion were least known, and health professionals, coaches, and those with a personal history of concussion had the highest levels of overall knowledge. Language, age, educational level, annual household income, and traumatic brain injury history were good predictors of better concussion knowledge. CONCLUSION Those designing and implementing interventions aimed at concussion management and prevention should ensure that younger, lower income, lower educational, non-English-speaking persons, and those without experience of traumatic brain injury or concussion be specifically accounted for in the design and implementation of interventions to prevent and treat concussion and mild traumatic brain injury.
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Affiliation(s)
- Michael D Cusimano
- Injury Prevention Research Office, Division of Neurosurgery, Li Ka Shing Knowledge Institute and Trauma and Neurosurgery Program, St. Michael's Hospital, Toronto, ON, Canada.,Faculty of Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Departments of Surgery, University of Toronto, Toronto, ON, Canada
| | - Stanley Zhang
- Injury Prevention Research Office, Division of Neurosurgery, Li Ka Shing Knowledge Institute and Trauma and Neurosurgery Program, St. Michael's Hospital, Toronto, ON, Canada
| | - Jane Topolovec-Vranic
- Injury Prevention Research Office, Division of Neurosurgery, Li Ka Shing Knowledge Institute and Trauma and Neurosurgery Program, St. Michael's Hospital, Toronto, ON, Canada
| | - Michael G Hutchison
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
| | - Rowan Jing
- Injury Prevention Research Office, Division of Neurosurgery, Li Ka Shing Knowledge Institute and Trauma and Neurosurgery Program, St. Michael's Hospital, Toronto, ON, Canada
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23
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Gänsslen A, Neubauer T, Hartl C, Moser N, Rickels E, Lüngen H, Nerlich M, Krutsch W. [School re-integration after child brain dislocation : The trauma surgeon's role]. Unfallchirurg 2017; 120:442-448. [PMID: 28130573 DOI: 10.1007/s00113-017-0317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Concussion injury of the brain is still a frequently underestimated injury, which can be associated with long-lasting consequences. Compared to adults, the recovery phase is often prolonged in childhood. Primary treatment consists of symptom-dependent physical and mental activities. Re-integration into daily life is crucial. In childhood, the primary focus is therefore on returning to school. New symptoms, or an increased presence of symptoms must be detected, to avoid prolonged recovery courses. School restrictions have to be minimized. Corresponding concepts are already implemented in North America. Comparable concepts are not established in Germany. In addition to well-known standard return-to-play protocols for sport re-integration, it is urgently recommended to integrate gradual return-to-learn protocols.Thus, academic adaptations and support must be established as well as symptom-oriented organizational and teaching modules.
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Affiliation(s)
- A Gänsslen
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum Wolfsburg, Sauerbruchstr. 7, 38440, Wolfsburg, Deutschland.
| | - T Neubauer
- Unfallchirurgie, Landesklinikum Horn, Spitalgasse 10, 3580, Horn, Österreich
| | - C Hartl
- Unfallchirurgie, Landeskrankenhaus Steyr, Sierninger Str. 170, 4400, Steyr, Österreich
| | - N Moser
- Verwaltungs-Berufsgenossenschaft, Bezirksverwaltung München, Postfach 20 20 42, 80020, München, Deutschland
| | - E Rickels
- Klink für Unfallchirurgie, Orthopädie und Neurotraumatologie, Allgemeines Krankenhaus Celle, Siemensplatz 4, 29223, Celle, Deutschland
| | - H Lüngen
- ZNS - Hannelore Kohl Stiftung, Rochusstr. 24, 53123, Bonn, Deutschland
| | - M Nerlich
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - W Krutsch
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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24
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Pearce AJ, Young JA, Parrington L, Aimers N. Do as I say: contradicting beliefs and attitudes towards sports concussion in Australia. J Sports Sci 2016; 35:1911-1919. [DOI: 10.1080/02640414.2016.1241420] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Alan J. Pearce
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Janet A. Young
- Institute for Sport Exercise and Active Living, Victoria University, Melbourne, Australia
| | - Lucy Parrington
- Department of Biomedical and Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Nicole Aimers
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
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25
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Weerdenburg K, Schneeweiss S, Koo E, Boutis K. Concussion and its management: What do parents know? Paediatr Child Health 2016; 21:e22-6. [PMID: 27398059 DOI: 10.1093/pch/21.3.e22] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To determine the sensitivity of parental suspicion of concussion relative to paediatric emergency physicians in children who presented to an emergency department (ED) with a head injury. A secondary objective was to examine the variables associated with parental suspicion of concussion concordant with that of a physician. METHODS Parents of children five to 18 years of age presenting to an urban paediatric ED with a nonstructural head injury completed a 24-item questionnaire. RESULTS Of the 577 eligible parents, 495 (85.8%) consented to participate. The sensitivity of parental suspicion for concussion was 40.0% (95% CI 33.2% to 47.2%), while the specificity was 58.3% (95% CI 52.4% to 64.0%). The variable of child age ≥10 years was associated with an increased odds (OR 3.0) of a parental suspicion of concussion concordant with that of a physician; parent age, parent sex, mechanism of head injury and history of concussion in the child were not. Although 453 (91.5%) parents would stop activity if they believed their child sustained a concussion, only 159 (32.1%) were familiar with return-to-play guidelines. CONCLUSIONS Parents often did not suspect a concussion when it was ultimately diagnosed by a paediatric emergency physician, although they were more likely to do so in older children. Only approximately one-third were aware of return-to-play guidelines. To enhance the potential for parent-driven advocacy in the recognition and management of concussion, these data support the need for increased parental education on this injury.
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Affiliation(s)
- Kirstin Weerdenburg
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Suzan Schneeweiss
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Ellen Koo
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Kathy Boutis
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
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26
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Concussed or Not? An Assessment of Concussion Experience and Knowledge Within Elite and Semiprofessional Rugby Union. Clin J Sport Med 2016; 26:320-5. [PMID: 26513391 DOI: 10.1097/jsm.0000000000000256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The primary aim was to assess experience and knowledge of adult concussion among international, professional and semiprofessional players, coaches, medical staff, and referees within Rugby Union. The secondary aim was to identify preferred education dissemination routes. DESIGN Questionnaires devised specifically for players, coaches, medical staff, and referees. SETTING AND PARTICIPANTS A total of 370 players, 44 coaches, 40 medical staff, and 33 referees from within Wales were surveyed. MAIN OUTCOME MEASURES Knowledge of the signs and symptoms of concussion, return to play guidelines and consequences of concussion were investigated along with experiences of, and attitudes towards, concussion. RESULTS The respondents had extensive experience of sustaining or witnessing rugby-related concussion. Medical staff had the greatest level of concussion knowledge, with coaches having the least. Players and coaches exhibited a disconnection between being "knocked-out" and practically applying this when managing concussion. Almost half of the players and coaches did not indicate concussion could impair performance. Eighty percent of medical staff had felt pressured to clear a concussed player. Most players (82%), coaches (66%), and referees (64%) incorrectly believed protective equipment prevents concussion. Players and coaches prefer concussion education from medical staff, whereas medical staff and referees prefer such education from governing body Web sites or training courses. CONCLUSIONS Several role-specific misconceptions and deficiencies in concussion knowledge were identified and should be targeted through education. Medical staff had the highest level of concussion knowledge and were the preferred sources of education for players and coaches. Therefore, they are encouraged to play a greater role in providing concussion education.
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27
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Exploring minor hockey players' knowledge and attitudes toward concussion: implications for prevention. J Head Trauma Rehabil 2016; 30:219-27. [PMID: 24590152 DOI: 10.1097/htr.0000000000000018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate minor hockey players' attitudes and knowledge about sport concussions. PARTICIPANTS Male and female Pee Wee, Bantam, and Midget level players (n = 183) participating in minor hockey and a comparison group of non-hockey players (n = 57). DESIGN Survey. MAIN MEASURES Player knowledge and attitudes were evaluated with a standardized questionnaire developed for the purpose of this study. Descriptive statistics including cross-tabulations and proportion comparisons were used to report the data. RESULTS Players had foundational knowledge about concussions; however, more than half underestimated the prevalence and more than 30% were unaware of return to play protocols. Although nearly all players knew what they "should" do when concussed, 33% did not follow recommendations. Players reported more concern and appreciation of the seriousness of concussion than non-players, but they tended to minimize their vulnerability. The most common and helpful information sources were parents, doctors, and coaches, and therefore knowledge translation efforts should target theses audiences. CONCLUSION Young athletes continue to demonstrate gaps in their knowledge of concussions. In addition, attitudes toward concussion suggest a developmental trajectory with younger athletes being most likely to ignore current recommended guidelines.
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28
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Nathanson JT, Connolly JG, Yuk F, Gometz A, Rasouli J, Lovell M, Choudhri T. Concussion Incidence in Professional Football: Position-Specific Analysis With Use of a Novel Metric. Orthop J Sports Med 2016; 4:2325967115622621. [PMID: 26848481 PMCID: PMC4731682 DOI: 10.1177/2325967115622621] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: In the United States alone, millions of athletes participate in sports with potential for head injury each year. Although poorly understood, possible long-term neurological consequences of repetitive sports-related concussions have received increased recognition and attention in recent years. A better understanding of the risk factors for concussion remains a public health priority. Despite the attention focused on mild traumatic brain injury (mTBI) in football, gaps remain in the understanding of the optimal methodology to determine concussion incidence and position-specific risk factors. Purpose: To calculate the rates of concussion in professional football players using established and novel metrics on a group and position-specific basis. Study Design: Case-control study; Level of evidence, 3. Methods: Athletes from the 2012-2013 and 2013-2014 National Football League (NFL) seasons were included in this analysis of publicly available data. Concussion incidence rates were analyzed using established (athlete exposure [AE], game position [GP]) and novel (position play [PP]) metrics cumulatively, by game unit and position type (offensive skill players and linemen, defensive skill players and linemen), and by position. Results: In 480 games, there were 292 concussions, resulting in 0.61 concussions per game (95% CI, 0.54-0.68), 6.61 concussions per 1000 AEs (95% CI, 5.85-7.37), 1.38 concussions per 100 GPs (95% CI, 1.22-1.54), and 0.17 concussions per 1000 PPs (95% CI, 0.15-0.19). Depending on the method of calculation, the relative order of at-risk positions changed. In addition, using the PP metric, offensive skill players had a significantly greater rate of concussion than offensive linemen, defensive skill players, and defensive linemen (P < .05). Conclusion: For this study period, concussion incidence by position and unit varied depending on which metric was used. Compared with AE and GP, the PP metric found that the relative risk of concussion for offensive skill players was significantly greater than other position types. The strengths and limitations of various concussion incidence metrics need further evaluation. Clinical Relevance: A better understanding of the relative risks of the different positions/units is needed to help athletes, team personnel, and medical staff make optimal player safety decisions and enhance rules and equipment.
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Affiliation(s)
- John T Nathanson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - James G Connolly
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Frank Yuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alex Gometz
- Concussion Management of New York, New York, New York, USA
| | - Jonathan Rasouli
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mark Lovell
- imPACT Applications, Inc, Pittsburgh, Pennsylvania, USA
| | - Tanvir Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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29
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Recognizing the Symptoms of Mental Illness following Concussions in the Sports Community: A Need for Improvement. PLoS One 2015; 10:e0141699. [PMID: 26536016 PMCID: PMC4633152 DOI: 10.1371/journal.pone.0141699] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 10/12/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the awareness of concussion-related symptoms amongst members of the sports community in Canada. METHODS A cross-sectional national electronic survey was conducted. Youth athletes, parents, coaches and medical professionals across Canada were recruited through mailing lists from sports-related opt-in marketing databases. Participants were asked to identify, from a list of options, the symptoms of a concussion. The proportion of identified symptoms (categorized as physical, cognitive, mental health-related and overall) as well as participant factors associated with symptom recognition were analyzed. RESULTS The survey elicited 6,937 responses. Most of the respondents (92.1%) completed the English language survey, were male (57.7%), 35-54 years of age (61.7%), with post-secondary education (58.2%), or high reported yearly household income (>$80,000; 53.0%). There were respondents from all provinces and territories with the majority of respondents from Ontario (35.2%) or British Columbia (19.1%). While participants identified most of the physical (mean = 84.2% of symptoms) and cognitive (mean = 91.2% of symptoms), they on average only identified 53.5% of the mental health-related symptoms of concussions. Respondents who were older, with higher education and household income, or resided in the Northwest Territories or Alberta identified significantly more of the mental health-related symptoms listed. INTERPRETATION While Canadian youth athletes, parents, coaches and medical professionals are able to identify most of the physical and cognitive symptoms associated with concussion, identification of mental health-related symptoms of concussion is still lagging.
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Mrazik M, Dennison CR, Brooks BL, Yeates KO, Babul S, Naidu D. A qualitative review of sports concussion education: prime time for evidence-based knowledge translation. Br J Sports Med 2015; 49:1548-53. [DOI: 10.1136/bjsports-2015-094848] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2015] [Indexed: 11/03/2022]
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Rose SC, McNally KA, Heyer GL. Returning the student to school after concussion: what do clinicians need to know? ACTA ACUST UNITED AC 2015; 1:CNC4. [PMID: 30202549 PMCID: PMC6114019 DOI: 10.2217/cnc.15.4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 04/10/2015] [Indexed: 11/21/2022]
Abstract
Participation in school is vital to a child's academic and social development. Following concussion, returning the student to school can pose several challenges for families, healthcare providers and school personnel. The complex constellation of postconcussion symptoms can impair learning and can make the school environment intolerable. Research evidence to guide the return to school process is lacking, but protocols have been proposed that outline a gradual reintroduction to school with academic accommodations tailored to the student's specific symptoms. Key medical and school personnel must understand their respective roles to optimize the process. This review of the current literature examines the available data and expert recommendations that can support a student's successful return to school following concussion.
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Affiliation(s)
- Sean C Rose
- Division of Pediatric Neurology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Neurology, The Ohio State University, Columbus, OH, USA.,Division of Pediatric Neurology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Kelly A McNally
- Division of Pediatric Psychology & Neuropsychology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA.,Division of Pediatric Psychology & Neuropsychology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Geoffrey L Heyer
- Division of Pediatric Neurology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Neurology, The Ohio State University, Columbus, OH, USA.,Division of Pediatric Neurology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Neurology, The Ohio State University, Columbus, OH, USA
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Guskiewicz K, Teel E, McCrea M. Concussion: key stakeholders and multidisciplinary participation in making sports safe. Neurosurgery 2015; 75 Suppl 4:S113-8. [PMID: 25232875 DOI: 10.1227/neu.0000000000000494] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
As unstructured play declines, organized sports leagues have become a highly popular form of physical activity in young people. As concussive injuries are garnering increased media attention and public awareness, there is a growing concern for athlete safety. Although athletic trainers and physicians play a large role in keeping athletes healthy and safe, this article investigates nontraditional, multidisciplinary teams that are involved in promoting athlete safety, including the role of equipment makers, coaches, referees, governing bodies of sport, lawmakers, and fans. As opposed to a focus on diagnosing or managing concussive injuries, this article seeks to promote injury prevention strategies.
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Affiliation(s)
- Kevin Guskiewicz
- *Department of Exercise and Sport Science, University of North Carolina at Chapel Hill; ‡Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center; §Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; ¶Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin; ‖Clement Zablocki Milwaukee VA Medical Center, Milwaukee, Wisconsin
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Concussion in rugby: knowledge and attitudes of players. Ir J Med Sci 2015; 185:521-8. [DOI: 10.1007/s11845-015-1313-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/16/2015] [Indexed: 10/23/2022]
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Lin AC, Salzman GA, Bachman SL, Burke RV, Zaslow T, Piasek CZ, Edison BR, Hamilton A, Upperman JS. Assessment of parental knowledge and attitudes toward pediatric sports-related concussions. Sports Health 2015; 7:124-9. [PMID: 25984257 PMCID: PMC4332649 DOI: 10.1177/1941738115571570] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Parents of young athletes play a major role in the identification and management of sports-related concussions. However, they are often unaware of the consequences of concussions and recommended management techniques. Hypothesis: This study quantitatively assessed parental understanding of concussions to identify specific populations in need of additional education. We predicted that parents with increased education and prior sports- and concussion-related experience would have more knowledge and safer attitudes toward concussions. Study Design: Cross-sectional survey. Level of Evidence: Level 5. Methods: Participants were parents of children brought to a pediatric hospital and 4 satellite clinics for evaluation of orthopaedic injuries. Participants completed a validated questionnaire that assessed knowledge of concussion symptoms, attitudes regarding diagnosis and return-to-play guidelines, and previous sports- and concussion-related experience. Results: Over 8 months, 214 parents completed surveys. Participants scored an average of 18.4 (possible, 0-25) on the Concussion Knowledge Index and 63.1 (possible, 15-75) on the Concussion Attitude Index. Attitudes were safest among white women, and knowledge increased with income and education levels. Previous sports experience did not affect knowledge or attitudes, but parents who reported experiencing an undiagnosed concussion had significantly better concussion knowledge than those who did not. Conclusion: Parents with low income and education levels may benefit from additional concussion-related education. Clinical Relevance: There exist many opportunities for improvement in parental knowledge and attitudes about pediatric sports-related concussions. Ongoing efforts to understand parental knowledge of concussions will inform the development of a strategic and tailored approach to the prevention and management of pediatric concussions.
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Affiliation(s)
- Ann C Lin
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California ; Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Garrett A Salzman
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Shelby L Bachman
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Rita V Burke
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California ; Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Tracy Zaslow
- Keck School of Medicine, University of Southern California, Los Angeles, California ; Children's Orthopedic Center Sports Medicine and Concussion Program, Children's Hospital Los Angeles, Los Angeles, California
| | - Carolina Z Piasek
- Children's Orthopedic Center Sports Medicine and Concussion Program, Children's Hospital Los Angeles, Los Angeles, California
| | - Bianca R Edison
- Keck School of Medicine, University of Southern California, Los Angeles, California ; Children's Orthopedic Center Sports Medicine and Concussion Program, Children's Hospital Los Angeles, Los Angeles, California
| | - Anita Hamilton
- Keck School of Medicine, University of Southern California, Los Angeles, California ; Children's Orthopedic Center Sports Medicine and Concussion Program, Children's Hospital Los Angeles, Los Angeles, California
| | - Jeffrey S Upperman
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California ; Keck School of Medicine, University of Southern California, Los Angeles, California
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Boutis K, Weerdenburg K, Koo E, Schneeweiss S, Zemek R. The diagnosis of concussion in a pediatric emergency department. J Pediatr 2015; 166:1214-1220.e1. [PMID: 25919731 DOI: 10.1016/j.jpeds.2015.02.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/12/2015] [Accepted: 02/05/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare the proportion of children diagnosed with a concussion by pediatric emergency physicians vs the proportion who met criteria for this injury as recommended by Zurich Fourth International Conference on Concussion consensus statement and to determine clinical variables associated with a physician diagnosis of a concussion. STUDY DESIGN This was a prospective, cross-sectional study conducted at a tertiary care pediatric emergency department. We enrolled children ages 5 through 17 who presented with a head injury and collected data on demographics, mechanism of injury, head injury-related symptoms/signs, physician diagnosis, and discharge advice. RESULTS We identified 495 children whose mean age was 10.1 years (SD 3.4 years); 308 (62.2%) were male. Emergency physicians diagnosed concussion in 200 (40.4%; 95% CI 36.1, 44.7) children, and 443 (89.5%; 95% CI 86.8, 92.2) met criteria for concussion in accordance with the Zurich consensus statement (P<.0001). Age≥10 years (OR 1.8), presentation≥1 day after injury (OR 2.4), injury from collision sports (OR 5.6), and symptoms of headache (OR 2.2) or amnesia (OR 3.4) were the variables significantly associated with an emergency physician's diagnosis of concussion. CONCLUSIONS Pediatric emergency physicians diagnosed concussion less often relative to international consensus-based guidelines and used a limited number of variables to make this diagnosis compared with current recommendations. Thus, pediatric emergency physicians may be missing cases of concussion and the corresponding opportunity to provide critical advice for cognitive and physical management.
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Affiliation(s)
- Kathy Boutis
- Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada.
| | - Kirstin Weerdenburg
- Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ellen Koo
- Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Suzan Schneeweiss
- Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Roger Zemek
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario and the University of Ottawa, Ottawa, Canada
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Hunt TN. Video Educational Intervention Improves Reporting of Concussion and Symptom Recognition. ACTA ACUST UNITED AC 2015. [DOI: 10.4085/100165] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Context
Concussion management is potentially complicated by the lack of reporting due to poor educational intervention in youth athletics.
Objective
Determine if a concussion-education video developed for high school athletes will increase the reporting of concussive injuries and symptom recognition in this group.
Design
Cross-sectional, between groups.
Setting
Athletes participating in South Carolina interscholastic athletics.
Patients or Other Participants
High school athletes (N = 68; males n = 42; females n = 26; mean age = 14.78 ± 1.38 years) participated in this study. The athletes were randomly assigned into 2 groups: concussion education (n = 34) and control (n = 34).
Main Outcome Measures
Participants were administered a survey before and after watching a video about concussion incidence, symptoms, and reporting conditions (intervention group) or a nutrition video (control group). Total symptom score and survey items served as dependent variables. Examination of group differences was performed through χ2 analyses and repeated-measures analysis of variance (ANOVA) calculations in SPSS 19.0 (SPSS Inc, Chicago, IL). Significance levels were set a priori at .05.
Results
Of all participants, 70.5% (48/68) reported not knowing the signs and symptoms of concussion before the study, and 26.5% (n = 18) reported having had at least 1 prior concussion. A statistically significant difference existed between those reporting having vs. not having knowledge of the signs and symptoms of concussion on total symptom score at baseline (t1,66 = 2.17, P = .038). Repeated-measures ANOVA calculated a statistically significant difference for concussion symptom recognition before and after the intervention (F1,66 = 7.47, P = .008)
Conclusions
A large percentage of high school athletes do not know the signs and symptoms of concussion. After an educational video, participants' symptom knowledge and previous concussions reported increased. Education of those involved in athletics using a standardized tool may increase reporting and aid in the assessment and management of concussion in this population.
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Affiliation(s)
- Tamerah N. Hunt
- School of Health and Rehabilitation Sciences, Ohio State University, Columbus
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Abstract
Background and Objectives:Concussion is a prevalent brain injury in the community. While primary prevention strategies need to be enhanced, it is also important to diagnose and treat concussions expertly and expeditiously to prevent serious complications that may be life-threatening or long lasting. Therefore, physicians should be knowledgeable about the diagnosis and management of concussions. The present study assesses Ontario medical students’ and residents’ knowledge of concussion management.Methods:A survey to assess the knowledge and awareness of the diagnosis and treatment of concussions was developed and administered to graduating medical students (n= 222) and neurology and neurosurgery residents (n = 80) at the University of Toronto.Results:Residents answered correctly significantly more of the questions regarding the diagnosis and management of concussions than the medical students (mean = 5.8 vs 4.1, t= 4.48, p<0.01). Gender, participation in sports, and personal concussion history were not predictive of the number of questions answered correctly. Several knowledge gaps were identified in the sample population as a whole. Approximately half of the medical students and residents did not recognize chronic traumatic encephalopathy (n = 36) or the second impact syndrome (n = 44) as possible consequences of repetitive concussions. Twenty-four percent of the medical students (n = 18) did not think that “every concussed individual should see a physician” as part of management.Conclusions:A significant number of medical students and residents have incomplete knowledge about concussion diagnosis and management. This should be addressed by targeting this population during undergraduate medical education.
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Let's Standardize the Definition of Concussion and Get Reliable Incidence Data. Can J Neurol Sci 2014; 36:405-6. [DOI: 10.1017/s031716710000771x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Miyashita TL, Diakogeorgiou E, Hellstrom B, Kuchwara N, Tafoya E, Young L. High School Athletes' Perceptions of Concussion. Orthop J Sports Med 2014; 2:2325967114554549. [PMID: 26535279 PMCID: PMC4555556 DOI: 10.1177/2325967114554549] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The perception high school athletes have regarding concussions may influence their injury-reporting behavior, and if their perceptions are based on incorrect or incomplete information, they may be at risk for subsequent head injuries. PURPOSE To determine whether the recent influx of concussion information has had a positive impact on high school athletes' knowledge of concussions, to determine their perceptions regarding the severity of a concussion injury, and to determine whether receiving correct information will potentially alter their future reporting behavior. STUDY DESIGN Cross-sectional study; Level of evidence, 4. METHODS A total of 454 high school athletes (212 females, 242 males; mean age, 15.7 ± 1.15 years) from 6 different schools participated in an anonymous survey. The researchers met with teams individually at their high schools to collect data and provide an educational intervention regarding sports-related concussions. The survey questions assessed the athletes' personal injury histories and perceptions and knowledge of the severity of concussion injuries. RESULTS There was a difference in the number of athletes who reported having their "bell rung" (n = 297) versus the number of athletes reporting at least 1 concussion (n = 172) (t (453) = -11.60, P = .000, d = -0.54). There was also a difference in the number of athletes who reported a history of at least 1 concussion at the beginning of the study session (n = 172) versus the number of athletes who reported at least 1 concussion at the end of the session (n = 292) (t (453) = -12.018, P = .000, d = 0.732). Fifty percent of athletes also stated that the importance of a game/event should dictate when they return to play. CONCLUSION High school athletes continue to fail to realize when they have sustained a concussion. Additionally, athletes lack understanding regarding the severity and seriousness of a concussion. A better effort at formalized education must be made if the culture of sports is to change. CLINICAL RELEVANCE Allied health care professionals need to continue to put forth a great effort in educating all student athletes on what a concussion is and the dangers of a concussion injury. Preseason meetings should be used as an opportunity to provide formalized education to all student athletes.
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Affiliation(s)
| | | | - Brian Hellstrom
- Metropolitan State University of Denver, Denver, Colorado, USA
| | - Nick Kuchwara
- Metropolitan State University of Denver, Denver, Colorado, USA
| | - Erica Tafoya
- Metropolitan State University of Denver, Denver, Colorado, USA
| | - Lori Young
- Metropolitan State University of Denver, Denver, Colorado, USA
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Echlin PS, Johnson AM, Holmes JD, Tichenoff A, Gray S, Gatavackas H, Walsh J, Middlebro T, Blignaut A, MacIntyre M, Anderson C, Fredman E, Mayinger M, Skopelja EN, Sasaki T, Bouix S, Pasternak O, Helmer KG, Koerte IK, Shenton ME, Forwell LA. The Sport Concussion Education Project. A brief report on an educational initiative: from concept to curriculum. J Neurosurg 2014; 121:1331-6. [PMID: 25280091 DOI: 10.3171/2014.8.jns132804] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Current research on concussion is primarily focused on injury identification and treatment. Prevention initiatives are, however, important for reducing the incidence of brain injury. This report examines the development and implementation of an interactive electronic teaching program (an e-module) that is designed specifically for concussion education within an adolescent population. This learning tool and the accompanying consolidation rubric demonstrate that significant engagement occurs in addition to the knowledge gained among participants when it is used in a school curriculum setting.
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Abstract
CONTEXT Participating in sports while experiencing symptoms of a concussion can be dangerous. An athlete's lack of knowledge may be one factor influencing his or her decision to report symptoms. In an effort to enhance concussion education among high school athletes, legislation in Florida has attempted to address the issue through parental consent forms. OBJECTIVE To survey high school varsity football players to determine their level of knowledge about concussions after the initiation of new concussion-education legislation. DESIGN Cross-sectional study. SETTING Descriptive survey administered in person during a team meeting. PATIENTS OR OTHER PARTICIPANTS A total of 334 varsity football players from 11 high schools in Florida. MAIN OUTCOME MEASURE(S) Participants completed a survey and identified the symptoms and consequences of a concussion among distractors. They also indicated whether they had received education about concussions from a parent, formal education, neither, or both. RESULTS The most correctly identified symptoms were headache (97%), dizziness (93%), and confusion (90%), and the most correctly identified consequence was persistent headache (93%). Participants reported receiving education from their parents (54%) or from a formal source (60%). Twenty-five percent reported never receiving any education regarding concussions. No correlations were found between the method of education and the knowledge of symptoms or consequences of concussion. CONCLUSIONS The high school football players we surveyed did not have appropriate knowledge of the symptoms and consequences of concussions. Nausea or vomiting, neck pain, grogginess, difficulty concentrating, and personality or behavioral changes were often missed by participants, and only a small proportion correctly identified brain hemorrhage, coma, and death as possible consequences of inappropriate care after a concussion. Even with parents or guardians signing a consent form indicating they discussed concussion awareness with their child, 46% of athletes suggested they had not.
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Mutch WAC, Ellis MJ, Graham MR, Wourms V, Raban R, Fisher JA, Mikulis D, Leiter J, Ryner L. Brain MRI CO2 stress testing: a pilot study in patients with concussion. PLoS One 2014; 9:e102181. [PMID: 25032707 PMCID: PMC4102518 DOI: 10.1371/journal.pone.0102181] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/15/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There is a real need for quantifiable neuro-imaging biomarkers in concussion. Here we outline a brain BOLD-MRI CO2 stress test to assess the condition. METHODS This study was approved by the REB at the University of Manitoba. A group of volunteers without prior concussion were compared to post-concussion syndrome (PCS) patients--both symptomatic and recovered asymptomatic. Five 3-minute periods of BOLD imaging at 3.0 T were studied--baseline 1 (BL1--at basal CO2 tension), hypocapnia (CO2 decreased ∼5 mmHg), BL2, hypercapnia (CO2 increased ∼10 mmHg) and BL3. Data were processed using statistical parametric mapping (SPM) for 1st level analysis to compare each subject's response to the CO2 stress at the p = 0.001 level. A 2nd level analysis compared each PCS patient's response to the mean response of the control subjects at the p = 0.05 level. RESULTS We report on 5 control subjects, 8 symptomatic and 4 asymptomatic PCS patients. Both increased and decreased response to CO2 was seen in all PCS patients in the 2nd level analysis. The responses were quantified as reactive voxel counts: whole brain voxel counts (2.0±1.6%, p = 0.012 for symptomatic patients for CO2 response < controls and 3.0±5.1%, p = 0.139 for CO2 response > controls: 0.49±0.31%, p = 0.053 for asymptomatic patients for CO2 response < controls and 4.4±6.8%, p = 0.281 for CO2 response > controls). CONCLUSIONS Quantifiable alterations in regional cerebrovascular responsiveness are present in concussion patients during provocative CO2 challenge and BOLD MRI and not in healthy controls. Future longitudinal studies must aim to clarify the relationship between CO2 responsiveness and individual patient symptoms and outcomes.
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Affiliation(s)
- W. Alan C. Mutch
- Department of Anesthesia and Perioperative Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael J. Ellis
- Department of Surgery, Section of Neurosurgery, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - M. Ruth Graham
- Department of Anesthesia and Perioperative Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Vincent Wourms
- Department of Anesthesia and Perioperative Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Roshan Raban
- Department of Anesthesia and Perioperative Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joseph A. Fisher
- Department of Anesthesia and Pain Management, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David Mikulis
- Department of Radiology, Section of Neuroimaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Leiter
- Department of Surgery, Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lawrence Ryner
- Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba, Canada
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Head Injury in the Elderly: Is Our Health Care System Ready for the Fall(s)? Can J Neurol Sci 2014; 41:407-8. [DOI: 10.1017/s0317167100018400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Donaldson A, Newton J, McCrory P, White P, Davis G, Makdissi M, Finch CF. Translating Guidelines for the Diagnosis and Management of Sports-Related Concussion Into Practice. Am J Lifestyle Med 2014; 10:120-135. [PMID: 30202266 DOI: 10.1177/1559827614538751] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/20/2014] [Accepted: 03/06/2014] [Indexed: 11/15/2022] Open
Abstract
Sports injuries are a significant clinical and public health concern. There is a growing call to improve the translation of available evidence-based and expert-informed sports injury prevention interventions into sustained use in practice by physicians and others (eg, athletic trainers, coaches, and parents) who care for injured athletes. This article provides a brief overview of the current sport injury prevention implementation literature before focusing specifically on the translation of guidelines (including consensus and position statements) developed to assist physicians and others diagnose and manage athletes with sport-related concussion and the associated return-to-play decisions. The outcomes of more than 20 published studies indicate that physician, athletic trainer, coach, parent, and athlete knowledge, use of, and compliance with sport-related concussion guidelines are limited. More concerted, coordinated, and theory-informed efforts are required to facilitate the widespread dissemination, translation, and implementation of such guidelines. An example is provided of how implementation drivers could be used to inform the development of a comprehensive, multilevel implementation strategy targeting the individual, organizational, and system-level changes necessary to support the translation of available sport-related concussion guidelines in both the clinical and sports settings.
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Affiliation(s)
- Alex Donaldson
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia (AD, PW, CFF, PM).,Deakin University, Burwood, Victoria, Australia (JN).,The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (PM, GD, MM).,Department of Neurosurgery, Cabrini Hospital, Malvern, Victoria, Australia (GD)
| | - Joshua Newton
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia (AD, PW, CFF, PM).,Deakin University, Burwood, Victoria, Australia (JN).,The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (PM, GD, MM).,Department of Neurosurgery, Cabrini Hospital, Malvern, Victoria, Australia (GD)
| | - Paul McCrory
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia (AD, PW, CFF, PM).,Deakin University, Burwood, Victoria, Australia (JN).,The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (PM, GD, MM).,Department of Neurosurgery, Cabrini Hospital, Malvern, Victoria, Australia (GD)
| | - Peta White
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia (AD, PW, CFF, PM).,Deakin University, Burwood, Victoria, Australia (JN).,The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (PM, GD, MM).,Department of Neurosurgery, Cabrini Hospital, Malvern, Victoria, Australia (GD)
| | - Gavin Davis
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia (AD, PW, CFF, PM).,Deakin University, Burwood, Victoria, Australia (JN).,The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (PM, GD, MM).,Department of Neurosurgery, Cabrini Hospital, Malvern, Victoria, Australia (GD)
| | - Michael Makdissi
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia (AD, PW, CFF, PM).,Deakin University, Burwood, Victoria, Australia (JN).,The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (PM, GD, MM).,Department of Neurosurgery, Cabrini Hospital, Malvern, Victoria, Australia (GD)
| | - Caroline F Finch
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia (AD, PW, CFF, PM).,Deakin University, Burwood, Victoria, Australia (JN).,The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (PM, GD, MM).,Department of Neurosurgery, Cabrini Hospital, Malvern, Victoria, Australia (GD)
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Kerr ZY, Register-Mihalik JK, Marshall SW, Evenson KR, Mihalik JP, Guskiewicz KM. Disclosure and non-disclosure of concussion and concussion symptoms in athletes: Review and application of the socio-ecological framework. Brain Inj 2014; 28:1009-21. [PMID: 24738743 DOI: 10.3109/02699052.2014.904049] [Citation(s) in RCA: 175] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Zachary Y Kerr
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina-Chapel Hill , Chapel Hill, NC , USA
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Epidemiology of concussion in sport: a literature review. J Chiropr Med 2014; 12:230-51. [PMID: 24396326 DOI: 10.1016/j.jcm.2012.11.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/19/2012] [Accepted: 11/30/2012] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The purpose of this study was to summarize sport concussion incidence data, identify sports that present higher injury frequency, reveal the degree of risk in some lesser-known sports, and outline specific details within the sports literature that raise additional concerns, such as helmet-to-helmet contact and player positions that experience frequent impact. METHODS A systematic literature review of Pub Med using keyword search on injury, concussion, and sports was performed through May 2012. Abstracts were identified, selections were made based upon inclusion criteria, and full-length articles were obtained. Additional articles were considered following review of reference sections. Articles were reviewed and tabulated according to sport. RESULTS Two hundred eighty-nine articles were screened, and 62 articles were reviewed. The overall incidence of concussion in sport ranged from 0.1 to 21.5 per 1000 athletic exposures. The lowest incidence was reported in swimming and diving. Concussion incidence was highest in Canadian junior ice hockey, but elevated incidence in American football remains a concern because of the large number of participants. CONCLUSIONS The literature reviewed included incidence of concussion on the field of play under real-world conditions and influenced by the current culture of sport. The studies examined in this article show that there is risk of concussion in nearly every sport. Some sports have higher concussion frequency than others, which may depend upon the forces and roles of the positions played in these sports. Younger athletes have a higher incidence of concussion, and female incidence is greater than male in many comparable sports. Headgear may reduce concussion in some sports but may also give athletes a false sense of protection.
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Abstract
OBJECTIVE The purpose of this study was to determine college athletes' knowledge regarding concussions and to determine if an educational lecture before their sport season would improve their knowledge and reporting of concussions. DESIGN Cross-sectional study. SETTING University classroom. PARTICIPANTS Seventy National College Athletic Association Division II men's/women's soccer players and men's/women's basketball players. INTERVENTIONS Educational lecture regarding the basics of concussions. MAIN OUTCOME MEASURES Descriptive statistics, ANOVAs, and a paired sample t test determined the athletes' knowledge of concussion before and after the season and the impact of the educational intervention. RESULTS A paired sample t test indicated that the athletes scored better on the postseason concussion knowledge assessment [t(49) = 10.34, P < 0.000, d = 1.47]. CONCLUSIONS After an educational intervention, athletes demonstrated an improvement in their knowledge on concussions.
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Cusimano MD, Chipman M, Donnelly P, Hutchison MG. Effectiveness of an educational video on concussion knowledge in minor league hockey players: a cluster randomised controlled trial. Br J Sports Med 2013; 48:141-6. [DOI: 10.1136/bjsports-2012-091660] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Echlin PS, Skopelja EN, Worsley R, Dadachanji SB, Lloyd-Smith DR, Taunton JA, Forwell LA, Johnson AM. A prospective study of physician-observed concussion during a varsity university ice hockey season: incidence and neuropsychological changes. Part 2 of 4. Neurosurg Focus 2013. [PMID: 23199425 DOI: 10.3171/2012.10.focus12286] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The primary objective of this study was to measure the incidence of concussion according to a relative number of athlete exposures among 25 male and 20 female varsity ice hockey players. The secondary objective was to present neuropsychological test results between preseason and postseason play and at 72 hours, 2 weeks, and 2 months after concussion. METHODS Every player underwent baseline assessments using the Sport Concussion Assessment Tool-2 (SCAT2), Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), and MRI. Each regular season and postseason game was observed by 2 independent observers (a physician and a nonphysician observer). Players with a diagnosed concussion were removed from the game, examined in the team physician's office using the SCAT2 and ImPACT, and sent to undergo MRI. RESULTS Eleven concussions occurred during the 55 physician-observed games (20%). The incidence of concussion, expressed as number of concussions per 1000 athlete exposures, was 10.70 for men and women combined in regular season play, 11.76 for men and women combined across both the regular season and playoff season, 7.50 for men and 14.93 for women in regular season play, and 8.47 for men across both the regular season and playoff season. One male player experienced repeat concussions. No concussions were reported during practice sessions, and 1 concussion was observed and diagnosed in an exhibition game. Neuropsychological testing suggested no statistically significant preseason/postseason differences between athletes who sustained a physician-diagnosed concussion and athletes who did not sustain a physician-diagnosed concussion on either the ImPACT or SCAT2. The athletes who sustained a physician-diagnosed concussion demonstrated few reliable changes postinjury. CONCLUSIONS Although the incidence of game-related concussions per 1000 athlete exposures in this study was half the highest rate reported in the authors' previous research, it was 3 times higher than the incidence reported by other authors within the literature concerning men's collegiate ice hockey and 5 times higher than the highest rate previously reported for woman's collegiate ice hockey. Interestingly, the present results suggest a substantively higher incidence of concussion among women (14.93) than men (7.50). The reproducible and significantly higher incidence of concussion among both men and woman ice hockey players, when compared with nonphysician-observed games, suggests a significant underestimation of sports concussion in the scientific literature.
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Affiliation(s)
- Paul S Echlin
- Elliott Sports Medicine Clinic, Burlington, Ontario, Canada.
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Trends in North American newspaper reporting of brain injury in ice hockey. PLoS One 2013; 8:e61865. [PMID: 23613957 PMCID: PMC3629225 DOI: 10.1371/journal.pone.0061865] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/14/2013] [Indexed: 11/21/2022] Open
Abstract
The frequency and potential long-term effects of sport-related traumatic brain injuries (TBI) make it a major public health concern. The culture within contact sports, such as ice hockey, encourages aggression that puts youth at risk of TBI such as concussion. Newspaper reports play an important role in conveying and shaping the culture around health-related behaviors. We qualitatively studied reports about sport-related TBI in four major North American newspapers over the last quarter-century. We used the grounded-theory approach to identify major themes and then did a content analysis to compare the frequency of key themes between 1998–2000 and 2009–2011. The major themes were: perceptions of brain injury, aggression, equipment, rules and regulations, and youth hockey. Across the full study period, newspaper articles from Canada and America portrayed violence and aggression that leads to TBI both as integral to hockey and as an unavoidable risk associated with playing the game. They also condemned violence in ice hockey, criticized the administrative response to TBI, and recognized the significance of TBI. In Canada, aggression was reported more often recently and there was a distinctive shift in portraying protective equipment as a solution to TBI in earlier years to a potential contributing factor to TBI later in the study period. American newspapers gave a greater attention to ‘perception of risks’ and the role of protective equipment, and discussed TBI in a broader context in the recent time period. Newspapers from both countries showed similar recent trends in regards to a need for rule changes to curb youth sport-related TBI. This study provides a rich description of the reporting around TBI in contact sport. Understanding this reporting is important for evaluating whether the dangers of sport-related TBI are being appropriately communicated by the media.
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