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Finan JD, Vogt TE, Samei Y. Cavitation in blunt impact traumatic brain injury. EXPERIMENTS IN FLUIDS 2024; 65:114. [PMID: 39036013 PMCID: PMC11255084 DOI: 10.1007/s00348-024-03853-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/29/2024] [Accepted: 07/04/2024] [Indexed: 07/23/2024]
Abstract
Traumatic brain injury (TBI) poses a major public health challenge. No proven therapies for the condition exist so protective equipment that prevents or mitigates these injuries plays a critical role in minimizing the societal burden of this condition. Our ability to optimize protective equipment depends on our capacity to relate the mechanics of head impact events to morbidity and mortality. This capacity, in turn, depends on correctly identifying the mechanisms of injury. For several decades, a controversial theory of TBI biomechanics has attributed important classes of injury to cavitation inside the cranial vault during blunt impact. This theory explains counter-intuitive clinical observations, including the coup-contre-coup pattern of injury. However, it is also difficult to validate experimentally in living subjects. Also, blunt impact TBI is a broad term that covers a range of different head impact events, some of which may be better described by cavitation theory than others. This review surveys what has been learned about cavitation through mathematical modeling, physical modeling, and experimentation with living tissues and places it in context with competing theories of blunt injury biomechanics and recent research activity in the field in an attempt to understand what the theory has to offer the next generation of innovators in TBI biomechanics.
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Affiliation(s)
- John D. Finan
- Department of Mechanical and Industrial Engineering, University of Illinois Chicago, Chicago, IL USA
| | - Thea E. Vogt
- Department of Mechanical and Industrial Engineering, University of Illinois Chicago, Chicago, IL USA
| | - Yasaman Samei
- Department of Mechanical and Industrial Engineering, University of Illinois Chicago, Chicago, IL USA
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Bakhtiarydavijani A, Stone TW. Impact of prior axonal injury on subsequent injury during brain tissue stretching - A mesoscale computational approach. J Mech Behav Biomed Mater 2024; 153:106489. [PMID: 38428206 DOI: 10.1016/j.jmbbm.2024.106489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
Epidemiology studies of traumatic brain injury (TBI) show individuals with a prior history of TBI experience an increased risk of future TBI with a significantly more detrimental outcome. But the mechanisms through which prior head injuries may affect risks of injury during future head insults have not been identified. In this work, we show that prior brain tissue injury in the form of mechanically induced axonal injury and glial scar formation can facilitate future mechanically induced tissue injury. To achieve this, we use finite element computational models of brain tissue and a history-dependent pathophysiology-based mechanically-induced axonal injury threshold to determine the evolution of axonal injury and scar tissue formation and their effects on future brain tissue stretching. We find that due to the reduced stiffness of injured tissue and glial scars, the existence of prior injury can increase the risk of future injury in the vicinity of prior injury during future brain tissue stretching. The softer brain scar tissue is shown to increase the strain and strain rate in its vicinity by as much as 40% in its vicinity during dynamic stretching that reduces the global strain required to induce injury by 20% when deformed at 15 s-1 strain rate. The results of this work highlight the need to account for patient history when determining the risk of brain injury.
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Affiliation(s)
| | - Tonya W Stone
- Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS, 39759, USA; Department of Mechanical Engineering, Mississippi State University, Mississippi State, MS, 39762, USA
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Harper BA, Soangra R. Assessing Brain Processing Deficits Using Neuropsychological and Vision-Specific Tests for Concussion. Sports (Basel) 2024; 12:125. [PMID: 38786994 PMCID: PMC11125887 DOI: 10.3390/sports12050125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Since verbal memory and visual processing transpire within analogous cerebral regions, this study assessed (i) if a visual function can predict verbal memory performance. It also hypothesized whether neurocognitive (e.g., ImPACT) tests focusing on the Visual Memory and Cognitive Efficacy Index will predict Verbal Memory scores and (ii) if vision metrics and age can identify individuals with a history of concussion. Finally, it also hypothesized that King-Devick and near point of convergence scores alongside age considerations will identify candidates with a prior reported history of concussion. MATERIALS AND METHODS This observational cohort assessed 25 collegiate ice hockey players prior to the competitive season considering age (19.76 ± 1.42 years) and BMI (25.9 ± 3.0 kg/cm2). Hypothesis 1 was assessed using a hierarchical (sequential) multiple regression analysis, assessing the predictive capacity of Visual Memory and Cognitive Efficacy Index scores in relation to Verbal Memory scores. Hypothesis 2 utilized a binomial logistic regression to determine if King-Devick and near point of convergence scores predict those with a prior history of concussion. RESULTS Hypothesis 1 developed two models, where Model 1 included Visual Memory as the predictor, while Model 2 added the Cognitive Efficacy Index as a predictor for verbal memory scores. Model 1 significantly explained 41% of the variance. Results from Model 2 suggest that the Cognitive Efficacy Index explained an additional 24.4%. Thus, Model 2 was interpreted where only the Cognitive Efficacy Index was a significant predictor (p = 0.001). For every 1 unit increase in the Cognitive Efficacy Index, Verbal Memory increased by 41.16. Hypothesis 2's model was significant, accounting for 37.9% of the variance in those with a history of concussion. However, there were no significant unique predictors within the model as age (Wald = 1.26, p = 0.261), King-Devick (Wald = 2.31, p = 0.128), and near point of convergence (Wald = 2.43, p = 0.119) were not significant predictors individually. CONCLUSIONS The conflicting findings of this study indicate that baseline data for those with a history of concussion greater than one year may not be comparable to the same metrics during acute concussion episodes. Young athletes who sustain a concussion may be able to overcompensate via the visual system. Future prospective studies with larger sample sizes are required using the proposed model's objective metrics.
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Affiliation(s)
- Brent A. Harper
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA 92618, USA;
- Department of Physical Therapy, Radford University, Roanoke, VA 24013, USA
| | - Rahul Soangra
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA 92618, USA;
- Fowler School of Engineering, Chapman University, Orange, CA 92866, USA
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Schussler E, Jagacinski RJ, Chaudhari A, Buford JA, Onate JA. Models of Video Feedback for Youth Athletes Performing an American Football Tackle. J Athl Train 2024; 59:281-288. [PMID: 37071504 PMCID: PMC10976344 DOI: 10.4085/1062-6050-0602.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
CONTEXT Video feedback is an expeditious method for improving athlete safety when performing activities with an inherent risk of injury. Providing appropriate and validated feedback during tackling training in American football may be a mechanism for athletes to learn safe tackling performance. OBJECTIVE To determine the effect of video feedback in the instruction of tackling form. DESIGN Controlled laboratory study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 32 youth football athletes (28 boys, 4 girls; age = 11.8 ± 0.8 years) participated in 1 day of training. Of those, 14 participants completed 2 additional days of training and a 48-hour retention and transfer test. INTERVENTION(S) Video feedback using self as model, expert as model, combined self and expert model, and oral feedback to promote safe tackling performance in a laboratory environment. MAIN OUTCOME MEASURE(S) Shoulder extension, cervical extension, trunk angle, pelvis height, and step length by training block and over time. RESULTS For the 1-day training group, main effects for time were observed for shoulder extension (P < .01), cervical extension (P = .01), pelvis height (P < .01), and step length (P < .01), with better performance for pelvis height and step length after combined feedback. For the 3-day training group, main effects of time were identified in pelvis height (P < .01) and step length (P < .01), with combined feedback showing better performance than other methods in shoulder extension and pelvis height. Combined feedback resulted in better performance compared with its component parts and oral feedback alone. In the combined model, participants viewed both their performance and the expert model, enabling them to see the difference between current and required performance. CONCLUSIONS Combined feedback may be superior to other forms of feedback in improving movement performance. This effect can be generalized across disciplines that provide instruction and feedback in movement.
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Affiliation(s)
- Eric Schussler
- Rehabilitation Sciences, Old Dominion University, Norfolk, VA
| | | | - Ajit Chaudhari
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | - John A. Buford
- Department of Physical Therapy, The Ohio State University, Columbus
| | - James A. Onate
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
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Boden BP, Anderson SA, Sheehan FT. Catastrophic Sports Injuries: Causation and Prevention. J Bone Joint Surg Am 2024; 106:62-73. [PMID: 37988459 DOI: 10.2106/jbjs.23.00335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
➤ Catastrophic injuries in U.S. high school and college athletes are rare but devastating injuries.➤ Catastrophic sports injuries are classified as either traumatic, caused by direct contact during sports participation, or nontraumatic, associated with exertion while participating in a sport.➤ Football is associated with the greatest number of traumatic and nontraumatic catastrophic injuries for male athletes, whereas cheerleading has the highest number of traumatic catastrophic injuries and basketball has the highest number of nontraumatic catastrophic injuries for female athletes.➤ The incidence of traumatic catastrophic injuries for all sports has declined over the past 40 years, due to effective rule changes, especially in football, pole-vaulting, cheerleading, ice hockey, and rugby. Further research is necessary to reduce the incidence of structural brain injury in contact sports such as football.➤ The incidence of nontraumatic catastrophic injuries has increased over the last 40 years and requires additional research and preventive measures. Avoiding overexertion during training, confirming sickle cell trait status in high school athletes during the preparticipation physical examination, and developing cost-effective screening tools for cardiac abnormalities are critical next steps.
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Affiliation(s)
- Barry P Boden
- The Orthopaedic Center, The Centers for Advanced Orthopaedics, Rockville, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Frances T Sheehan
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland
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Boden BP, Brown ID, Huckleby JM, Ahmed AE, Anderson SA. Sport-related Structural Brain Injury in High School and College American Football Athletes, 2002-2020: Effect of Lystedt Law. Sports Health 2023; 15:718-726. [PMID: 36457209 PMCID: PMC10467486 DOI: 10.1177/19417381221134112] [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: 08/31/2023] Open
Abstract
BACKGROUND A previous report revealed an average of 7.2 (0.67 per 100,000 participants) sport-related structural brain injuries (SRSBIs) with macroscopic lesions per year in high school (HS) and college football players. The Lystedt law and other rule changes have been implemented with intent to reduce the risk of brain injury in football. HYPOTHESIS To update the profile of SRSBIs in HS and college football players and evaluate the efficacy of legislation intended to reduce brain injuries. STUDY DESIGN Descriptive epidemiology study. LEVEL OF EVIDENCE Level 4. METHODS We retrospectively reviewed 18 academic years (July 2002 through June 2020) of SRSBIs catalogued by the National Registry of Catastrophic Sports Injuries. The incidence of SRSBIs was assessed at the HS level during the pre (July 2002 through June 2009), transitional (July 2009 through June 2014), and post (July 2014 through June 2020) universal adoption time periods of the Lystedt law. In addition, the incidence of SRSBIs during the second half of the study (2011-2012 through 2019-2020) was compared with the first half of the study (2002-2003 through 2010-2011). RESULTS During the study period, there was a total of 228 SRSBIs (12.7 per year, 1.01 per 100,000 participants): 212 (93%, 11.8 per year, 1.00 per 100,000) in HS athletes and 16 (7%, 0.89 per year, 1.17 per 100,000) in college athletes. There were 52 fatalities (2.9 per year, 0.22 per 100,000 participants) with 46 (2.56 per year, 0.22 per 100,000) in HS athletes and 6 (0.33 per year, 0.43/100,000) in college athletes. There was no significant difference in risk of HS total SRSBIs or fatalities during the 3 Lystedt periods. The risk of combined SRSBI cases [relative risk (RR) = 1.22, P = 0.13] and fatalities (RR = 1.20, P = 0.52) was similar in the second half of the study compared with the first half of the study. CONCLUSION Despite implementation of rule changes intended to reduce head injury, in particular the Lystedt law, the incidence of SRSBIs has remained unchanged. Further research is necessary to develop effective prevention programs for SRSBIs. CLINICAL RELEVANCE SRSBIs remain a persistent problem in HS and college American football. The recent head injury rule changes have not been effective at reducing SRSBIs.
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Affiliation(s)
- Barry P. Boden
- The Orthopedic Center, a division of CAO, Rockville, Maryland
| | - Isaiah D.J. Brown
- The University of Chicago Pritzer School of Medicine, Chicago, Illinois
| | - Jeremy M. Huckleby
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Anwar E. Ahmed
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Scott A. Anderson
- Department of Intercollegiate Athletics, University of Oklahoma, Norman, Oklahoma
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Nicholson CA, Shott S, Levy NB, Ghannad LA, Lagattuta L, McArdle E, Alland JA. Disparities in Sports Medicine Health Care Access in Illinois High Schools: Access to Team Physicians, Athletic Trainers, and Automated External Defibrillators. Curr Sports Med Rep 2023; 22:70-72. [PMID: 36866947 DOI: 10.1249/jsr.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
ABSTRACT High school athletes have higher rates of injuries and sudden death than their college counterparts. Medical care for these athletes should include access to team physicians, athletic trainers, and automated external defibrillators. Disparities in medical care access provided by high schools for their athletes may be due to school characteristics or socioeconomic or racial factors. This study investigated relationships between these factors and access to team physicians, athletic trainers, and automated external defibrillators. Medical care access is negatively related to the percentage of low-income students and positively related to the number of sports offered. Relationships between race and access to a team physician became nonsignificant when the percentage of low-income students was considered. Physicians who treat high school athletes should consider the medical care access provided by their schools when they educate these patients about preventing and treating sports injuries.
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Affiliation(s)
- Caitlin A Nicholson
- Division of Primary Care Sports Medicine, Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Chicago, IL
| | - Susan Shott
- Orion Statistical Consulting, Brookfield, WI
| | - Nicole Boniquit Levy
- Division of Primary Care Sports Medicine, Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Chicago, IL
| | - Leda A Ghannad
- Division of Primary Care Sports Medicine, Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Chicago, IL
| | - Lane Lagattuta
- Department of Physical Medicine and Rehabilitation, Rush University Medical Center, Chicago, IL
| | - Emily McArdle
- Division of Primary Care Sports Medicine, Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Chicago, IL
| | - Jeremy A Alland
- Division of Primary Care Sports Medicine, Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Chicago, IL
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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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Wang N, Yang J, Zheng Y. SOCCER SPORTS INJURIES AMONG CAMPUS TEENAGERS. REV BRAS MED ESPORTE 2023. [DOI: 10.1590/1517-8692202329012022_0803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
ABSTRACT Introduction College soccer is a major priority for the Chinese sports department. Among the most relevant issues is the search for solutions to prevent sports injuries among young college soccer players in the development process. Objective Investigate the causes and characteristics of sports injuries among young college soccer players, aiming to develop scientific measures for prevention and control. Methods A total of 304 young people from primary and secondary schools in one city were selected as volunteers for the research, and the causes and characteristics of sports injuries among these players were analyzed using questionnaires, interviews with experts, and statistical-mathematical analysis. Results According to the characteristics of injury factors of soccer players at different learning stages, a good job should be done on preventing sports injuries of physiological, psychological, technological, training, and other aspects, to reduce the risk of sports injuries in young soccer players. Conclusion Fully understanding sports injury risk prevention, timely summarizing the experience and learnings, and doing a good job in sports injury prevention from the aspects of physiology, psychology, technology, training, and other aspects according to the characteristics of injury factors of soccer players at different school stages are desirable practices to reduce the risk of sports injury and improve the quality of school soccer training and competition for young college soccer players. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.
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Affiliation(s)
- Nannan Wang
- Xi’an University of Posts and Telecommunications, China
| | - Jin Yang
- Xi’an University of Posts and Telecommunications, China
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Canseco JA, Franks RR, Karamian BA, Divi SN, Reyes AA, Mao JZ, Al Saiegh F, Donnally CJ, Schroeder GD, Harrop JS, Pepe MD, Vaccaro AR. Overview of Traumatic Brain Injury in American Football Athletes. Clin J Sport Med 2022; 32:236-247. [PMID: 33797476 DOI: 10.1097/jsm.0000000000000918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/17/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this review is to provide a summary of the epidemiology, clinical presentation, pathophysiology, and treatment of traumatic brain injury in collision athletes, particularly those participating in American football. DATA SOURCES A literature search was conducted using the PubMed/MEDLINE and Google Scholar databases for publications between 1990 and 2019. The following search phrases were used: "concussion," "professional athletes," "collision athletes," "mild traumatic brain injury," "severe traumatic brain injury," "management of concussion," "management of severe traumatic brain injury," and "chronic traumatic encephalopathy." Publications that did not present epidemiology, clinical presentation, pathophysiology, radiological evaluation, or management were omitted. Classic articles as per senior author recommendations were retrieved through reference review. RESULTS The results of the literature review yielded 147 references: 21 articles discussing epidemiology, 16 discussing clinical presentation, 34 discussing etiology and pathophysiology, 10 discussing radiological evaluation, 34 articles for on-field management, and 32 articles for medical and surgical management. CONCLUSION Traumatic brain injuries are frequent in professional collision athletes, and more severe injuries can have devastating and lasting consequences. Although sport-related concussions are well studied in professional American football, there is limited literature on the epidemiology and management of severe traumatic brain injuries. This article reviews the epidemiology, as well as the current practices in sideline evaluation, acute management, and surgical treatment of concussions and severe traumatic brain injury in professional collision athletes. Return-to-play decisions should be based on individual patient symptoms and recovery.
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Affiliation(s)
- Jose A Canseco
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - R Robert Franks
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
- Rothman Sports Concussion Institute, Rothman Institute, Philadelphia, Pennsylvania; and
| | - Brian A Karamian
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Srikanth N Divi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ariana A Reyes
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jennifer Z Mao
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Fadi Al Saiegh
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Chester J Donnally
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gregory D Schroeder
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James S Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew D Pepe
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Lininger MR, Yeargin SW, Hirschhorn RM, Mensch J. Assessing the validity of a helmet fit checklist in a sample of youth football players. Res Sports Med 2021:1-11. [PMID: 34633258 DOI: 10.1080/15438627.2021.1988949] [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
The dynamics of American youth football make it critical to ensure that helmets are appropriately fit to decrease the risk of injuries. Currently, there is only one researcher-developed checklist to determine helmet fit, and psychometric testing is lacking; therefore, the aim of this work was to determine the validity of the checklist. The 13-item checklist was used to measure helmet fit in 267 youth football players prior to the start of the season. Using a Principal Components Analysis to assess validity, a 5-component model was found explaining 58% of the available variance. These results suggest that a single, summative score should not be used for this checklist; rather five scores should be calculated for each component (stability, snugness, size, integrity, and accessory). A more practical and valid tool to assess fit, such as a sub-sectioned chronological American football-specific checklist, can better assist coaches/administrators responsible for helmet fit and player safety.
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Affiliation(s)
- M R Lininger
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, AZ, USA
| | - S W Yeargin
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | - R M Hirschhorn
- School of Kinesiology, Auburn University, Auburn, AL, USA
| | - J Mensch
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
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Improper Fit in American Youth Football Helmets Across One Competitive Season. Ann Biomed Eng 2021; 49:2924-2931. [PMID: 34389900 DOI: 10.1007/s10439-021-02817-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
Improper helmet fit is related to sport-related concussion symptomology. The objective of this study was to determine the prevalence of improperly fit helmets in American youth tackle football players across one competitive season. Four recreation leagues including 147 players (45.2 ± 14.7 cm, 147.5 ± 9.0 kg), aged 7-12 years, participated in pre-season and post-season data collection timepoints. Participant and league demographics were collected at pre-season. Helmet fit was assessed at pre- and post-season using a 13-item checklist. A helmet was defined as improperly fit if failed to comply with or more of the checklist items. Most players (84%) rented helmets from the league. At preseason, 71.4% of helmets, and at post-season 79.6%, were improperly fit with no significant change over time (p = 0.14). Of the 105 improperly fit helmets at the start of the season, 61% were still considered improperly fit at post season. The 11-12 year old age group had significantly more improperly fit helmets than the 7-10 year old age group at post-season (p = 0.033), but not pre-season (p = 0.655). American youth football players depend on the league to fit their helmet. Most players did not meet at least one checklist criteria. Helmets improperly fit at preseason were still not fit at post.
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Abstract
Back pain in sport is a common complaint and seen by athletes, trainers, and treating physicians. Although there are a multitude of pain generators, mechanical sources are most common. Certain sports can lead to increased mechanical and axial loading, such as competitive weightlifting and football. Common mechanical causes of pain include disk herniation and spondylolysis. Patients typically respond to early identification and conservative treatment. In others, surgical intervention is required to provide stability and prevent long-term sequelae.
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Affiliation(s)
- Andrew Z Mo
- Department of Orthopaedics, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, 12th Floor, Miami, FL 33136, USA
| | - Joseph P Gjolaj
- Department of Orthopaedics, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, 12th Floor, Miami, FL 33136, USA.
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Dymek M, Ptak M, Ratajczak M, Fernandes FAO, Kwiatkowski A, Wilhelm J. Analysis of HIC and Hydrostatic Pressure in the Human Head during NOCSAE Tests of American Football Helmets. Brain Sci 2021; 11:287. [PMID: 33669105 PMCID: PMC7996556 DOI: 10.3390/brainsci11030287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/10/2021] [Accepted: 02/22/2021] [Indexed: 11/21/2022] Open
Abstract
Brain damage is a serious economic and social burden. Contact sports such as American football, are one of the most common sources of concussions. The biomechanical response of the head-helmet system caused by dynamic loading plays a major role. The literature has focused on measuring the resultant kinematics that act on the head and helmet during tackles. However, few studies have focused on helmet validation tests, supported by recent findings and emerging numerical approaches. The future of helmet standards could benefit from insights at the level of injury mechanisms, using numerical tools to assess the helmets. Therefore, in this work, a numerical approach is employed to investigate the influence of intracranial pressure (ICP) on brain pathophysiology during and after helmeted impacts, which are common in American football. The helmeted impacts were performed at several impact locations according to the NOCSAE standard (configurations A, AP, B, C, D, F, R, UT). In order to evaluate the ICP levels, the αHEAD finite element head and brain model was combined with a Hybrid III-neck structure and then coupled with an American football helmet to simulate the NOCSAE impacts. In addition, the ICP level was analyzed together with the resulting HIC value, since the latter is commonly used, in this application and others, as the injury criterion. The obtained results indicate that ICP values exceed the common threshold of head injury criteria and do not correlate with HIC values. Thus, this work raises concern about applying the HIC to predict brain injury in American football direct head impacts, since it does not correlate with ICP predicted with the FE head model.
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Affiliation(s)
- Mateusz Dymek
- Faculty of Mechanical Engineering, Wroclaw University of Science and Technology, Lukasiewicza 7/9, 50-371 Wroclaw, Poland
| | - Mariusz Ptak
- Faculty of Mechanical Engineering, Wroclaw University of Science and Technology, Lukasiewicza 7/9, 50-371 Wroclaw, Poland
| | - Monika Ratajczak
- Faculty of Mechanical Engineering, University of Zielona Gora, ul. Szafrana 4, 65-516 Zielona Gora, Poland;
| | - Fábio A. O. Fernandes
- TEMA—Centre for Mechanical Technology and Automation, Department of Mechanical Engineering, Campus de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Artur Kwiatkowski
- Department of Neurosurgery, Provincial Specialist Hospital in Legnica, ul. Iwaszkiewicza 5, 59-220 Legnica, Poland;
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Grozenski A, Zadell J, Kiel J, Parsons M. Delayed Presentation of an Acute Traumatic Subdural Hematoma in a High School Football Quarterback. Curr Sports Med Rep 2021; 20:16-18. [PMID: 33395126 DOI: 10.1249/jsr.0000000000000797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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De Stefano F, Fiani B, Mayo T. A Foundational “Survival Guide” Overview of Sports-Related Head Injuries. Cureus 2020; 12:e11636. [PMID: 33376648 PMCID: PMC7755598 DOI: 10.7759/cureus.11636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Garavito DMN, Reyna VF, DeTello JE, Landow BR, Tarpinian LM. Intentions to report concussion symptoms in nonprofessional athletes: A fuzzy‐trace theory approach. APPLIED COGNITIVE PSYCHOLOGY 2020. [DOI: 10.1002/acp.3734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
| | - Valerie F. Reyna
- Department of Human Development Cornell University Ithaca New York USA
| | - Joseph E. DeTello
- Department of Human Development Cornell University Ithaca New York USA
| | - Bailey R. Landow
- Department of Human Development Cornell University Ithaca New York USA
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Bookbinder HA, Houston MN, Peck KY, Habecker S, Colsant BJ, Kelly TF, Roach SP, Malvasi SR, McGinty GT, Campbell DE, Svoboda SJ, Cameron KL. Factors Associated With Delayed Concussion Reporting by United States Service Academy Cadets. J Athl Train 2020; 55:843-849. [PMID: 32607554 DOI: 10.4085/1062-6050-362-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
CONTEXT Approximately half of individuals who sustain a concussion do not immediately report their injuries. Motivators for not reporting include thinking the suspected concussion was not a serious injury and wanting to continue participating in activity. Additionally, military personnel have concerns about how concussions may affect their careers. However, delayed reporting can prolong neurobehavioral recovery. Understanding the frequency of delayed reporting and contributing factors will aid in identifying individuals who may be more likely to delay reporting. OBJECTIVE To describe the frequency of delayed concussion reporting by service academy cadets and determine if sex, injury setting, sport level, or medical history is capable of predicting delayed reporting. DESIGN Cohort study. SETTING Service academies. PATIENTS OR OTHER PARTICIPANTS A total of 316 patients with concussions were observed from January 2014 to August 2016. MAIN OUTCOME MEASURE(S) All cadets completed an annual concussion baseline collection of demographic, medical history, and sports participation information. Delayed concussion reporting served as the outcome variable. Predictor variables were sex, injury setting, and sport level, as well as concussion, headache, and learning disorder history. Frequencies were calculated to describe the proportion of participants who delayed reporting. Univariable and multivariable logistic regression models were used to assess if the predictor variables were associated with delayed concussion reporting. Odds ratios (ORs) and 95% confidence intervals were calculated for all variables included in the final model. RESULTS Of the patients with concussion, 51% were classified as delayed reporting. In univariable models, females (OR = 1.70) and National Collegiate Athletic Association cadet-athletes (OR = 1.98) were more likely to delay reporting than males and intramural cadet-athletes, respectively. The multivariable model yielded similar findings. CONCLUSIONS Roughly half of the cadets who sustained a concussion failed to immediately report their injury. Specifically, our data suggested that female cadets, cadets injured outside of competition, and highly competitive cadet-athletes were almost twice as likely to delay reporting as others.
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Affiliation(s)
| | | | | | | | | | - Tim F Kelly
- United States Military Academy, West Point, NY
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Arakkal AT, Barón AE, Lamb MM, Fields SK, Comstock RD. Evaluating the effectiveness of traumatic brain injury state laws among high school athletes. Inj Epidemiol 2020; 7:12. [PMID: 32279659 PMCID: PMC7153238 DOI: 10.1186/s40621-020-00241-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/23/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Traumatic brain injury legislation varies across states. A comprehensive nationwide evaluation of state traumatic brain injury laws is vital given growing populations of high school athletes. This study evaluates the effectiveness of traumatic brain injury laws by examining longitudinal trends in incident and recurrent concussion rates and determines if state level variations in legislation's language affected the observed trends. METHODS In this retrospective ecological study of a large national sample of US high schools from 2005/06 through 2017/18, piecewise regression models along with a profile likelihood approach were utilized to examine longitudinal trends in incident and recurrent concussion rates. RESULTS Overall incident concussion rates increased by an additional 1.85%/standardized month (STDM) (95% confidence interval (CI): 1.14, 2.56%) prior to law passage and decreased by an additional 1.08%/ STDM (95%CI: - 1.43, - 0.72%) after law passage. Similar trends were observed for overall recurrent concussion rates. Among states that specified the category of healthcare provider for return to play clearance, post-law recurrent concussion rates decreased on average by an additional 1.59%/STDM (95%CI: - 3.42, 0.22%) compared to states that did not specify the category of healthcare provider. CONCLUSIONS The passage of state level traumatic brain injury laws was associated with an increase in overall incident and recurrent concussion rates prior to law passage and a decrease in rates after law passage. Although not statistically significant, states with traumatic brain injury laws specifying the category of healthcare provider for return to play clearance had a greater rate of decline in post-law recurrent concussion rates compared to states not specifying the category of healthcare provider. The findings suggest that state traumatic brain injury laws may benefit from specifying the category of healthcare provider allowed to provide return to play clearance, if they do not already include such language.
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Affiliation(s)
- Alan T Arakkal
- Department of Epidemiology, College of Public Health, University of Iowa, 145 N Riverside Dr 100 CPHB, Iowa City, IA, 52242, USA.
| | - Anna E Barón
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Molly M Lamb
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sarah K Fields
- Department of Communication, University of Colorado Denver, Denver, Colorado, USA
| | - R Dawn Comstock
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
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Bates TJ, Lee P, Ellison TM, Ahuero JS, Schmitz MR. Acute subdural hematoma in an elite-level rugby union player. Trauma Case Rep 2020; 26:100295. [PMID: 32154358 PMCID: PMC7058922 DOI: 10.1016/j.tcr.2020.100295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2020] [Indexed: 12/04/2022] Open
Abstract
Acute subdural hematoma is a rare but potentially fatal medical condition in athletes. This condition has been reported in both contact and non-contact sports. Patients who survive an acute subdural hematoma typically have lifelong deficits and require extensive rehabilitation. Prompt recognition of this condition and access to a hospital with an available neurosurgeon is critical. To our knowledge, this is the first report of a subdural hematoma in an elite-level rugby player. Prompt recognition of head injuries is vital to prevent devastating outcomes. History and subjective symptoms should be carefully assessed after a head injury. Medical staff should remain vigilant, symptoms may develop over days or weeks. Expedient transport to a facility with neurosurgical support should be available. Transport should be considered, even in the absence of concerning exam findings.
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Affiliation(s)
- Taylor J. Bates
- San Antonio Military Medical Center, Department of Orthopaedic Surgery, Fort Sam Houston, TX, United States of America
- Corresponding author at: San Antonio Military Medical Center, Department of Orthopaedic Surgery, 3551 Roger Brooke Drive, JBSA-Fort Sam Houston, TX 78219, United States of America.
| | - Paul Lee
- University of New England College of Osteopathic Medicine, Biddeford, ME, United States of America
| | - Tayt M. Ellison
- San Antonio Military Medical Center, Department of Orthopaedic Surgery, Fort Sam Houston, TX, United States of America
| | - Jason S. Ahuero
- Houston Methodist Orthopaedics and Sports Medicine, Houston, TX, United States of America
| | - Matthew R. Schmitz
- San Antonio Military Medical Center, Department of Orthopaedic Surgery, Fort Sam Houston, TX, United States of America
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Second Impact Syndrome. Myth or reality? Neurochirurgie 2020; 67:265-275. [PMID: 32169407 DOI: 10.1016/j.neuchi.2019.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/21/2019] [Accepted: 12/27/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Second impact syndrome (SIS) is a devastating condition occurring in sport-induced mild brain injury. SIS is drastically defined by anamnestic, clinical and radiological criteria, which is unusual in the field of cranial traumatology. The purpose of this study was to provide a literature review of this syndrome. MATERIAL AND METHODS We conducted a literature review of all published studies on PubMed. The keywords were "second impact syndrome and catastrophic head injury", "second impact syndrome and sport", "repeat concussion and catastrophic brain injury", "catastrophic head injury and concussion", "catastrophic head injury", "concussion and second impact syndrome", "concussion and repetitive head injury". RESULTS Eighty-two full-text articles were assessed for eligibility. Finally, 41 studies were included in qualitative synthesis and 21 were included in quantitative synthesis. DISCUSSION The number of cases reported in the literature was extremely small compared to the population at risk, i.e., the number of athletes exposed to repeated concussions. SIS was similar to talk and die syndrome, with which it shares certain characteristics. If we consider SIS according to "talk and deteriorate tables", it opens up interesting perspectives because they are specific in children and adolescents. Taking into account the scarcity of this syndrome, one may question whether athlete-intrinsic features may be involved in at least some cases of SIS. On a pathophysiological level, many explanations remained unsatisfactory because they were unable to explain all the clinical phenomena and observed lesions. Triggering the trigeminocardiac reflex is a crucial element in explaining the sequence of clinical events. Its association with a state of neurogenic inflammation provides an almost complete explanation for this particular condition. Finally, on a practical level, a concussion occurring during the playing of a sport must be considered as any other injury before allowing a return to play.
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Acute Sports-Related Head Injuries. Prim Care 2020; 47:177-188. [DOI: 10.1016/j.pop.2019.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Yengo-Kahn A, Zuckerman SL. Letter: Preventable Deaths, Video Analysis, Artificial Intelligence, and the Future of Sport. Neurosurgery 2019; 86:E349-E350. [DOI: 10.1093/neuros/nyz452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aaron Yengo-Kahn
- Vanderbilt Sport Concussion Center Vanderbilt University Medical Center Nashville, Tennessee
- Department of Neurological Surgery Vanderbilt University Medical Center Nashville, Tennessee
| | - Scott L Zuckerman
- Vanderbilt Sport Concussion Center Vanderbilt University Medical Center Nashville, Tennessee
- Department of Neurological Surgery Vanderbilt University Medical Center Nashville, Tennessee
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Lerner A, Fost N. Informed Consent for Youth Tackle Football: Implications of the AAP Policy Statement. Pediatrics 2019; 144:peds.2019-1985. [PMID: 31645457 DOI: 10.1542/peds.2019-1985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alec Lerner
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Norman Fost
- Departments of Pediatrics and Medical History and Bioethics and
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The Epidemiology of Sport-Related Concussion: What the Rehabilitation Clinician Needs to Know. J Orthop Sports Phys Ther 2019; 49:768-778. [PMID: 31672116 DOI: 10.2519/jospt.2019.9105] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sport-related concussion is common in full-contact and collision sports. Epidemiology studies use different types of surveillance systems and concussion definitions. Concussion incidence rates vary across age, sex, sport, and level of competition. Incidence rates are increasing, likely due to higher rates of reporting following improved knowledge and increased regulations. In this review, we summarize 7 key concepts related to concussion epidemiology: concussion definition, changes in concussion knowledge, reliability and accuracy of injury surveillance systems, conservative management and return to play, reliability of self-report, incidence of concussion across levels of play, and understanding the behaviors of players, coaches, and medical personnel from a multidisciplinary management perspective. J Orthop Sports Phys Ther 2019;49(11):768-778. doi:10.2519/jospt.2019.9105.
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26
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Fanton MG, Sganga JA, Camarillo D. Vulnerable locations on the head to brain injury and implications for helmet design. J Biomech Eng 2019; 141:975510. [PMID: 31523753 DOI: 10.1115/1.4044876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Indexed: 12/16/2022]
Abstract
In studying traumatic brain injury (TBI), it has been long hypothesized that the head is more vulnerable to injury from impacts in certain directions or locations, as the relationship between impact force and the resulting neurological outcome is complex and can vary significantly between individual cases. Many studies have identified head angular acceleration to be the putative cause of brain trauma, but it is not well understood how impact location can affect the resulting head kinematics and tissue strain. Here, we identify the susceptibility of the head to accelerations and brain strain from normal forces at contact points across the surface of the skull and jaw using a 3-dimensional, 20 degree-of-freedom rigid-body head and cervical spine model. We find that head angular acceleration and brain tissue strain resulting from an input force can vary by orders of magnitude based on impact location on the skull, with the mandible as the most vulnerable region. Conversely, head linear acceleration is not sensitive to contact location. Using these analyses, we present an optimization scheme to distribute helmet padding thickness to minimize angular acceleration, resulting in a reduction of angular acceleration by an estimated 25% at the most vulnerable contact point compared to uniform thickness padding. This work gives intuition behind the relationship between input force and resulting brain injury risk, and presents a framework for developing and evaluating novel head protection gear.
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Affiliation(s)
- Michael G Fanton
- Department of Mechanical Engineering, Stanford University, Stanford, CA
| | - Jake A Sganga
- Department of Bioengineering, Stanford University, Stanford, CA
| | - David Camarillo
- Department of Bioengineering, Stanford University, Stanford, CA
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27
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Jones NS, Wieschhaus K, Martin B, Tonino PM. Medical Supervision of High School Athletics in Chicago: A Follow-up Study. Orthop J Sports Med 2019; 7:2325967119862503. [PMID: 31448300 PMCID: PMC6691665 DOI: 10.1177/2325967119862503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND High school sports participation in the United States has increased dramatically over the past 25 years. A corresponding increase in the number of injuries has been noted, particularly in contact sports such as football. This has led medical and sports organizations nationwide to advocate for proper medical supervision of athletes at games and practices. PURPOSE To gather information from Chicago public high schools to gauge how medical supervision for high school sports has changed in 2017 compared with 2003. STUDY DESIGN Cross-sectional study. METHODS Survey questionnaires were sent to the athletic directors of all 99 Chicago public high schools to complete via email. The questionnaire survey contained the same questions as in a survey conducted in 2003 by Tonino and Bollier, with the addition of 4 novel questions relating to emergency action plans (EAPs), automated external defibrillators, concussion management policy, and tackling progression drills. RESULTS The response rate was 66.67% (66/99 schools). Of the 66 responding schools, all with football programs, no school had a physician on the sideline at home games (decrease from 10.6% in 2003), 37.9% had an athletic trainer present (increase from 8.5% in 2003), and 63.6% had a paramedic available (decrease from 89.4% in 2003). In 2017, 65.6% of responding schools had a coach certified in cardiopulmonary resuscitation (CPR) available at practice to handle medical problems, compared with 89.4% in 2003 (P < .001). Regarding the 4 novel questions, 93.9% of the responding schools had proper tackling progression drills in place, followed by 89.1% who had appropriate EAPs and 93.9% with concussion management protocols, including return-to-play and return-to-learn protocols. CONCLUSION Although significant improvement was found in athletic trainer coverage, especially at games, physician coverage was lacking and fewer coaches were certified in CPR in 2017 compared with 2003. EAPs and concussion management protocols were present in most Chicago public high schools. Overall, greater medical supervision is needed, which we believe should come in the form of increased athletic training and physician involvement and coverage, given that expert, expedited medical care saves lives.
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Affiliation(s)
- Nathaniel S. Jones
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago–Stritch School of Medicine, Maywood, Illinois, USA
| | - Kyle Wieschhaus
- Loyola University Chicago–Stritch School of Medicine, Maywood, Illinois, USA
| | | | - Pietro M. Tonino
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago–Stritch School of Medicine, Maywood, Illinois, USA
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Abstract
Concussions have gained attention in medical literature, legal literature, and lay media over the past several years as a public health affecting children, particularly those who do not improve in the first few days after an injury. We discuss strategies for acute management immediately after a concussion and an introduction to medical and non-medical options for treatment of the complex symptoms that persist in some patients with concussions. We examine the role of rest and exercise during recovery. We briefly discuss the role of the multidisciplinary approach to concussion in a setting that engages multiple specialists. Finally, we address policy changes related to sport-concussions and their efficacy in improving long term outcomes.
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Affiliation(s)
- Karameh Kuemmerle
- Neurology Foundation, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115; Harvard Medical School, Boston, MA.
| | - William P Meehan
- Harvard Medical School, Boston, MA; Division of Sports Medicine, Boston Children's Hospital, Boston, MA.
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29
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Sport-Related Structural Brain Injury in High School Soccer: Epidural Hemorrhage After a “Header”. World Neurosurg 2019; 127:20-23. [DOI: 10.1016/j.wneu.2019.03.198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 11/21/2022]
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30
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Akhand O, Rizzo JR, Rucker JC, Hasanaj L, Galetta SL, Balcer LJ. History and Future Directions of Vision Testing in Head Trauma. J Neuroophthalmol 2019; 39:68-81. [DOI: 10.1097/wno.0000000000000726] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Long AS, Niemeier JP, McWilliams A, Patterson CG, Perrin P, Templin M, Price DE. Comparison of Neurocognitive Changes Over One Competitive Season in Adolescent Contact and Non-contact Athletes. ACTA ACUST UNITED AC 2019. [DOI: 10.3928/19425864-20180430-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Halstead ME, Walter KD, Moffatt K, LaBella CR, Brooks MA, Canty G, Diamond AB, Hennrikus W, Logan K, Nemeth BA, Pengel KB, Peterson AR, Stricker PR. Sport-Related Concussion in Children and Adolescents. Pediatrics 2018; 142:peds.2018-3074. [PMID: 30420472 DOI: 10.1542/peds.2018-3074] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Sport-related concussion is an important topic in nearly all sports and at all levels of sport for children and adolescents. Concussion knowledge and approaches to management have progressed since the American Academy of Pediatrics published its first clinical report on the subject in 2010. Concussion's definition, signs, and symptoms must be understood to diagnose it and rule out more severe intracranial injury. Pediatric health care providers should have a good understanding of diagnostic evaluation and initial management strategies. Effective management can aid recovery and potentially reduce the risk of long-term symptoms and complications. Because concussion symptoms often interfere with school, social life, family relationships, and athletics, a concussion may affect the emotional well-being of the injured athlete. Because every concussion has its own unique spectrum and severity of symptoms, individualized management is appropriate. The reduction, not necessarily elimination, of physical and cognitive activity is the mainstay of treatment. A full return to activity and/or sport is accomplished by using a stepwise program while evaluating for a return of symptoms. An understanding of prolonged symptoms and complications will help the pediatric health care provider know when to refer to a specialist. Additional research is needed in nearly all aspects of concussion in the young athlete. This report provides education on the current state of sport-related concussion knowledge, diagnosis, and management in children and adolescents.
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Affiliation(s)
| | - Kevin D. Walter
- Department of Orthopaedic Surgery, Pediatric Sports Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Kody Moffatt
- Creighton University School of Medicine, Omaha, Nebraska
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Effectiveness of Vestibular Rehabilitation Therapy for Treatment of Concussed Adolescents With Persistent Symptoms of Dizziness and Imbalance. J Sport Rehabil 2018; 27:485-490. [DOI: 10.1123/jsr.2016-0222] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Context:Adolescents who suffer sport concussion typically respond to a prescription of cognitive and physical rest in the acute phases of healing; however, some adolescents do not respond to rest alone. Dizziness, unsteadiness, and imbalance are impairments, which may linger longer than 30 days, leading to a diagnosis of postconcussion syndrome (PCS). Vestibular assessment and therapy may benefit adolescents suffering from these persistent symptoms.Clinical Question:Does vestibular rehabilitation therapy (VRT) rather than continued prescription of rest (cognitive and physical) reduce recovery time and persistent symptoms of dizziness, unsteadiness, and imbalance in adolescents (12–18 y) who suffer PCS following a sports-related concussion?Summary of Key Findings:All 4 studies selected included adolescents suffering from PCS, specifically continued dizziness, unsteadiness, and imbalance. VRT was an effective intervention for this population. Adolescents presenting with this cluster of symptoms may also demonstrate verbal and visual memory loss linked to changes in the vestibular system postconcussion. Improved screening tools can help better understand vestibular system changes, identify adolescents who may benefit from VRT sooner, and decrease long-term impairments.Clinical Bottom Line:Moderate evidence supports that adolescents who suffer from persistent symptoms of dizziness, unsteadiness, and imbalance following sport concussion should be evaluated more specifically and earlier for vestibular dysfunction and can benefit from participation in individualized VRT. Early evaluation and treatment may result in a reduction of time lost from sport as well as a return to their premorbid condition. For these adolescents, VRT may be more beneficial than continued physical and cognitive rest when an adolescent’s symptoms last longer than 30 days.Strength of Recommendation:Grade B evidence exists to support that VRT is more effective than continued cognitive and physical rest in reducing persistent symptoms of dizziness, unsteadiness, and imbalance in adolescents who suffer PCS.
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Kerr ZY, Wilkerson GB, Caswell SV, Currie DW, Pierpoint LA, Wasserman EB, Knowles SB, Dompier TP, Comstock RD, Marshall SW. The First Decade of Web-Based Sports Injury Surveillance: Descriptive Epidemiology of Injuries in United States High School Football (2005-2006 Through 2013-2014) and National Collegiate Athletic Association Football (2004-2005 Through 2013-2014). J Athl Train 2018; 53:738-751. [PMID: 30138047 PMCID: PMC6188086 DOI: 10.4085/1062-6050-144-17] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT: The advent of Web-based sports injury surveillance via programs such as the High School Reporting Information Online system and the National Collegiate Athletic Association Injury Surveillance Program has aided the acquisition of football injury data. OBJECTIVE: To describe the epidemiology of injuries sustained in high school football in the 2005-2006 through 2013-2014 academic years and collegiate football in the 2004-2005 through 2013-2014 academic years using Web-based sports injury surveillance. DESIGN: Descriptive epidemiology study. SETTING: Online injury surveillance from football teams of high school boys (annual average = 100) and collegiate men (annual average = 43). PATIENTS OR OTHER PARTICIPANTS: Football players who participated in practices and competitions during the 2005-2006 through 2013-2014 academic years in high school or the 2004-2005 through 2013-2014 academic years in college. MAIN OUTCOME MEASURE(S): Athletic trainers collected time-loss injury (≥24 hours) and exposure data. Injury rates per 1000 athlete-exposures (AEs), injury rate ratios (IRRs) with 95% confidence intervals (CIs), and injury proportions by body site and diagnosis were calculated. RESULTS: The High School Reporting Information Online system documented 18 189 time-loss injuries during 4 539 636 AEs; the National Collegiate Athletic Association Injury Surveillance Program documented 22 766 time-loss injuries during 3 121 476 AEs. The injury rate was higher among collegiate than high school (7.29 versus 4.01/1000 AEs; IRR = 1.82; 95% CI = 1.79, 1.86) athletes. Most injuries occurred during competitions in high school (53.2%) and practices in college (60.9%). The competition injury rate was higher than the practice injury rate among both high school (IRR = 5.62; 95% CI = 5.46, 5.78) and collegiate (IRR = 6.59; 95% CI = 6.41, 6.76) players. Most injuries at both levels affected the lower extremity and the shoulder/clavicle and were diagnosed as ligament sprains and muscle/tendon strains. However, concussion was a common injury during competitions among most positions. CONCLUSIONS: Injury rates were higher in college than in high school and higher for competitions than for practices. Concussion was a frequent injury sustained during competitions, which confirms the need to develop interventions to mitigate its incidence and severity.
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Affiliation(s)
- Zachary Y. Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Gary B. Wilkerson
- Graduate Athletic Training Education Program, University of Tennessee at Chattanooga
| | - Shane V. Caswell
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, Manassas, VA
| | - Dustin W. Currie
- Department of Epidemiology, University of Colorado Anschutz, Aurora
| | | | - Erin B. Wasserman
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | | | - Thomas P. Dompier
- Department of Athletic Training, Lebanon Valley College, Annville, PA
| | - R. Dawn Comstock
- Department of Epidemiology, University of Colorado Anschutz, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Stephen W. Marshall
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
- Department of Epidemiology, University of North Carolina at Chapel Hill
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Weber CD, Horst K, Nguyen AR, Lefering R, Pape HC, Hildebrand F. Evaluation of severe and fatal injuries in extreme and contact sports: an international multicenter analysis. Arch Orthop Trauma Surg 2018; 138:963-970. [PMID: 29675749 DOI: 10.1007/s00402-018-2935-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Indexed: 01/21/2023]
Abstract
PURPOSE The participation in extreme and contact sports has grown internationally, despite the significant risk for major and multiple injuries. We conducted this multicenter study to evaluate sport-specific injury patterns and mechanisms, to characterize individuals at risk and to identify possible approaches for prevention. METHODS We compared demographic data, severity and patterns of injuries; and the pre- and in-hospital management from an international population-based prospective trauma database (TraumaRegister DGU®). The registry was screened for sport-related injuries, and only patients with major injuries [Injury Severity Score (ISS) ≥ 9 points] related to extreme or contact sports activities were included (January 1, 2002, to December 31, 2012). Parameters were compared for different types of sports activities: (1) Airborne sports, (2) Climbing, (3) Skateboarding/Skating, (4) Contact sports. The following countries participated: Germany, Austria, Switzerland, Finland, Slovenia, Belgium, Luxembourg, and The Netherlands. Statistical analyses were performed with SPSS (Version 22, IBM Inc., Armonk, New York). RESULTS A total of 278 athletes were identified within the study period and classified into four groups: Airborne sports (n = 105) were associated with the highest injury severity (ISS 22.4 ± 14.6), followed by climbing (n = 35, ISS 16.5 ± 12), skating (n = 67, ISS 15.2 ± 10.3) and contact sports (n = 71, ISS 10.4 ± 9.2). Especially high falls resulted in a significant rate of spinal injuries in airborne activities (68.6%, p < 0.001) and in climbing accidents (45.7%). Skating was associated with the highest rate of loss of consciousness (LOC) at scene (27.1%), the highest pre-hospital intubation rate (33.3%), and also the highest in-hospital mortality (15.2%, p < 0.001), related to major head injuries. CONCLUSIONS Extreme and contact sports related major injuries predominantly affect young male athletes. Especially skaters are at risk for debilitating and lethal head injuries. Individuals recognizing sport-specific hazards might modify their risk behavior. LEVEL OF EVIDENCE Descriptive Epidemiologic Study, Level II.
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Affiliation(s)
- Christian D Weber
- Department of Orthopaedics and Trauma, RWTH Aachen University, Pauwels street 30, 52074, Aachen, Germany. .,Olympic Center Rhineland, Aachen, Germany.
| | - Klemens Horst
- Department of Orthopaedics and Trauma, RWTH Aachen University, Pauwels street 30, 52074, Aachen, Germany
| | - Anthony R Nguyen
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Rolf Lefering
- Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU), Cologne, Germany
| | | | - Frank Hildebrand
- Department of Orthopaedics and Trauma, RWTH Aachen University, Pauwels street 30, 52074, Aachen, Germany
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Wolff CS, Cantu RC, Kucera KL. Catastrophic neurologic injuries in sport. ACTA ACUST UNITED AC 2018; 158:25-37. [DOI: 10.1016/b978-0-444-63954-7.00004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Yengo-Kahn AM, Gardner RM, Kuhn AW, Solomon GS, Bonfield CM, Zuckerman SL. Sport-Related Structural Brain Injury: 3 Cases of Subdural Hemorrhage in American High School Football. World Neurosurg 2017; 106:1055.e5-1055.e11. [DOI: 10.1016/j.wneu.2017.07.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
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Wallace J, Covassin T, Nogle S, Gould D, Kovan J. Concussion Knowledge and Reporting Behavior Differences Between High School Athletes at Urban and Suburban High Schools. THE JOURNAL OF SCHOOL HEALTH 2017; 87:665-674. [PMID: 28766322 DOI: 10.1111/josh.12543] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 12/21/2016] [Accepted: 02/13/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND We determined differences in knowledge of concussion and reporting behaviors of high school athletes attending urban and suburban high schools, and whether a relationship exists between underreporting and access to an athletic trainer in urban schools. METHODS High school athletes (N = 715) from 14 high schools completed a validated knowledge of concussion survey consisting of 83 questions. The independent variable was school type (urban/suburban). We examined the proportion of athletes who correctly identified signs and symptoms of concussion, knowledge of concussion and reasons why high school athletes would not disclose a potential concussive injury across school classification. Data were analyzed using descriptive, non-parametric, and inferential statistics. RESULTS Athletes attending urban schools have less concussion knowledge than athletes attending suburban schools (p < .01). Athletes attending urban schools without an athletic trainer have less knowledge than urban athletes at schools with an athletic trainer (p < .01) There was no significant relationship between reporting percentage and school type (p = .73); however, significant relationships exist between AT access at urban schools and 10 reasons for not reporting. CONCLUSION Concussion education efforts cannot be homogeneous in all communities. Education interventions must reflect the needs of each community.
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Affiliation(s)
- Jessica Wallace
- Kinesiology & Sport Science Department, Youngstown State University, 1 University Plaza, 307 L Beeghly Center, Youngstown, OH 44555
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, 105 IM Circle, East Lansing, MI 48824
| | - Sally Nogle
- Department of Athletics, Michigan State University, 105 IM Circle, East Lansing, MI 48824
| | - Daniel Gould
- Department of Kinesiology, Michigan State University, 308 W. Circle Drive, East Lansing, MI 48824
| | - Jeffrey Kovan
- Department of Radiology, Michigan State University, 4660 South Hagadorn Road, Suite 420, East Lansing, MI 48824
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40
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Speirs JN, Lyons MI, Johansson BE. Emergency Medical Service Personnel Recognize Pediatric Concussions. Glob Pediatr Health 2017; 4:2333794X17719187. [PMID: 28812053 PMCID: PMC5528916 DOI: 10.1177/2333794x17719187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 05/30/2017] [Indexed: 11/15/2022] Open
Abstract
Concussions are a major cause of morbidity in pediatrics. Many concussions occur during activities with emergency medical service (EMS) providers present to determine if a higher level of care is needed. Data are limited on how capable these providers are. We assessed the ability of EMS providers to recognize pediatric concussions. Fifty-six total responses were included, 38 from EMS and 18 from our MD/RN (medical doctor/registered nurse) group. No statistical differences were found between the 2 groups when adjusted for age, gender, number of years in practice, and number of pediatric concussions managed. This first of its kind pilot study was designed to assess EMS personnel’s ability to recognize and triage pediatric concussions. Our findings show EMS providers are statistically identical in their ability to recognize and triage concussions to physicians. The performance of our MD participants was lower than expected. Larger studies are needed to further investigate EMS providers’ ability to recognize a concussion.
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Affiliation(s)
- Joshua N. Speirs
- Texas Tech University Health Sciences Center, El Paso, TX, USA
- Joshua Speirs, Department of Orthopaedic Surgery, Loma Linda University, 11406 Loma Linda Drive, Suite 213, Loma Linda, CA 92354, USA.
| | | | - Bert E. Johansson
- Texas Tech University Health Sciences Center, El Paso, TX, USA
- El Paso Children’s Hospital El Paso, TX, USA
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41
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Influence of rapidly successive head impacts on brain strain in the vicinity of bridging veins. J Biomech 2017; 59:59-70. [DOI: 10.1016/j.jbiomech.2017.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 04/13/2017] [Accepted: 05/17/2017] [Indexed: 11/18/2022]
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42
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Clark MD, Asken BM, Marshall SW, Guskiewicz KM. Descriptive Characteristics of Concussions in National Football League Games, 2010-2011 to 2013-2014. Am J Sports Med 2017; 45:929-936. [PMID: 28056179 DOI: 10.1177/0363546516677793] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite a high reported incidence rate of concussion, little is known about the on-field characteristics of injurious head impacts in National Football League (NFL) games. PURPOSE To characterize on-field features (location, player position, and time during game) and biomechanical features (anticipation status, closing distance, impact location and type) associated with concussions in NFL games over a 4-season period (2010-2011 to 2013-2014). STUDY DESIGN Descriptive epidemiology study. METHODS We analyzed video of a subset of reported, in-game concussions for the 2010-2011 to 2013-2014 seasons. These videos represented a sample of injuries that were diagnosed and reported on the same day and that could be clearly associated with an in-game collision as captured on video. We determined anticipation status, closing distance, impact location on the injured player's helmet, and impact type (helmet-to-helmet, helmet-to-body, or helmet-to-ground). Associations between these variables were analyzed by use of descriptive statistics and tests of association. RESULTS A total of 871 diagnosed concussions were reported as occurring during NFL preseason, regular season, and postseason games for the 2010-2011, 2011-2012, 2012-2013, and 2013-2014 seasons. A total of 1324 games were played during this period, giving a concussion incidence rate of 0.658 per game (95% CI, 0.61-0.70). From the video-reviewed subset (n = 429; 49.3%), the majority of injurious impacts occurred with good anticipation (57.3%) and <10 yards of closing distance (59.0%). An association was found between anticipation status and play type ([Formula: see text] = 27.398, P < .001), largely because injuries occurring on pass plays were more likely to be poorly anticipated than injuries during run plays (43.0% vs 21.4%; [Formula: see text] = 14.78, P < .001). Kick returns had the greatest proportion of well-anticipated impacts (78%) and the greatest proportion of impacts with ≥10 yards of closing distance (80%). The type of impact was approximately equally divided between helmet-to-helmet, helmet-to-body, and helmet-to-ground types. The impact location was broadly distributed over the helmet of the injured player. CONCLUSION In-game concussions in the NFL occurred through a diverse variety of mechanisms, surprisingly tended to be well-anticipated, and, also surprisingly, occurred with <10 yards of closing distance. The impacts causing concussion were broadly distributed over the helmet. More concussions occurred during the second half of game play, but we do not have evidence to explain this finding.
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Affiliation(s)
- Michael D Clark
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Breton M Asken
- Department of Clinical and Health Psychology, Neuropsychology College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Stephen W Marshall
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kevin M Guskiewicz
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
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43
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Sussman ES, Ho AL, Pendharkar AV, Ghajar J. Clinical evaluation of concussion: the evolving role of oculomotor assessments. Neurosurg Focus 2017; 40:E7. [PMID: 27032924 DOI: 10.3171/2016.1.focus15610] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sports-related concussion is a change in brain function following a direct or an indirect force to the head, identified in awake individuals and accounting for a considerable proportion of mild traumatic brain injury. Although the neurological signs and symptoms of concussion can be subtle and transient, there can be persistent sequelae, such as impaired attention and balance, that make affected patients particularly vulnerable to further injury. Currently, there is no accepted definition or diagnostic criteria for concussion, and there is no single assessment that is accepted as capable of identifying all patients with concussion. In this paper, the authors review the available screening tools for concussion, with particular emphasis on the role of visual function testing. In particular, they discuss the oculomotor assessment tools that are being investigated in the setting of concussion screening.
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Affiliation(s)
- Eric S Sussman
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Allen L Ho
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Arjun V Pendharkar
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Jamshid Ghajar
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
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44
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Burger N, Lambert MI, Viljoen W, Brown JC, Readhead C, den Hollander S, Hendricks S. Mechanisms and Factors Associated With Tackle-Related Injuries in South African Youth Rugby Union Players. Am J Sports Med 2017; 45:278-285. [PMID: 28125898 DOI: 10.1177/0363546516677548] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The majority of injuries in rugby union occur during tackle events. The mechanisms and causes of these injuries are well established in senior rugby union. PURPOSE To use information from an injury database and assess video footage of tackle-related injuries in youth rugby union matches to identify environmental factors and mechanisms that are potentially confounding to these injuries. STUDY DESIGN Descriptive epidemiological study. METHODS Injury surveillance was conducted at the under-18 Craven Week rugby tournament. Tackle-related injury information was used to identify injury events in match video footage (role-matched noninjury tackle events were identified for the cohort of injured players). Events were coded using match situational variables (precontact, contact, and postcontact). Relative risk ratio (RRR; ratio of probability of an injury or noninjury outcome occurring when a characteristic was observed) was reported by use of logistic regression. RESULTS In comparison with the first quarter, injury risk was greater in the third (RRR = 9.75 [95% CI, 1.71-55.64]; P = .010) and fourth quarters (RRR = 6.97 [95% CI, 1.09-44.57]; P = .040) for ball carriers and in the fourth quarter (RRR = 9.63 [95% CI, 1.94-47.79]; P = .006) for tacklers. Ball carriers were less likely to be injured when they were aware of impending contact (RRR = 0.14 [95% CI, 0.03-0.66]; P = .012) or when they executed a moderate fend (hand-off) (RRR = 0.22 [95% CI, 0.06-0.84]; P = .026). Tacklers were less likely to be injured when performing shoulder tackles (same side as leading leg) in comparison to an arm-only tackle (RRR = 0.02 [95% CI, 0.001-0.79]; P = .037). Ball carriers (RRR = 0.09 [95% CI, 0.01-0.89]; P = .040) and tacklers (RRR = 0.02 [95% CI, 0.001-0.32]; P =.006) were less likely to be injured when initial contact was made with the tackler's shoulder/arm instead of his head/neck. CONCLUSION The relative risk of tackle-related injury was higher toward the end of matches. Incorrect technique may contribute to increased injury risk. Implementing recovery strategies between matches, training safe and effective techniques, and improving levels of conditioning may counter the negative effects of fatigue. These findings may assist stakeholders in youth rugby to formulate injury prevention strategies and may improve the preparation of field-side medical staff for managing tackle-related injuries at these or similar tournaments.
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Affiliation(s)
- Nicholas Burger
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mike Ian Lambert
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Public & Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Wayne Viljoen
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,South African Rugby Union (SA Rugby), Cape Town, South Africa
| | - James Craig Brown
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Public & Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Clint Readhead
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,South African Rugby Union (SA Rugby), Cape Town, South Africa
| | - Steve den Hollander
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sharief Hendricks
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Institute for Sport, Physical Activity and Leisure, Centre for Sport Performance, School of Sport, Fairfax Hall, Headingley Campus, Leeds Beckett University, Leeds, UK
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45
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Kay MC, Register-Mihalik JK, Gray AD, Djoko A, Dompier TP, Kerr ZY. The Epidemiology of Severe Injuries Sustained by National Collegiate Athletic Association Student-Athletes, 2009-2010 Through 2014-2015. J Athl Train 2017; 52:117-128. [PMID: 28118030 DOI: 10.4085/1062-6050-52.1.01] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Few researchers have described the incidence of the most severe injuries sustained by student-athletes at the collegiate level. OBJECTIVE To describe the epidemiology of severe injuries within 25 National Collegiate Athletic Association (NCAA) sports in the 2009-2010 through 2014-2015 academic years. DESIGN Descriptive epidemiology study. SETTING Aggregate injury and exposure data from 25 NCAA sports. PATIENTS OR OTHER PARTICIPANTS Collegiate student-athletes in the 2009-2010 through 2014-2015 academic years. MAIN OUTCOME MEASURE(S) Injury data from the NCAA Injury Surveillance Program were analyzed. A severe injury (1) occurred during a sanctioned competition or practice, (2) required medical attention by an athletic trainer or physician, and (3) resulted in at least 21 days lost from sport activity or a premature end to the sport season. Injury counts, proportions, rates per 1000 athlete-exposures (AEs), rate ratios (RRs), and injury proportion ratios were reported with 95% confidence intervals (CIs). RESULTS A total of 3183 severe injuries were reported, for an injury rate of 0.66/1000 AEs. Wrestling had the highest severe injury rate (1.73/1000 AEs), followed by women's gymnastics (1.40/1000 AEs) and football (0.97/1000 AEs). Overall, the severe injury rate was higher in competition than in practice (RR = 4.25, 95% CI = 3.97, 4.56). Most severe injuries were reported during the regular season (69.3%, n = 2206); however, severe injury rates did not differ between the preseason and regular season (RR = 0.98, 95% CI = 0.91, 1.06). Common severely injured body parts were the knee (32.9%, n = 1047), lower leg/ankle/foot (22.5%, n = 715), and head/face/neck (11.2%, n = 358). Common severe injury diagnoses were sprains (32.9%, n = 1048), strains (16.9%, n = 538), and fractures (14.4%, n = 458). Common severe injury mechanisms were player contact (39.3%, n = 1251), noncontact (25.1%, n = 800), and surface contact (12.0%, n = 383). CONCLUSIONS Severe injuries occurred across many sports and by numerous mechanisms. By identifying these sport-specific patterns, clinicians' efforts can be tailored toward improving injury-prevention strategies and health outcomes.
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Affiliation(s)
- Melissa C Kay
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | | | - Aaron D Gray
- School of Medicine, University of Missouri, Columbia
| | - Aristarque Djoko
- Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, IN
| | - Thomas P Dompier
- Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, IN
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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46
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Bailes JE, Patel V, Farhat H, Sindelar B, Stone J. Football fatalities: the first-impact syndrome. J Neurosurg Pediatr 2017; 19:116-121. [PMID: 27791701 DOI: 10.3171/2016.8.peds16355] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Julian E Bailes
- Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois.,University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - Vimal Patel
- Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois.,University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - Hamad Farhat
- Department of Neurosurgery, Advocate Christ Medical Center, Oak Lawn, Illinois
| | - Brian Sindelar
- Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois.,Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - James Stone
- Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois.,Department of Neurosurgery, University of Illinois at Chicago, Illinois
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47
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Kroshus E, Baugh CM, Stein CJ, Austin SB, Calzo JP. Concussion reporting, sex, and conformity to traditional gender norms in young adults. J Adolesc 2016; 54:110-119. [PMID: 27984789 DOI: 10.1016/j.adolescence.2016.11.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 11/03/2016] [Accepted: 11/04/2016] [Indexed: 11/29/2022]
Abstract
This study assessed whether between-sex differences in concussion reporting intention and behavior among young adults are explained by the extent to which the individual conforms to traditional masculine norms that often characterize contemporary sport culture. A survey of college athletes in the United States (n = 328) found greater symptom reporting intention among females as compared to males, but no difference in their likelihood continued play while experiencing symptoms of a possible concussion. Greater conformity to the norms of risk-taking was associated with greater likelihood of continued play while symptomatic among female athletes but not among male athletes. These findings suggest that gendered behavior, rather than biologically determined sex, is an important consideration for concussion safety in this age group. Addressing elements of the contemporary sport ethos that reinforce risk taking in service of athletic achievement may be a relevant direction for interventions aimed at improving injury reporting among all athletes.
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Affiliation(s)
- Emily Kroshus
- University of Washington, Department of Pediatrics, United States; Seattle Children's Research Institute, Center for Child Health, Behavior and Development, United States.
| | - Christine M Baugh
- Harborview Injury Prevention Research Center, United States; Harvard University, Interfaculty Initiative in Health Policy, United States; Boston Children's Hospital, Division of Sports Medicine, United States
| | - Cynthia J Stein
- Boston Children's Hospital, Division of Sports Medicine, United States
| | - S Bryn Austin
- Harvard T.H. Chan School of Public Health, United States; Harvard Medical School, Department of Pediatrics, United States; Boston Children's Hospital, Division of Adolescent and Young Adult Medicine, United States
| | - Jerel P Calzo
- Harvard Medical School, Department of Pediatrics, United States; Boston Children's Hospital, Division of Adolescent and Young Adult Medicine, United States
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48
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Affiliation(s)
- Cinthi Pillai
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - John W. Gittinger
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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49
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Hansen C, Cushman D, Anderson N, Chen W, Cheng C, Hon SD, Hung M. A Normative Dataset of the Balance Error Scoring System in Children Aged Between 5 and 14. Clin J Sport Med 2016; 26:497-501. [PMID: 27783573 DOI: 10.1097/jsm.0000000000000285] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Pediatric head injuries occur commonly and are being reported in increasing numbers. Balance testing is a key component in the evaluation of suspected concussion, and the balance error scoring system (BESS) is likely the most well-known and widely used measure. To date, normative BESS scores for adults have been reported but not for children. DESIGN Normative data for BESS scores and modified BESS scores were created in a cohort of healthy children. Potential variables were analyzed as predictors of BESS performance. SETTING Local elementary and junior high schools. PARTICIPANTS A total of 373 healthy children between the ages of 5 and 14. INTERVENTIONS The BESS was performed on all children. ASSESSMENT OF RISK FACTORS Gender, body mass index percentile, previous concussions, athletic participation, age, and the parental opinion of child's balance ability were examined as factors associated with the BESS score. MAIN OUTCOME MEASURES BESS scores. RESULTS Normative data are reported, stratified by age groups of 5 to 7 years, 8 to 10 years, and 11 to 14 years of age, for both BESS and modified BESS. Median BESS scores are 23 for children aged 5 to 7, 18 for children aged 8 to 10, and 16 for children aged 11 to 14. Median modified BESS scores are 8 for children age 5 to 7, 5 for children age 8 to 10, and 4 for children age 11 to 14. Increasing age and positive parental opinion regarding their child's balance ability were independently correlated with decreasing BESS scores (P < 0.01). CONCLUSIONS The normative data on BESS scores for healthy children reported here provide age-stratified reference values for suspected balance alterations.
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Affiliation(s)
- Colby Hansen
- *Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah;†Division of Epidemiology, University of Utah, Salt Lake City, Utah;‡College of Pharmacy, Roseman University, South Jordan, Utah;Departments of §Electrical & Computer Engineering; and¶Orthopaedics, University of Utah, Salt Lake City, Utah
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50
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Abstract
OBJECTIVE The primary objective of this study was to examine the proportion of US college coaches who receive annual concussion education from their institution and to describe the content and delivery modalities of this education. This study also tested the hypothesis that coaches receiving concussion education from their institution will have greater knowledge about concussions independent of other individual and institutional characteristics. DESIGN Cross-sectional online survey. SETTING US college sport. PARTICIPANTS College coaches in National Collegiate Athletic Association Division I, II, and III (n = 1818). INDEPENDENT VARIABLES Self-reported receipt of education from institution, sex, sport coached, division of competition. MAIN OUTCOME MEASURES Concussion identification and management knowledge. RESULTS Two-thirds of coaches reported receiving informational materials about concussion from their institution. The content of the education most frequently referred to symptoms of a concussion and information about proper management of a concussion. Coaches who received educational materials from their institution were better able to identify symptoms and had more conservative responses to concussion management scenarios. Male coaches of male contact or collision teams less frequently endorsed safe or correct response as compared with female coaches of noncontact or collision teams. CONCLUSIONS Not all US college coaches receive concussion education from their institution. Male Division I coaches of male contact/collision sport are a population for whom targeted educational outreach may be particularly valuable. CLINICAL RELEVANCE Education for coaches, delivered by clinicians at many institutions, is an important component of ensuring that coaches are prepared to be informed partners in supporting concussion safety.
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