Concussion management plans' compliance with NCAA requirements: Preliminary evidence suggesting possible improvement

Optimizing Concussion Care Seeking: Connecting Care-Seeking Behaviors and Neurophysiological States Through Blood Biomarkers

BACKGROUND

Timely and appropriate medical care after concussion presents a difficult public health problem. Concussion identification and treatment rely heavily on self-report, but more than half of concussions go unreported or are reported after a delay. If incomplete self-report increases exposure to harm, blood biomarkers may objectively indicate this neurobiological dysfunction.

PURPOSE/HYPOTHESIS

The purpose of this study was to compare postconcussion biomarker levels between individuals with different previous concussion diagnosis statuses and care-seeking statuses. It was hypothesized that individuals with undiagnosed concussions and poorer care seeking would show altered biomarker profiles.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Blood samples were collected from 287 military academy cadets and collegiate athletes diagnosed with concussion in the Advanced Research Core of the Concussion Assessment, Research and Education Consortium. The authors extracted each participant's self-reported previous concussion diagnosis status (no history, all diagnosed, ≥1 undiagnosed) and whether they had delayed or immediate symptom onset, symptom reporting, and removal from activity after the incident concussion. The authors compared the following blood biomarkers associated with neural injury between previous concussion diagnosis status groups and care-seeking groups: glial fibrillary acidic protein, ubiquitin c-terminal hydrolase-L1 (UCH-L1), neurofilament light chain (NF-L), and tau protein, captured at baseline, 24 to 48 hours, asymptomatic, and 7 days after unrestricted return to activity using tests of parallel profiles.

RESULTS

The undiagnosed previous concussion group (n = 21) had higher levels of NF-L at 24- to 48-hour and asymptomatic time points relative to all diagnosed (n = 72) or no previous concussion (n = 194) groups. For those with delayed removal from activity (n = 127), UCH-L1 was lower at 7 days after return to activity than that for athletes immediately removed from activity (n = 131). No other biomarker differences were observed.

CONCLUSION

Individuals with previous undiagnosed concussions or delayed removal from activity showed some different biomarker levels after concussion and after clinical recovery, despite a lack of baseline differences. This may indicate that poorer care seeking can create neurobiological differences in the concussed brain.

Beliefs affecting concussion reporting among military cadets: advanced observations through machine learning

BACKGROUND

Untreated concussions are an important health concern. The number of concussions sustained each year is difficult to pinpoint due to diverse reporting routes and many people not reporting. A growing body of literature investigates the motivations for concussion under-reporting, proposing ties with knowledge of concussion outcomes and concussion culture. The present work employs machine learning to identify trends in knowledge and willingness to self-report concussions.

METHODS

2,204 cadets completed a survey addressing athletic and pilot status, concussion symptoms and outcome beliefs, ethical beliefs, demographics, and reporting willingness.

RESULTS

Clustering and non-negative matrix analysis identified connections to self-report willingness within: knowledge of symptoms, ethical beliefs, reporting requirements, and belief of long-term concussion outcomes. Support vector machine classification of cadet reporting likelihood reveals symptom and outcome knowledge may be inversely related to reporting among those rating ethics considerations as low, while heightened ethics may predict higher reporting likeliness overall.

CONCLUSIONS

Machine-learning analysis bolsters prior theories on the importance of concussion culture in reporting and indicate more symptom knowledge may decrease willingness to report. Uniquely, our analysis indicated importance of ethical behavior may be associated with general concussion reporting willingness, inviting further consideration from healthcare practitioners seeking increased reporting.

Concussion Management Among National Collegiate Athletic Association Swim Programs

The nuances of swimming make the application of traditional return-to-play progressions following concussion challenging. Our purpose was to describe athletic training services and concussion management protocols among National Collegiate Athletic Association swim programs and compare them between the National Collegiate Athletic Association divisions. We surveyed 228 athletic trainers assigned to or with knowledge of their institution’s swim programs from a convenience sample of 539 (response rate = 42.3%) athletic trainers. Athletic training services were provided to 98.6% (214/217) of the programs. Nearly 80% (164/207) of the programs administered baseline concussion testing to swimmers, with differences observed between divisions (p < .001). No differences (p = .108) in the number of concussions sustained by swimmers in the past academic year were noted between divisions. Specific return-to-swim protocols were reported by 51.8% (115/222) of respondents with no differences in the presence of a specific return-to-swim protocol between divisions (p = .790). While concussions are reported less frequently in swimming than other sports, appropriate medical care, including a specific return-to-swim protocol, is warranted and provided for future use.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Football: 2014-2015 Through 2018-2019

CONTEXT

Football is among the most popular collegiate sports in the United States, and participation in National Collegiate Athletic Association (NCAA) football has risen in recent years.

BACKGROUND

Continued monitoring of football injuries is important for capturing the evolving burden of injuries in NCAA football. The purpose of this study was to describe the epidemiology of football-related injuries among men's NCAA football players during the 2014-2015 through 2018-2019 academic years.

METHODS

Exposure and injury data collected in the NCAA Injury Surveillance Program were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates.

RESULTS

The overall injury rate was 9.31 per 1000 athlete-exposures. Most injuries occurred during general play (17.5%), blocking (15.8%), and tackling (14.0%). Concussions (7.5%), lateral ligament complex tears (6.9%), and hamstring tears (4.7%) were the most commonly reported injuries.

CONCLUSIONS

Results of this study were generally consistent with previous findings, though changes over time in rates of commonly reported injuries warrant attention. Continued monitoring of injury incidence is needed to appraise the effectiveness of recently implemented rules changes.