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PubMed2005

Recognition and characteristics of concussions in the emergency department population.

An anonymous survey was conducted over a 6-month period of time using consenting Emergency Department (ED) patients in an attempt to better understand concussions occurring in the ED population. Calculations were made using the respondents' history and self-reported symptoms during the previous 12 months. Five hundred twenty-two of 700 approached patients responded to the anonymous questionnaire. Of respondents, 20.1% (105/522) answered that they had experienced symptoms of a concussion after being hit in the head during the previous 12 months. Of the 105 respondents who experienced a concussion, 88.6% (93/105) did not recognize that they had suffered a concussion. There were 28.2% (147/522) of all respondents who were actively engaging in at least one activity that was considered to be at high risk for concussions. Headache was the most common symptom for both recognized and unrecognized concussions. Respondents who experienced nausea after being hit in the head were the most likely to seek some form of medical attention, followed by people who suffered a loss of consciousness. Those patients who suffered a loss of consciousness were the most likely to visit an ED. Many patients have a poor understanding of concussions and these patients may be actively participating in high-risk activities while still suffering symptoms from a concussion. Therefore, these patients may be at risk for further concussions and Second Impact Syndrome.

Adolescent↗
PubMed2005

Association between recurrent concussion and late-life cognitive impairment in retired professional football players.

OBJECTIVE: Cerebral concussion is common in collision sports such as football, yet the chronic neurological effects of recurrent concussion are not well understood. The purpose of our study was to investigate the association between previous head injury and the likelihood of developing mild cognitive impairment (MCI) and Alzheimer's disease in a unique group of retired professional football players with previous head injury exposure. METHODS: A general health questionnaire was completed by 2552 retired professional football players with an average age of 53.8 (+/-13.4) years and an average professional football playing career of 6.6 (+/- 3.6) years. A second questionnaire focusing on memory and issues related to MCI was then completed by a subset of 758 retired professional football players (> or = 50 yr of age). Results on MCI were then cross-tabulated with results from the original health questionnaire for this subset of older retirees. RESULTS: Of the former players, 61% sustained at least one concussion during their professional football career, and 24% sustained three or more concussions. Statistical analysis of the data identified an association between recurrent concussion and clinically diagnosed MCI (chi = 7.82, df = 2, P = 0.02) and self-reported significant memory impairments (chi = 19.75, df = 2, P = 0.001). Retired players with three or more reported concussions had a fivefold prevalence of MCI diagnosis and a threefold prevalence of reported significant memory problems compared with retirees without a history of concussion. Although there was not an association between recurrent concussion and Alzheimer's disease, we observed an earlier onset of Alzheimer's disease in the retirees than in the general American male population. CONCLUSION: Our findings suggest that the onset of dementia-related syndromes may be initiated by repetitive cerebral concussions in professional football players.

Adult↗
PubMed2001

Concussions in hockey: there is cause for concern.

PURPOSE: The purpose of the study was to document various aspects of concussion in Canadian Amateur hockey including demographics, causes, treatment, and prevention in order to guide future recommendations on how to reduce injury. METHODS: A detailed prospective and retrospective concussion history was obtained from British Columbia Junior Hockey League players over the course of two seasons (1998-2000). RESULTS: Higher rates of concussions occur in games versus practice, and there was an overrepresentation of forwards injured versus defensemen or goaltenders. There was between 4.63 and 5.95 concussions per 1000 player/game hours with the average age of the first hockey-related concussion in the 15th year. The greatest cause of concussion was contact with the ice and/or the boards. Fighting was not a major cause of concussion, although other illegal actions such as elbowing were. CONCLUSIONS: The primary recommendation to reduce the number and severity of concussions is to eliminate plays where there is a demonstrable intent to injure another player. Concussions in hockey are of considerable concern; however, there is now encouraging information with respect to the treatment of these injuries.

Brain Concussion↗
PubMed2002

Immediate neurocognitive effects of concussion.

OBJECTIVE: To prospectively measure the immediate neurocognitive effects and early course of recovery from concussion and to examine the effects of loss of consciousness (LOC) and posttraumatic amnesia (PTA) on the severity of neurocognitive impairment immediately after concussion. METHODS: A sports-related concussion research model was used to allow prospective immediate evaluation of concussion. A total of 2385 high school and college football players were studied. Ninety-one players (3.8%) sustained concussions during the study. A brief neurocognitive and neurological screening measure, the Standardized Assessment of Concussion, was used to assess cognitive functioning before the football season, immediately after injury, and 15 minutes, 48 hours, and 90 days after injury. RESULTS: Standardized Assessment of Concussion scores immediately after concussion were significantly lower than the preseason baseline score and the noninjured population baseline mean, even for injured subjects without LOC or PTA. Subjects with LOC were most severely impaired immediately after injury, whereas those without LOC or PTA were least impaired. Significant impairment was also detected 15 minutes after injury, but all three groups returned to baseline levels of cognitive functioning within 48 hours. CONCLUSION: These findings are the first to demonstrate not only that a gradient of increasing concussion severity is represented by PTA and LOC but also that measurable neurocognitive abnormalities are evident immediately after injury without PTA or LOC.

Adolescent↗
PubMed2005

Comparison of mouth guard designs and concussion prevention in contact sports: a multicenter randomized controlled trial.

OBJECTIVES: To compare the effectiveness of the WIPSS mouth guard to other currently used mouth guards in the prevention of concussion injuries in athletes participating in varsity football and rugby. DESIGN: : Multicenter, cluster-randomized, controlled trial comparing the WIPSS Brain-Pad mouth guard against the standard use mouth guard of choice. Teams were monitored by their respective athletic therapist, trainer, or sports physician for 1 playing season to diagnose and record incident concussion injuries and dental trauma. Concussion symptoms were also recorded at the time of injury. SETTING: Five Ontario universities. PARTICIPANTS: University male football (394) and university male (129) and female (123) rugby athletes reporting to 2003 fall training camps. MAIN OUTCOME MEASUREMENTS: The primary end point was the incidence of any diagnosed concussion events during the 2003 playing season as defined by the American Academy of Neurology Concussion Guidelines. Secondary endpoints included the incidence of dental trauma events and observed concussion symptoms. RESULTS: There was no significant difference in the number of concussions observed between the intervention and control arms of this trial (P = 0.79; odds ratio, 1.06, in favor of controls; 95% CI, 0.51, <<1.61). No dental trauma events occurred. The 5 most common symptoms experienced by concussed athletes were dizziness, general headache, nausea, loss of visual focus, and personality changes. CONCLUSIONS: In this study, concussion rates were not significantly different for varsity football and rugby players who wore the WIPSS Brain-Pad mouth guard compared with other types of mouth guards.

Adolescent↗
PubMed2001

Computerised cognitive assessment of concussed Australian Rules footballers.

BACKGROUND: "Paper and pencil" neuropsychological tests play an important role in the management of sports related concussions. They provide objective information on the athlete's cognitive function and thus facilitate decisions on safe return to sport. It has been proposed that computerised cognitive tests have many advantages over such conventional tests, but their role in this domain is yet to be established. OBJECTIVES: To measure cognitive impairment after concussion in a case series of concussed Australian Rules footballers, using both computerised and paper and pencil neuropsychological tests. To investigate the role of computerised cognitive tests in the assessment and follow up of sports related concussions. METHODS: Baseline measures on the Digit Symbol Substitution Test (DSST), Trail Making Test-Part B (TMT), and a simple reaction time (SRT) test from a computerised cognitive test battery (CogState) were obtained in 240 players. Tests were repeated in players who had sustained a concussive injury. A group of non-injured players were used as matched controls. RESULTS: Six concussions were observed over a period of nine weeks. At the follow up, DSST and TMT scores did not significantly differ from baseline scores in both control and concussed groups. However, analysis of the SRT data showed an increase in response variability and latency after concussion in the injured athletes. This was in contrast with a decrease in response variability and no change in latency on follow up of the control players (p<0.02). CONCLUSION: Increased variability in response time may be an important cognitive deficit after concussion. This has implications for consistency of an athlete's performance after injury, as well as for tests used in clinical assessment and follow up of head injuries.

Adolescent↗
PubMedDate not supplied

Concussion incidence in elite college soccer players.

A unique aspect of soccer is the use of the head for directing the ball. The potential for resultant head injuries has been the focus of discussions worldwide. Prior work has attributed neuropsychologic deficits to the cumulative effects of heading, without evaluating concussion rates in soccer players. We prospectively studied the seven men's and eight women's varsity soccer teams in the Atlantic Coast Conference during two seasons to document concussion incidence. The 29 concussions diagnosed over the 2 years in 26 athletes, 17 (59%) concussions in men and 12 (41%) in women, resulted from contact with an opponent's head (8, 28%), elbow (4, 14%), knee (1, 3%), or foot (1, 3%); the ball (7, 24%); the ground (3, 10%); concrete sidelines (1, 3%); goalpost (1, 3%); or a combination of objects (3, 10%). Twenty concussions (69%) occurred in games; none resulted from intentional heading of the ball. The basic incidence was 0.96 concussions per team per season. The overall incidence was 0.6 per 1000 athlete-exposures for men, and 0.4 per 1000 athlete-exposures for women. By concussion grade, there were 21 (72%) grade 1, 8 (28%) grade 2, and no grade 3 concussions. These findings suggest that concussions are more common in soccer than anticipated and that acute head injuries may have potential for long-term neuropsychologic changes.

Brain Concussion↗
PubMed2001

Multiple Concussions and Neuropsychological Functioning in Collegiate Football Players.

OBJECTIVE: To document neurocognitive and neurobehavioral consequences of 1 versus 2 concussions. DESIGN AND SETTING: Nonequivalent, pretest-posttest cohort design with multiple dependent measures. Participants were selected from a large sample of athletes who participated in a comprehensive, multiuniversity study of football-related concussion. SUBJECTS: College football players who sustained 1 and 2 grade 1 concussive injuries were matched for age, education, and duration of competitive football. MEASUREMENTS: Neuropsychological tests and symptoms checklists. RESULTS: Multivariate analysis of variance did not show a statistically significant difference in test performance between players with 1 or 2 concussions. Chi square analyses revealed that concussions significantly increased the number of symptom complaints, but symptoms returned to baseline by 10 days postinjury. The effects of 2 injuries did not appear to be significantly greater than that of a single injury. Differences in response to concussion were observed. CONCLUSIONS: Neurocognitive and neurobehavioral consequences of 2 concussions did not appear to be significantly different from those of 1 concussion, but methodologic issues place limitations on data interpretation. Additional studies are needed to clarify the neuropsychological consequences of multiple concussions.

Journal Article↗
PubMed2001

Cerebral Concussion: Causes, Effects, and Risks in Sports.

OBJECTIVE: To characterize the causes, effects, and risks associated with concussion in sports. BACKGROUND: Concussion is an injury associated with sports and is most often identified with boxing, football, ice hockey, and the martial arts. In addition, recent research has shown that concussion occurs in many different sports. In the decade of the 1990s, concussion became a primary issue for discussion among the media, sports sponsors, sports medicine professionals, and athletes. DESCRIPTION: Concussion is an injury that results from a wide variety of mechanisms and has numerous signs and symptoms that are common to different types of injury. Continued improvement in prevention and management strategies for concussion requires a strong body of research from a variety of different disciplines. It is essential that research efforts focus on both prevention and management and that researchers and clinicians work closely toward their common goals. CONCLUSIONS/RECOMMENDATIONS: Until the research community is able to provide sound recommendations for the prevention and management of the concussion, the care of the injured player falls squarely on the clinician. It is important for sports medicine professionals to continue to stay up to date on the advances in understanding concussions and how to care individually for each player who sustains a concussion.

Journal Article↗
PubMedDate not supplied

Is neuropsychological testing useful in the management of sport-related concussion?

OBJECTIVE: Neuropsychological (NP) testing has been used for several years as a way of detecting the effects of sport-related concussion in order to aid in return-to-play determinations. In addition to standard pencil-and-paper tests, computerized NP tests are being commercially marketed for this purpose to professional, collegiate, high school, and elementary school programs. However, a number of important questions regarding the clinical validity and utility of these tests remain unanswered, and these questions present serious challenges to the applicability of NP testing for the management of sport-related concussion. Our purpose is to outline the criteria that should be met in order to establish the utility of NP instruments as a tool in the management of sport-related concussion and to review the degree to which existing tests have met these criteria. DATA SOURCES: A comprehensive literature review of MEDLINE and PsychLit from 1990 to 2004, including all prospective, controlled studies of NP testing in sport-related concussion. DATA SYNTHESIS: The effects of concussion on NP test performance are so subtle even during the acute phase of injury (1-3 days postinjury) that they often fail to reach statistical significance in group studies. Thus, this method may lack utility in individual decision making because of a lack of sensitivity. In addition, most of these tests fail to meet other psychometric criteria (eg, adequate reliability) necessary for this purpose. Finally, it is unclear that NP testing can detect impairment in players once concussion-related symptoms (eg, headache) have resolved. Because no current guideline for the management of sport-related concussion allows a symptomatic player to return to sport, the incremental utility of NP testing remains questionable. CONCLUSIONS/RECOMMENDATIONS: Despite the theoretic rationale for the use of NP testing in the management of sport-related concussion, no NP tests have met the necessary criteria to support a clinical application at this time. Additional research is necessary to establish the utility of these tests before they can be considered part of a routine standard of care, and concussion recovery should be monitored via the standard clinical examination and subjective symptom checklists until NP testing or other methods are proven effective for this purpose.

Journal Article↗
PubMed2003

Incidence of concussion in contact sports: a systematic review of the evidence.

PRIMARY OBJECTIVE: To estimate incidence of concussion in contact sports. RESEARCH DESIGN: Systematic review of the literature on concussion in contact sports. METHODS AND PROCEDURES: MEDLINE was searched from 1985-2000. Older articles cited in retrieved articles were also reviewed. Articles meeting the inclusion/exclusion criteria were critically appraised for methodologic quality. The incidence of concussion was recalculated in some cases. RESULTS: Twenty-three out of 63 identified articles were accepted to estimate the risk of concussion. Overall, ice hockey and rugby have the highest incidence of concussion and soccer has the lowest. Male boxers and female taekwondo participants have the highest frequency of concussion at the recreational level. CONCLUSIONS: There are few good studies on the incidence of concussion and limited information on the risk of concussion for females in contact sports. Some common methodological problems were also identified in this literature with the hope of improving future studies.

Athletic Injuries↗
PubMedDate not supplied

Self-reported headgear use and concussions among collegiate men's rugby union players.

The perceived effectiveness of rugby union headgear in reducing concussions in American male collegiate rugby union athletes was assessed. Data collection was conducted by survey method distributed using electronic mail. One hundred and thirty-one men's club rugby union participants from eight university teams in the United States were surveyed. Demographic data were assessed using frequencies, means, and standard deviations. An ANOVA was used to assess differences in the frequencies of responses between players with concussions and their perception of headgear, with an increase in positive perception of headgear with increased concussions. Player position and years of experience played a role in the number of concussions and use of protective headgear. Seventy-six different athletes reported a concussion while playing, with the majority (51%) not wearing headgear. Athletes who wore headgear experienced 24% of the concussions, compared to 76% of those who did not wear headgear. The incidence of concussions and severity of concussions were perceived as less severe among the group wearing headgear. The general perception of those individuals polled as to the effectiveness of headgear in reducing head injuries was positive.

Adult↗
PubMed2000

Cerebral concussion in athletes: evaluation and neuropsychological testing.

OBJECTIVE: To conduct a topic review of studies related to cerebral concussion in athletes, as an aid to improving decision-making and outcomes. METHODS: We review the literature to provide an historical perspective on the incidence and definition of and the management guidelines for mild traumatic brain injury in sports. In addition, metabolic changes resulting from cerebral concussion and the second-impact syndrome are reviewed, to provide additional principles for decision-making. Neuropsychological testing, as it applies to athletes, is discussed in detail, to delineate baseline assessments, the characteristics of the neuropsychological evaluation, the neuropsychological tests used, and the methods for in-season identification of cerebral concussion. Future directions in the management of concussions are presented. RESULTS: The incidence of cerebral concussions has been reduced from approximately 19 per 100 participants in football per season to approximately 4 per 100, i.e., 40,000 to 50,000 concussions per year in football alone. The most commonly used definitions of concussion are those proposed by Cantu and the American Academy of Neurology. Each has associated management guidelines. Concussion or loss of consciousness occurs when the extracellular potassium concentration increases beyond the upper normal limit of approximately 4 to 5 mmol/L, to levels of 20 to 50 mmol/L, inhibiting the action potential and leading to loss of consciousness. This phenomenon helps to explain the delayed effects of symptoms after trauma. CONCLUSION: Neuropsychological testing seems to be an effective way to obtain useful data on the short-term and long-term effects of mild traumatic brain injury. Moreover, knowledge of the various definitions and management strategies, as well as the utility of neuropsychological testing, is essential for those involved in decision-making with athletes with mild traumatic brain injuries.

Athletic Injuries↗
PubMed2003

Comparison of reporting systems to determine concussion incidence in NCAA Division I collegiate football.

OBJECTIVE: To determine the incidence of concussion during the 2001 Division I-A college football season through utilization of the Internet. DESIGN: Prospective Internet survey. SETTING: Internet Web site. PARTICIPANTS: Head athletic trainers from Division I-A collegiate football programs. MAIN OUTCOME MEASURES: During the 2001-2002 football season, head athletic trainers from 87 Division I-A football programs agreed to use an Internet Web site to submit weekly data on the number of athlete exposures and concussions. RESULTS: A total of 373 concussions were reported over the course of a season in both practices and games combined. Of these concussions, 256 (68.6%) occurred during games, and 117 (31.4%) occurred during practice. The injury rate per 1,000 athletic exposures was 5.56 in games and 0.25 in practices. There were 230 grade 1 (61.7%), 134 grade 2 (35.9%), and 9 grade 3 (2.4%) concussions reported. There was a significant (p < 0.01) difference found between the total concussion injury rate and game concussion injury rate when comparing the Internet and the NCAA injury data collection methods. CONCLUSIONS: The results of this study suggest an underreporting of concussions using the NCAA Injury Surveillance System and demonstrate that the Internet is a simple and effective tool for data collection.

Adult↗
PubMed2004

Incidence study of head blows and concussions in competition taekwondo.

OBJECTIVE: To examine the incidence of head blows and concussions in competition taekwondo. DESIGN: Incidence cohort design. SETTING: Taekwondo tournament in 2001, in South Korea. PARTICIPANTS: A total of 2328 competitors (female, 676; male, 1652; age, 11-19 years) from 424 schools participated in the tournament. All recipients of head blows were interviewed immediately after the match. All matches were recorded on videotape. MAIN OUTCOME MEASURES: Head blow and concussion rates were calculated. Also, factors associated with head blows and concussions were analyzed. RESULTS: The incidence of head blows and concussions was 226 and 50 per 1000 athlete exposures, respectively. Only 17% of competitors reported that they had had a concussion in the last 12 months. A multinomial logistic model showed that head blows and concussions were associated with young age and a lack of blocking skills. CONCLUSIONS: The incidence of head blows and concussions is high in competition taekwondo. Promoting blocking skills to prevent head blows could decrease concussions in taekwondo.

Adolescent↗
PubMed2003

Two-year prospective study of relative risk of a second cerebral concussion.

OBJECTIVE: To prospectively measure the relative risk of cerebral concussion among those with a history of concussion compared with those having no previous concussions by using a population of high school and college football players. DESIGN: A representative national sample of high school and college football players was followed for two football seasons over a 2-yr period (1997-1998) as part of a national football injury surveillance project. There were a total of 15,304 player-seasons and over 1 million athlete-exposures to the possibility of injury in practices and games; 975 of the player-seasons (6.4%) had a history of concussion in the previous 5 yr. RESULTS: There were 572 concussions recorded, 161 among those with a history (16.5%) and 411 among those with no history (2.9%). Relative risk for individuals with a history of concussion is 5.8 times greater than for individuals with no history (95% confidence interval, 4.8-6.8). CONCLUSION: This large prospective cohort study indicates the risk of sustaining a cerebral concussion is nearly six times greater for individuals with a history of concussion than for individuals with no such history.

Adolescent↗
PubMed2006

No cumulative effects for one or two previous concussions.

BACKGROUND: Sports medicine clinicians and the general public are interested in the possible cumulative effects of concussion. OBJECTIVE: To examine whether athletes with a history of one or two previous concussions differed in their preseason neuropsychological test performances or symptom reporting. METHOD: Participants were 867 male high school and university amateur athletes who completed preseason testing with ImPACT version 2.0. They were sorted into three groups on the basis of number of previous concussions. There were 664 athletes with no previous concussions, 149 with one previous concussion, and 54 with two previous concussions. Multivariate analysis of variance was conducted using the verbal memory, visual memory, reaction time, processing speed, and postconcussion symptom composite scores as dependent variables and group membership as the independent variable. RESULTS: There was no significant multivariate effect, nor were there any significant main effects for individual scores. There was no measurable effect of one or two previous concussions on athletes' preseason neuropsychological test performance or symptom reporting. CONCLUSION: If there is a cumulative effect of one or two previous concussions, it is very small and undetectable using this methodology.

Adolescent↗
PubMed2006

Concussion history is not a predictor of computerised neurocognitive performance.

BACKGROUND: The long term effects of self reported concussion on neurocognitive functioning have been found to be variable. OBJECTIVES: To evaluate cognitive performance on the Headminder concussion resolution index (CRI) and ImPACT assessment tests of subjects with and without a history of self reported concussion. METHODS: A retrospective analysis was completed on 235 Headminder CRI baseline assessments and 264 ImPACT baseline assessments. Participants were divided into four groups on the basis of reported number of concussions (zero, one, two, or three). Multivariate analysis of variance was used to evaluate differences between the concussion history groups on the two computer based concussion assessment programs. RESULTS: Multivariate analysis of variance indicated no significant difference between those with and without a history of concussion on the CRI (Lambda = 0.963, F((15, 627.05)) = 0.57, p = 0.898). It also revealed no significant differences between groups on the ImPACT test (Lambda = 0.951, F((12, 672.31)) = 1.07, p = 0.381). CONCLUSIONS: The results suggest that either long term cognitive decrements may not be associated with a history of concussion or the decrements may be subtle and undetectable by these computer programs.

Adult↗