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Bullock GS, Emery CA, Nelson VR, Prats-Uribe A, Gilliland RG, Thigpen CA, Shanley E. Higher rates of concussion following COVID-19 infection in high school athletes. Br J Sports Med 2023; 57:590-594. [PMID: 36754589 DOI: 10.1136/bjsports-2022-106436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To compare concussion rates (CRs) over one academic year in high school athletes with and without a COVID-19 infection prior to concussion. METHODS Illness and concussion were prospectively reported for male and female high school athletes across six states over one academic year in the Players Health Rehab surveillance system. Concussion was truncated to 60 days following recovery and return to sport from COVID-19. CRs were estimated per 1000 athletes per academic year and stratified by those who tested positive for COVID-19 infection (with COVID-19) and those who did not (no COVID-19). Poisson regression analyses estimated rate ratio (RR) of concussion controlling for state, gender and an offset of the log athlete participation (with COVID-19 and no COVID-19). RESULTS Of 72 522 athletes, 430 COVID-19 infections and 1273 concussions were reported. The CR was greater in athletes who reported COVID-19 (CR=74.4/1000 athletes/year, 95% CI 49.6 to 99.3) compared with those who did not (CR=17.2, 95% CI 16.3 to 18.2). Athletes with recent COVID-19 had a threefold higher rate of concussion (RR=3.1, 95% CI 2.0 to 4.7). CONCLUSION Athletes returning from COVID-19 had higher CRs than those who did not experience COVID-19. This may be related to ongoing COVID-19 sequelae or deconditioning related to reduced training and competition load during the illness and when returning to sport. Further research is needed to understand the association of recent COVID-19 infection and concussion in order to inform preventive strategies.
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Affiliation(s)
- Garrett S Bullock
- Department of Orthopaedic Surgery & Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
| | - Vicki R Nelson
- Sports Medicine, Prisma Health, Greenville, South Carolina, USA
| | | | | | - Charles A Thigpen
- Clinical Excellence, ATI Physical Therapy, Greenville, Illinois, USA
| | - Ellen Shanley
- Sports Medicine, ATI Physical Therapy, Bolingbrook, Illinois, USA.,Clinical Excellence, ATI Physical Therapy, Greenville, Illinois, USA
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2
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Veliz P, McCabe SE, Eckner JT, Schulenberg JE. Trends in the Prevalence of Concussion Reported by US Adolescents, 2016-2020. JAMA 2021; 325:1789-1791. [PMID: 33944882 PMCID: PMC8097492 DOI: 10.1001/jama.2021.1538] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study analyzes the increased incidence of concussion among US teens.
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Affiliation(s)
- Phil Veliz
- School of Nursing, University of Michigan, Ann Arbor
| | | | - James T. Eckner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor
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3
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Haarbauer-Krupa J, Lebrun-Harris LA, Black LI, Veliz P, Daugherty J, Desrocher R, Schulenberg J, Pilkey D, Breiding M. Comparing prevalence estimates of concussion/head injury in U.S. children and adolescents in national surveys. Ann Epidemiol 2021; 54:11-20. [PMID: 33227432 PMCID: PMC8157314 DOI: 10.1016/j.annepidem.2020.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Reports on pediatric lifetime concussions/head injuries (LCHI) from national surveys have offered estimates on prevalence that range from 2.5% to 18% in the general population. The purpose of this study is to examine national surveys to compare methodologies and limitations pertaining to LCHI data collection. METHODS Three nationally representative surveys that measure LCHI in children, including the National Survey of Children's Health, the National Health Interview Survey, and the Monitoring the Future Survey were examined. Children were grouped by ages 3-17 years and adolescent ages 13-17 years, stratified by selected demographic characteristics. Participants in the surveys included parents (NSCH and NHIS) and adolescents (MTF survey). The primary outcome measure is an estimate of LCHI in children. RESULTS Estimates of prevalence of LCHI ranged from 3.6% to 7.0% for children ages 3-17 years and from 6.5% to 18.3% for adolescents 13-17 years. Survey modality, question wording, and respondent may contribute to differing estimates. Prevalence showed consistent variation by age, sex, and race/ethnicity across surveys. Associations were inconsistent between LCHI and insurance status, parental education, and household primary language. CONCLUSIONS Although there are methodological differences in capturing pediatric LCHI across surveys, the prevalence estimates and correlational associations generated can offer awareness about the burden of these injuries and insights to research and clinical care.
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Affiliation(s)
- Juliet Haarbauer-Krupa
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control, Atlanta, GA.
| | - Lydie A Lebrun-Harris
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | - Lindsey I Black
- National Center for Health Statistics, Centers for Disease Control, Hyattsville, MD
| | - Philip Veliz
- School of Nursing, University of Michigan, Ann Arbor
| | - Jill Daugherty
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control, Atlanta, GA
| | - Rebecca Desrocher
- Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, MD
| | - John Schulenberg
- Institute for Social Research and Department of Psychology, Survey Research Center, University of Michigan, Ann Arbor
| | - Diane Pilkey
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | - Matthew Breiding
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control, Atlanta, GA
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Veliz P, Ryan J, Eckner JT. Head, Neck, and Traumatic Brain Injury Among Children Involved in Sports: Results From the Adolescent Brain Cognitive Development Study. J Adolesc Health 2021; 68:414-418. [PMID: 32674966 PMCID: PMC7855291 DOI: 10.1016/j.jadohealth.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/08/2020] [Accepted: 06/01/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to assess the prevalence of head and neck injury (HNI) requiring hospitalization or emergency care and traumatic brain injury with loss of consciousness (TBI-LOC) among youth athletes and nonathletes (ages 9-10 years) using the baseline cohort of the Adolescent Brain Cognitive Development study. METHODS National data from the baseline cohort of the Adolescent Brain Cognitive Development study (2016-2018; n = 11,869) were analyzed. RESULTS The analysis found that 12.1% of the sample indicated HNI during their lifetime, while .8% indicated TBI-LOC. Participation in multiple sports (adjusted prevalence rate ratio [aPRR] = 1.29, 95% confidence interval [CI] = 1.06,1.55), contact sports (aPRR = 1.19, 95% CI = 1.05,1.34), and who had participated in sport for five or more years (aPRR = 1.42, 95% CI =1.16,1.73) had modestly higher prevalence rate ratios of reporting HNI compared to nonparticipants. Sport participation was not found to be associated with TBI-LOC. CONCLUSIONS The study provides needed epidemiological information on the prevalence of HNI and TBI-LOC among younger adolescents who participate in sports. While the risk of TBI-LOC appears to be low among youth athletes and nonathletes, the risk of more serious head injuries may increase due to length of participation in sport and involvement in high contact sports.
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Affiliation(s)
- Philip Veliz
- School of Nursing, University of Michigan, Ann Arbor, Michigan.
| | | | - James T. Eckner
- Addiction Research Center, Department of Physical Medicine and Rehabilitation, University of Michigan
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Knell G, Burkhart SO, Caze TJ, Polousky JD, Kohl HW, Messiah SE. Association Between Concussion History and Factors Relating to Cognitive, Behavioral, and Emotional Health Among American High School Athletes: A Cross-sectional Analysis. Am J Sports Med 2020; 48:2534-2543. [PMID: 32692937 DOI: 10.1177/0363546520938776] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The cognitive, behavioral, and emotional deficits that may be associated with sports-related concussions among adolescents are unclear. PURPOSE To examine the association between reported concussion history and factors relating to cognitive, behavioral, and emotional health among a population-based sample of US high school-aged adolescents. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Participants included a representative sample of US high school student-athletes who reported a concussion history (in the past 12 months) and relevant behaviors/outcomes within 3 domains: cognitive (academics, difficulty concentrating), behavioral (drinking and driving, carrying a weapon, physically fighting, tobacco use, marijuana use, binge drinking), and emotional (symptoms of depression, suicidal thoughts/actions). The adjusted relative odds of experiencing 0 and at least 1, 2, 3, or ≥4 concussions were modeled while mutually adjusting for the behaviors of interest in addition to age, race/ethnicity, and sleep problems. Data were reported in sex stratum. RESULTS A total of 13,268 participants were included in the unweighted data set. Overall, 14.5% (95% CI, 12.9%-16.2%) of female and 18.1% (95% CI, 16.4%-19.8%) of male student-athletes had at least 1 concussion in the past 12 months. As compared with those who reported not engaging in any of the behaviors deleterious to health or having had any of the negative health outcomes (composite score of 0), female athletes with composite scores of 1 to 4, 5 to 7, and 8 to 11 were 1.94 (95% CI, 1.55-2.43), 3.13 (95% CI, 2.30-4.33), and 6.05 (95% CI, 3.75-9.75) times more likely to have a recent history of concussions after accounting for relevant factors. As compared with those having a composite score of 0, male athletes with composite scores of 1 to 4, 5 to 7, and 8 to 11 were 2.03 (95% CI, 1.58-2.59), 3.80 (95% CI, 2.71-5.34), and 8.23 (95% CI, 4.91-13.77) times more likely to have a recent history of concussions after accounting for relevant factors. CONCLUSION Self-reported concussions among US high school athletes is related to several deleterious health behaviors and outcomes. These associations should be confirmed in longitudinal analyses.
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Affiliation(s)
- Gregory Knell
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA.,Center for Pediatric Population Health, The University of Texas Health Science Center at Houston, Dallas, Texas, USA
| | - Scott O Burkhart
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA.,Center for Pediatric Population Health, The University of Texas Health Science Center at Houston, Dallas, Texas, USA
| | - Todd J Caze
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA.,Peter O'Donnell Jr Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - John D Polousky
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA.,Center for Pediatric Population Health, The University of Texas Health Science Center at Houston, Dallas, Texas, USA
| | - Harold W Kohl
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, Austin, Texas, USA.,Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas, USA
| | - Sarah E Messiah
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Center for Pediatric Population Health, The University of Texas Health Science Center at Houston, Dallas, Texas, USA
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6
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Veliz P, McCabe SE, Eckner JT, Schulenberg JE. Concussion, sensation-seeking and substance use among US adolescents. Subst Abus 2019; 42:183-191. [PMID: 31638885 DOI: 10.1080/08897077.2019.1671938] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND No large-scale epidemiological survey of adolescents in the US has assessed the association between lifetime history of concussion, propensity toward sensation-seeking, and recent substance use. Methods: This study assesses the association between lifetime history of diagnosed concussions, sensation-seeking, and recent substance use (i.e., cigarette use, binge drinking, marijuana use, illicit drug use, and nonmedical prescription drug use) using the 2016 and 2017 Monitoring the Future study of 25,408 8th, 10th, and 12th graders. Results: Lifetime diagnosis of concussion was associated with greater odds of past 30-day/2-week substance use. Adolescents who indicated multiple diagnosed concussions (versus none) had two times greater odds of all types of recent substance use, after adjusting for potential confounding factors. Adolescents indicating multiple diagnosed concussions also had higher adjusted odds of cigarette use, binge drinking, and marijuana use) when compared to adolescents who only indicated one diagnosed concussion. Accounting for adolescents' propensity toward sensation-seeking did not significantly change the association between substance use and multiple diagnosed concussions. Conclusions: This study provides needed epidemiological data regarding concussion and substance use among US adolescents. Exposure to a single diagnosed concussion is associated with a modest increase in the risk of substance use and this association increases with the accumulation of multiple diagnosed concussions. These associations hold when controlling for sensation-seeking. Substance use prevention efforts should be directed toward adolescents who have a history of multiple concussions.
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Affiliation(s)
- Phil Veliz
- School of Nursing Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Sean Esteban McCabe
- School of Nursing Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, Ann Arbor, Michigan, USA
| | - James T Eckner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - John E Schulenberg
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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