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Waltzman D, DePadilla L, Breiding M, Pierpoint L, Collins C. The Role of Level of Play in Concussions in High School Athletes. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:99-110. [PMID: 37566801 DOI: 10.1097/phh.0000000000001791] [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: 08/13/2023]
Abstract
OBJECTIVES To examine level of play (LOP) as a risk factor for concussion severity and recovery-related outcomes among high school athletes, stratified by sex, and among boys, by sport (football, non-football male sports). DESIGN/SETTING Secondary analysis of data collected through the High School Reporting Information Online surveillance system for academic years 2007-2008 through 2018-2019. PARTICIPANTS A total of 9916 concussions were reported between the academic years 2007-2008 and 2018-2019 from 9 sports (5189 from football; 2096 from non-football male sports; 2631 from female sports). MAIN OUTCOME MEASURE Examined the association between LOP (Freshman, Junior Varsity [JV], and Varsity teams) and concussion outcomes (number of concussion symptoms, symptom resolution time [SRT], and time to return to play [RTP]). RESULTS Compared with Varsity football athletes, concussed JV football athletes had on average 0.19 fewer concussion symptoms, longer SRT (>1 week vs <1 week: odds ratio [OR] = 1.3; 95% confidence interval [CI], 1.1-1.5), and longer RTP (1-3 weeks vs <1 week: OR = 1.5; 95% CI, 1.2-1.9; >3 weeks vs <1 week: OR = 1.6; 95% CI, 1.1-2.3). Compared with Varsity football athletes, Freshman football athletes had on average 0.48 fewer concussion symptoms, longer SRT (OR = 1.3; 95% CI, 1.1-1.5), and longer RTP (1-3 weeks vs <1 week: OR = 1.5; 95% CI, 1.1-2.0; >3 weeks vs <1 week: OR = 2.0; 95% CI, 1.3-3.0). Similarly, compared with female athletes on Varsity teams, concussed JV female athletes had longer RTP (1-3 weeks vs <1 week: OR = 1.8; 95% CI, 1.2-2.7). Trend analyses revealed an increase in the number of concussion symptoms between 2015-2016 and 2018-2019, a decrease between 2009-2010 and 2018-2019 for SRT of less than 1 week, and an increase between 2014-2015 and 2018-2019 for RTP of less than 1 week among Varsity football athletes. Among Varsity female athletes, there was a linear decrease during the study period for RTP of less than 1 week. CONCLUSIONS Despite a higher number of symptoms overall and in recent years, Varsity football players had shorter RTP than Freshman and JV athletes.
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Affiliation(s)
- Dana Waltzman
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Waltzman, DePadilla, and Breiding); Colorado School of Public Health, and University of Colorado School of Medicine, Aurora, Colorado (Dr Pierpoint); and Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, Indiana (Dr Collins)
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Weber Rawlins ML, Valovich McLeod TC. Concussion education perceptions among secondary school athletic trainers. Brain Inj 2023; 37:468-477. [PMID: 36939261 DOI: 10.1080/02699052.2023.2191009] [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: 03/21/2023]
Abstract
PURPOSE Describe concussion education perceptions among secondary school athletic trainers and determine the relationship between education program characteristics and perceived effectiveness. METHODS Two hundred and three participants completed at least one survey item (age = 35.2 ± 9.4 years; male = 27.6%). We used descriptive statistics to describe concussion education characteristics and point out biserial correlations to determine if relationships existed between concussion education characteristics and perceived effectiveness. RESULTS The most frequently used mandated concussion education programs were informational handouts created by the state interscholastic association, the Centers for Disease Control and Prevention's (CDC) Heads Up materials, and the National Federation of State High School Athletic Association's materials. The CDC's Heads Up materials, handouts created by the state interscholastic association, and in-person presentations created by respondents were the most frequent concussion educational programs utilized by respondents who indicated no specific program mandated. Educational programs that were engaging increased perceived effectiveness (n = 131, rpb = 0.31,p < 0.001). CONCLUSIONS Our results highlight that materials created by state interscholastic association and the CDC's Heads Up program among others are utilized to satisfy mandates and are perceived to be moderately effective, especially when perceived to be engaging. These results can help guide future studies to examine specific educational tools and administration strategies to determine effectiveness on concussion disclosure.
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Affiliation(s)
| | - Tamara C Valovich McLeod
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa,AZ, USA.,School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ, USA
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Radlicz C, Jackson K, Hautmann A, Shi J, Yang J. Influence of insurance type on rate and type of initial concussion-related medical visits among youth. BMC Public Health 2021; 21:1565. [PMID: 34407798 PMCID: PMC8375144 DOI: 10.1186/s12889-021-11586-y] [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: 10/26/2020] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background A growing number of studies report increased concussion-related health care utilization in recent years, but factors impacting care-seeking behaviors among youth following a concussion are not well described. This study aimed to evaluate the influence of insurance type on the rate and type of initial concussion visits and the time from injury to the initial visit in youth. Methods We extracted and analyzed initial concussion-related medical visits for youth ages 10 to 17 from electronic health records. Patients must have visited Nationwide Children’s Hospital’s (NCH) concussion clinic at least once between 7/1/2012 and 12/31/2017. We evaluated the trends and patterns of initial concussion visits across the study period using regression analyses. Results Of 4955 unique concussion visits included, 60.1% were males, 80.5% were white, and 69.5% were paid by private insurance. Patients’ average age was 13.9 years (SD = 3.7). The rate of the initial concussion visits per 10,000 NCH visits was consistently higher in privately insured than publicly insured youth throughout the study period (P < .0001). Privately insured youth had greater odds of initial concussion visits to sports medicine clinics (AOR = 1.45, 95% CI = 1.20, 1.76) but lower odds of initial concussion visits to the ED/urgent care (AOR = 0.74, 95% CI = 0.60, 0.90) than publicly insured youth. Days from injury to initial concussion visit significantly decreased among both insurance types throughout the study (P < .0001), with a greater decrease observed in publicly insured than privately insured youth (P = .011). Conclusions Results on the differences in the rate, type, and time of initial concussion-related visits may help inform more efficient care of concussion among youth with different types of insurance.
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Affiliation(s)
- Chris Radlicz
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive, RBIII-WB5403, Columbus, OH, 43205, USA
| | - Kenneth Jackson
- Biostatistics Resource, Nationwide Children's Hospital, Columbus, OH, USA.,Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Amanda Hautmann
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive, RBIII-WB5403, Columbus, OH, 43205, USA
| | - Junxin Shi
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive, RBIII-WB5403, Columbus, OH, 43205, USA
| | - Jingzhen Yang
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive, RBIII-WB5403, Columbus, OH, 43205, USA. .,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA.
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Beidler E, Welch Bacon CE, Hattrup N, Powers C, Saitz L, McLeod TV. Going Beyond the State Law: Investigating High School Sport-Related Concussion Protocols. J Athl Train 2020; 57:466508. [PMID: 34129675 PMCID: PMC8775288 DOI: 10.4085/1062-6050-0505.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
CONTEXT State laws provide general guidelines for sport-related concussion (SRC) management, but do not comprehensively address the multiple layers of management for this complex injury. While high schools are encouraged to develop a SRC protocol that includes both state law tenets and additional management practices, the execution of this warrants examination. OBJECTIVE To investigate state law compliance and practice components included in high school SRC protocols, and determine whether the degree of sports medicine coverage influenced protocol quality. DESIGN Qualitative document analysis. SETTING High school athletics. PARTICIPANTS In total, 184 Pennsylvania high schools [24.3% of schools statewide; full-time athletic trainer=149, part-time athletic trainer=13, missing=21] voluntarily provided copies of their protocol from the 2018-2019 academic year. MAIN OUTCOME MEASURES Four athletic trainers conducted document analyses using a 67-item component analysis guide. Frequencies were computed for included protocol components related to the state law, preparticipation and prevention, recognition and assessment, and management. The difference in the total number of included components (max 60) by sports medicine coverage was assessed using a Mann-Whitney U test. RESULTS There was heterogeneity in components included in the submitted protocols. Only 23.4% included all mandatory state law tenets. Immediate removal from play was noted in 67.4% of protocols, while only 1.6% contained prevention strategies. Return-to-play was addressed more frequently than return-to-learn (74.5% versus 32.6%). The sample had a mean of 15.5±9.7 total components per protocol. Schools with full-time sports medicine coverage had significantly more protocol components than those with part-time athletic trainers (15 [8.5-22.5] versus 6 [3-10.5] median components; U = 377.5, p < .001) Conclusions: School-level written SRC protocols were often missing components of the state law and additional best practice recommendations. Full-time sports medicine coverage in high schools is recommended to increase SRC protocol and healthcare quality.
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Affiliation(s)
| | - Cailee E Welch Bacon
- A.T. Still University, Athletic Training Programs, School of Osteopathic Medicine in Arizona, 5850 E Still Circle, Mesa, AZ 85206, United States,
| | - Nicholas Hattrup
- Boston University, Athletic Training Services, 285 Babcock Street, Boston, Massachusetts 02215, United States,
| | - Cassidy Powers
- Duquesne University, Department of Athletic Training, 600 Forbes Avenue, Pittsburgh, Pennsylvania 15282, United States,
| | - Lilly Saitz
- Mount Holyoke College, Department of Environmental Studies, 50 College Street, South Hadley, Massachusetts 01075, United States,
| | - Tamara Valovich McLeod
- A.T. Still University, Athletic Training Programs, School of Osteopathic Medicine in Arizona, 5850 E Still Circle, Mesa, Arizona 85206, United States,
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Register-Mihalik JK, Marshall SW, Kay MC, Kerr ZY, Peck KY, Houston MN, Linnan LA, Hennink-Kaminski H, Gildner P, Svoboda SJ, Cameron KL. Perceived social norms and concussion-disclosure behaviours among first-year NCAA student-athletes: implications for concussion prevention and education. Res Sports Med 2020; 29:1-11. [PMID: 31984812 DOI: 10.1080/15438627.2020.1719493] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Timely disclosure and identification of concussion symptoms are essential to proper care. Perceived social norms are a potential driving factor in many health-related decisions. The study purpose was to describe concussion disclosure behaviours and identify the association between perceived social norms and these disclosure behaviours. First-year student-athletes (n = 391) at two NCAA institutions completed a cross-sectional survey about concussion disclosure and disclosure determinants. Log-binomial regression models identified factors associated with concussion disclosure behaviour prevalence for: higher intention to disclose symptoms, disclosed all at time of injury, eventually disclosed all, and never participated with concussion symptoms. More favourable perceived social norms were associated with higher prevalence of intention to disclose (PR = 1.34; 95%CI: 1.18, 1.53) and higher prevalence of never participating in sports with concussion symptoms (PR = 1.50; 95%CI: 1.07, 2.10). Clinicians, coaches, sports administrators, and healthcare practitioners should be mindful of the need to create supportive social environments to improve concussion symptom disclosure.
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Affiliation(s)
- Johna K Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Stephen W Marshall
- Injury Prevention Research Center, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA.,Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Melissa C Kay
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA.,School of Health Professions, University of Southern Mississippi , Hattiesburg, MS, USA
| | - Zachary Y Kerr
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Karen Y Peck
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital , West Point, NY, USA
| | - Megan N Houston
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital , West Point, NY, USA
| | - Laura A Linnan
- Department of Health Behavior, School of Public Health, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Heidi Hennink-Kaminski
- School of Media and Journalism, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Paula Gildner
- Injury Prevention Research Center, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Steven J Svoboda
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital , West Point, NY, USA
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital , West Point, NY, USA
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Miller LE, Pinkerton EK, Fabian KC, Wu LC, Espeland MA, Lamond LC, Miles CM, Camarillo DB, Stitzel JD, Urban JE. Characterizing head impact exposure in youth female soccer with a custom-instrumented mouthpiece. Res Sports Med 2019; 28:55-71. [DOI: 10.1080/15438627.2019.1590833] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Logan E. Miller
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston Salem, NC, USA
| | - Elizabeth K. Pinkerton
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Katie C. Fabian
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lyndia C. Wu
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Mark A. Espeland
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lindsey C. Lamond
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Christopher M. Miles
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Joel D. Stitzel
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston Salem, NC, USA
| | - Jillian E. Urban
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston Salem, NC, USA
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Hood EA, Klima DW, Chui KK, Avallone NJ. Pre-season concussion assessment utilizing the King-Devick Test. Res Sports Med 2018; 27:467-472. [DOI: 10.1080/15438627.2018.1535434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Ethan A. Hood
- Doctor of Physical Therapy Program, DeSales University, Center Valley, PA, USA
| | - Dennis W. Klima
- Department of Physical Therapy, University of Maryland- Eastern Shore, Princess Anne, MD, USA
| | - Kevin K. Chui
- School of Physical Therapy and Athletic Training, Pacific University, Forest Grove, OR, USA
| | - Nicholas J. Avallone
- Department of Orthopaedic Surgery, St. Luke’s University Health Network, Phillipsburg, NJ, USA
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