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Beidler E, Schmitt AJ, Matta M, Griger C. Diagnosed and Nondisclosed Sport-Related Concussion: An Exploratory Comparison Study by ADHD Status in Collegiate Athletes. J Atten Disord 2022; 26:606-615. [PMID: 34009041 DOI: 10.1177/10870547211015432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine if ADHD status in collegiate athletes was associated with differences in the number of diagnosed and nondisclosed sport-related concussions, and reasons why suspected concussive injuries were not reported. METHOD A cross-sectional survey was completed by 858 collegiate athletes (65 with ADHD; 793 without ADHD). The survey included self-report items regarding ADHD status and histories of diagnosed and nondisclosed sport-related concussions. Groups were matched for gender, age, and sport with a ratio of one participant with ADHD to four without ADHD. RESULTS Collegiate athletes with ADHD reported significantly more diagnosed sport-related concussions and were more likely to have a history of diagnosis compared to those without ADHD. There were no significant differences between groups regarding sport-related concussion nondisclosure history. CONCLUSION Collegiate athletes with ADHD have an increased prevalence rate of diagnosed sport-related concussions compared to those without ADHD; however, this developmental disorder may not influence injury nondisclosure decisions.
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Kerschner AE, Huber DL, Brett BL, Meier TB, Nelson LD, McCrea MA. Age-Group Differences and Annual Variation in Return-To-Play Practices After Sport-Related Concussion. Clin J Sport Med 2022; 32:e52-e60. [PMID: 32941381 PMCID: PMC7956921 DOI: 10.1097/jsm.0000000000000871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/30/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine return-to-play (RTP) practice differences between high school and collegiate athletes, as well as the stability (ie, year-by-year) in these practices over a 5-year period. We hypothesized that similar protocols for treatment will be comparable across competition levels and that these practices will vary year-to-year. DESIGN Prospective cohort study. SETTING Nine high schools and 4 National Collegiate Athletic Association Division III colleges in Southeastern Wisconsin. PARTICIPANTS AND INDEPENDENT VARIABLES Two-hundred seventy-three (N = 273) athletes with sport-related concussions (SRCs). Independent predictors included competition level (high school, n = 88 vs collegiate, n = 185) and year-of-injury. OUTCOME MEASURES Athletes were evaluated prospectively for differences in symptom duration, symptom free waiting period (SFWP), and time to RTP, as well as longitudinal changes in management. RESULTS High school and collegiate athletes experienced comparable median symptom duration (high school, 6.0 days, interquartile range (IQR) = 3.5-11.0; college, 6.0 days, IQR = 4.0-9.0, P = 0.95), SFWP (high school, 5.0 days, IQR = 3.0-8.0; college, 5.0 days, IQR = 3.0-7.0, P = 0.12), and total time to RTP (high school, 10.5 days, IQR = 7.0-16.0; college, 11.0 days, IQR = 8.0-14.0 days, P = 0.94). A Cox regression analysis revealed a nonsignificant trend toward longer SFWPs in high school athletes (P = 0.055; hazard ratio = 1.347, confidence interval = 0.99-1.83). Among football players, SFWPs in 2017 (Median = 3.5 days, IQR = 1.5-5.0 days) were significantly longer than those in 2014 (Median = 5.0 days, IQR = 4.0-8.5 days, P = 0.029) after correction for multiple comparisons. CONCLUSION Similar postinjury and RTP management practices were observed at the high school and collegiate levels after SRCs. Symptom duration and time from injury to unrestricted RTP were comparable, although high school athletes may have longer SFWPs.
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Affiliation(s)
- Anna E Kerschner
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Daniel L Huber
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin; and
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin; and
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin; and
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Doucette MM, Du Plessis S, Webber AM, Whalen C, Garcia-Barrera MA. In it to win it: Competitiveness, concussion knowledge and nondisclosure in athletes. PHYSICIAN SPORTSMED 2021; 49:194-202. [PMID: 32767898 DOI: 10.1080/00913847.2020.1807886] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Despite having a general understanding of concussions, many athletes choose not to report symptoms of a sports-related concussion (SRC) which leads to a larger burden on our healthcare system due to longer recoveries, more Emergency Department visits, and future medical appointments. Thus, there is a need to identify factors, such as competitiveness, that may help to better explain the nondisclosure of concussion symptoms. The current study aimed to investigate the role of athletes' concussion knowledge and competitiveness on concussion nondisclosure. METHODS Participants included 161 Canadian athletes (ages 14-32; 71% male) participating in collision sports (American football, rugby, hockey), soccer or rowing. Concussion knowledge, reporting and competitiveness were measured using the Rosenbaum Concussion Attitude and Knowledge Survey and Sports Orientation Questionnaire (SOQ). Two logistic regression models were performed to explain both history and future intention of playing despite experiencing concussion symptoms. RESULTS Age, sex, and concussion knowledge were not significant for the regression models. The SOQ scores (measuring competitiveness) were significant for both regression models, such that higher competitiveness was associated with increased likelihood for past nondisclosure (b =.03, p =.03, OR = 1.03 (97.5% CI: 1.003,1.06)) and future nondisclosure intention (b =.05, p =.00, OR = 1.05 (97.5% CI: 1.03,1.08)). Regarding concussion knowledge, soccer players had significantly higher knowledge than those in collision sports and rugby, F(2, 158) = 140.5, p =.00; female athletes had significantly higher knowledge than males, t(66) = -4.26, p =.00; age was negatively associated with concussion knowledge (r = -0.35, p < .01). CONCLUSION The results suggest that healthcare providers should be aware that athletes tend to have adequate concussion knowledge, but this knowledge does not explain past nondisclosure or future nondisclosure intention. Based on these findings, healthcare providers should focus on being able to identify highly competitive athletes who are most at risk of nondisclosure instead of exclusively aiming to increase concussion knowledge in athletes.
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Affiliation(s)
- Madeline M Doucette
- Department of Psychology, CORTEX Lab, University of Victoria, Victoria, Canada
| | - Sané Du Plessis
- Department of Psychology, CORTEX Lab, University of Victoria, Victoria, Canada
| | - Amanda M Webber
- Department of Psychology, CORTEX Lab, University of Victoria, Victoria, Canada
| | - Chelsea Whalen
- Department of Psychology, CORTEX Lab, University of Victoria, Victoria, Canada
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Zuckerman SL, Vance EH, Brett BL. Commentary: The Florida Youth Concussion Law: A Survey-Based Observational Study of Physician Practices and Their Legislative Awareness. Neurosurgery 2019; 85:E959-E961. [PMID: 31504854 DOI: 10.1093/neuros/nyz320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 05/26/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - E Haley Vance
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Benjamin L Brett
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Oddo A, O'Conor E, Shore S, Piraino M, Gibney K, Tsao J, Stanfill AG. Making Headway for Discussions About Concussions: Experiences of Former High School and Collegiate Student-Athletes. Front Neurol 2019; 10:698. [PMID: 31333560 PMCID: PMC6624741 DOI: 10.3389/fneur.2019.00698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/14/2019] [Indexed: 12/03/2022] Open
Abstract
In order to better understand how to identify and treat student-athletes who experience concussions, better insight into reporting behavior of athletes is needed. This study aims to identify information influencing athletes' attitudes toward reporting their concussions and the perceived trajectory of their recovery both athletically and academically. Twenty-five former high school and collegiate athletes who experienced concussions in a wide variety of sports, organizational levels, and time periods gave insight through structured, qualitative interviews. A number of factors regarding education about concussions, proper diagnosis of concussions, and motivational pressures within high school and collegiate athletics were assessed. Eight major themes were identified regarding the participants' experiences with sport-related concussion: optimism bias, invisibility of the injury, diagnostic barriers, desire to play, external support and pressures, uncertainty of long-term prognosis, generational factors, and protection of future athletes. The findings support that underreporting of concussions among those players interviewed is related to misperceived risk, lack of education, and a struggle between internal and external pressures to play through injury. However, those who did seek medical and academic support, often did receive the necessary aid.
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Affiliation(s)
- Anthony Oddo
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Ellen O'Conor
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Sarah Shore
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Mary Piraino
- Department of Acute and Tertiary Care, College of Nursing, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Kyla Gibney
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Jack Tsao
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Ansley Grimes Stanfill
- Department of Acute and Tertiary Care, College of Nursing, University of Tennessee Health Science Center, Memphis, TN, United States
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On-Field Signs Predict Future Acute Symptoms After Sport-Related Concussion: A Structural Equation Modeling Study. J Int Neuropsychol Soc 2018; 24:476-485. [PMID: 29307322 DOI: 10.1017/s1355617717001321] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This study investigated the relationship between on-field, objective signs immediately following sport-related concussion and self-reported symptom endorsement within 1 day post injury. METHODS A retrospective case series of 237 concussed high school athletes was performed. On-field signs were evaluated immediately post injury. Self-reported symptoms (2 clusters) were collected within 1 day post injury. A two-step structural equation model and follow-up bivariate regression analyses of significant on-field signs and symptom clusters were performed. RESULTS Signs of immediate memory, β=0.20, p=.04, and postural instability, β=0.19, p < .01, significantly predicted a greater likelihood of endorsing the cognitive-migraine-fatigue symptom cluster within 1 day post injury. Regarding signs correlated with specific symptoms, immediate memory was associated with symptoms of trouble remembering, χ 2 =37.92, p < .001, odds ratio (OR)=3.89 (95% confidence interval (CI) [2.47, 6.13]), and concentration difficulties, χ 2 =10.84, p=.001, OR=2.13 (95% CI [1.37, 3.30]). Postural instability was associated with symptom endorsement of trouble remembering, χ 2 =12.08, p < .001, OR=1.76 (95% CI [1.29, 2.40]). CONCLUSIONS Certain post-concussion on-field signs exhibited after injury were associated with specific symptom endorsement within 1 day post injury. Based on these associations, individualized education-based interventions and academic accommodations may help reduce unanticipated worry from parents, students, and teachers following a student-athlete's sport-related concussion, especially in cases of delayed onset symptoms. (JINS, 2018, 24, 476-485).
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Brett BL, Kuhn AW, Yengo-Kahn AM, Kerr ZY, Bonfield CM, Solomon GS, Zuckerman SL. Initial symptom presentation after high school football-related concussion varies by time point in a season: an initial investigation. SPORTS MEDICINE-OPEN 2018; 4:8. [PMID: 29387986 PMCID: PMC5792382 DOI: 10.1186/s40798-018-0121-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/22/2018] [Indexed: 12/14/2022]
Abstract
Background Schedule-based and in-season factors (e.g., competition type) have been shown to be associated with symptom reporting patterns and injury severity in sport-related concussion (SRC). To determine if acute neurocognitive and symptom presentation following SRC differ by time point within a high school football season. Methods Multicenter ambispective cohort of high school football players who sustained a SRC (N = 2594). Timing (early, mid, and late season) of SRC was based on median dates for the start of the pre-season, regular season, and playoffs of each states’ football schedules. Analysis of covariance (ANCOVA) investigated differences across season period groups for: (1) neurocognitive test scores, (2) total symptom scores (TSS), and (3) individual symptom increases from baseline within 1-week post-injury. Results Significant group differences were observed in TSS, F(2, 2589) = 15.40, p < 0.001, ηp2 = 0.01, and individual symptom increases from baseline, F(2, 2591) = 16.40, p < 0.001, ηp2 = 0.01. Significant increases were seen from baseline to both midseason and late season in both TSS, χ2 = 24.40, p < 0.001, Φ = 0.10 and individual symptoms, χ2 = 10.32, p = 0.006, Φ = 0.10. Post hoc tests indicated a linear trend, with late-season injured athletes reporting approximately twice the TSS (13.10 vs. 6.77) and new symptoms (5.70 vs. 2.68) as those with early-season injuries. Conclusion In a cohort of American high school football student-athletes, those suffering SRC in the late-season time period had increased acute symptom burden. SRC sustained later in-season may require more conservative management.
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Affiliation(s)
- Benjamin L Brett
- Department of Psychology, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Department Counseling, Educational Psychology and Research, University of Memphis, Memphis, TN, USA.,Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Andrew W Kuhn
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA
| | - Christopher M Bonfield
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA. .,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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