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Kroshus-Havril E, Leeds DD, McAllister TW, Kerr ZY, Knight K, Register-Mihalik JK, Lynall RC, D'Lauro C, Ho Y, Rahman M, Broglio SP, McCrea MA, Schmidt JD, Port N, Campbell D, Putukian M, Chrisman SPD, Cameron KL, Susmarski AJ, Goldman JT, Benjamin H, Buckley T, Kaminski T, Clugston JR, Feigenbaum L, Eckner JT, Mihalik JP, Kontos A, McDevitt J, Brooks MA, Rowson S, Miles C, Lintner L, Kelly L, Master C. Optimizing Concussion Care Seeking: Using Machine Learning to Predict Delayed Concussion Reporting. Am J Sports Med 2024; 52:2372-2383. [PMID: 39101733 DOI: 10.1177/03635465241259455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
BACKGROUND Early medical attention after concussion may minimize symptom duration and burden; however, many concussions are undiagnosed or have a delay in diagnosis after injury. Many concussion symptoms (eg, headache, dizziness) are not visible, meaning that early identification is often contingent on individuals reporting their injury to medical staff. A fundamental understanding of the types and levels of factors that explain when concussions are reported can help identify promising directions for intervention. PURPOSE To identify individual and institutional factors that predict immediate (vs delayed) injury reporting. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS This study was a secondary analysis of data from the Concussion Assessment, Research and Education (CARE) Consortium study. The sample included 3213 collegiate athletes and military service academy cadets who were diagnosed with a concussion during the study period. Participants were from 27 civilian institutions and 3 military institutions in the United States. Machine learning techniques were used to build models predicting who would report an injury immediately after a concussive event (measured by an athletic trainer denoting the injury as being reported "immediately" or "at a delay"), including both individual athlete/cadet and institutional characteristics. RESULTS In the sample as a whole, combining individual factors enabled prediction of reporting immediacy, with mean accuracies between 55.8% and 62.6%, depending on classifier type and sample subset; adding institutional factors improved reporting prediction accuracies by 1 to 6 percentage points. At the individual level, injury-related altered mental status and loss of consciousness were most predictive of immediate reporting, which may be the result of observable signs leading to the injury report being externally mediated. At the institutional level, important attributes included athletic department annual revenue and ratio of athletes to athletic trainers. CONCLUSION Further study is needed on the pathways through which institutional decisions about resource allocation, including decisions about sports medicine staffing, may contribute to reporting immediacy. More broadly, the relatively low accuracy of the machine learning models tested suggests the importance of continued expansion in how reporting is understood and facilitated.
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Affiliation(s)
- Emily Kroshus-Havril
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute & Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Daniel D Leeds
- Computer and Information Sciences, Fordham University, New York, New York, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Zachary Yukio Kerr
- Matthew Gfeller Center & Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Kristen Knight
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Johna K Register-Mihalik
- Matthew Gfeller Center & Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Robert C Lynall
- UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Christopher D'Lauro
- Department of Behavioral Sciences and Leadership, US Air Force Academy, Colorado Springs, Colorado, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Yuet Ho
- Computer and Information Sciences, Fordham University, New York, New York, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Muhibur Rahman
- Computer and Information Sciences, Fordham University, New York, New York, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Steven P Broglio
- University of Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Julianne D Schmidt
- UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Nicholas Port
- School of Optometry, Indiana University, Bloomington, Indiana, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Darren Campbell
- Intermountain Sports Medicine, Ogden, Utah, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Margot Putukian
- Athletic Medicine, Princeton University, Princeton, New Jersey, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Sara P D Chrisman
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Kenneth L Cameron
- Keller Army Hospital, US Military Academy, West Point, New York, USA; Annapolis, Maryland, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Adam James Susmarski
- Department Head Brigade Orthopaedics and Sports Medicine, US Naval Academy
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Joshua T Goldman
- Departments of Family Medicine & Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Holly Benjamin
- Department of Rehabilitation Medicine and Pediatrics, University of Chicago, Chicago, Illinois, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Thomas Buckley
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Thomas Kaminski
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - James R Clugston
- Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Luis Feigenbaum
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, Florida, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - James T Eckner
- Department of PM&R, University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Jason P Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Anthony Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Jane McDevitt
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - M Alison Brooks
- Department of Orthopedics, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Steve Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Christopher Miles
- Department of Family and Community Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Laura Lintner
- Wake Forest School of Medicine Family Medicine, Winston Salem State University, Winston-Salem, North Carolina, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Louise Kelly
- Department of Exercise Science, California Lutheran University, Thousand Oaks, California, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
| | - Christina Master
- Division of Orthopedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Investigation performed at the University of Georgia, Athens, Georgia, USA
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Munce TA, Peplowski AD, Bowman TG, Kelshaw PM, Campbell TR, Ahonen SB, Valentine VD, Cifu DX, Resch JE. Concussion diagnosis and recovery in relation to collegiate athletic department classification: a LIMBIC MATARS consortium investigation. Brain Inj 2024:1-11. [PMID: 38334036 DOI: 10.1080/02699052.2024.2310800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE We investigated time to reach concussion diagnosis and recovery milestones in collegiate athletes relative to their schools' National Collegiate Athletic Association (NCAA) classification. METHODS We retrospectively examined 849 (43.1% female) concussion cases from 11 NCAA institutions (Division I Power 5 [n = 4], Division I Non-Power 5 [n = 4], and Division II/III [n = 3]) from the 2015-16 to 2019-20 athletic seasons. Our primary outcome measures were days to reach specific clinical milestones following concussion. RESULTS Median (IQR) time from injury to diagnosis was significantly longer at Division II/III institutions (1 [0-4] days) compared to Division I Power 5 (0 [0-1] days) and Division I Non-Power 5 (0 [0-1] days) institutions (p < 0.001). Likewise, Division II/III athletes (15 [11-22] days) took significantly longer to return to sport after concussion than Division I Power 5 (10 [7-16] days) and Division I Non-Power 5 (11 [7-18.5] days) athletes (p < 0.001). CONCLUSION Division II/III athletes had delayed concussion diagnoses and return to sport timelines compared to Division I athletes. Our results suggest that differences in sports medicine resources across NCAA divisions may influence injury recognition and recovery in collegiate athletes with concussion.
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Affiliation(s)
- Thayne A Munce
- Environmental Influences on Health & Disease Group, Sanford Research, Sioux Falls, South Dakota, USA
| | - Allison D Peplowski
- Environmental Influences on Health & Disease Group, Sanford Research, Sioux Falls, South Dakota, USA
- Department of Biology, University of South Dakota, Vermillion, South Dakota, USA
| | - Thomas G Bowman
- Department of Athletic Training, College of Health Sciences, University of Lynchburg, Lynchburg, Virginia, USA
| | - Patricia M Kelshaw
- Department of Kinesiology, Brain Research and Assessment Initiative of New Hampshire (BRAIN) Laboratory, University of New Hampshire, Durham, New Hampshire, USA
| | - Thomas R Campbell
- School of Rehabilitation Sciences, College of Health Sciences, Old Dominion University, Norfolk, Virginia, USA
| | - Sean B Ahonen
- Intercollegiate Athletics and Community Wellness, Virginia Union University, Richmond, Virginia, USA
| | - Verle D Valentine
- Sanford Orthopedics and Sports Medicine, Sanford Health, Sioux Falls, South Dakota, USA
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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Walton SR, Kelshaw PM, Munce TA, Beidler E, Bowman TG, Oldham JR, Wilmoth K, Broshek DK, Rosenblum DJ, Cifu DX, Resch JE. Access to athletic trainers and sex as modifiers of time to reach clinical milestones after sport-related concussion in collegiate athletes. Brain Inj 2024:1-8. [PMID: 38318792 DOI: 10.1080/02699052.2024.2310787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Investigate whether an athlete's biological sex and exposure to a dedicated athletic trainer (AT) were related to clinical milestones after a sports-related concussion (SRC). DESIGN Retrospective chart review. METHODS Medical charts of collegiate athletes (n = 196 [70.9% female]) diagnosed with SRC were reviewed to extract: biological sex, dedicated AT exposure for their sport (yes/no), and time (days) to reaching clinical milestones (diagnosis, symptom resolution, unrestricted return to sport [RTS]). Mann-Whitney U tests were used to determine whether time to clinical milestones differed by sex, AT exposure, or their interaction. Proportions of same-day diagnoses and times to diagnosis, symptom resolution, and unrestricted RTS were evaluated with chi-squared and spearman's rank correlations, respectively. RESULTS There were no significant differences in times to reaching any clinical milestone by sex, AT exposure, or their interaction (ps > 0.05). Forty-three percent of participants were diagnosed on the day of their SRC. This did not differ by sex or AT exposure (ps > 0.29). Longer times to SRC diagnosis were associated with more days to symptom resolution (ρ = 0.236, p = 0.001) and unrestricted RTS (ρ = 0.223, p < 0.001). CONCLUSIONS Athlete sex and AT exposure were not associated with times to reach any clinical milestone; however, delayed diagnosis was associated with longer times to reach clinical recovery.
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Affiliation(s)
- Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Patricia M Kelshaw
- Department of Kinesiology, Brain Research and Assessment Initiative of New Hampshire Laboratory, University of New Hampshire, Durham, New Hampshire, USA
| | - Thayne A Munce
- Environmental Influences on Health & Disease Group, Sanford Research, Sioux Falls, South Dakota, USA
| | - Erica Beidler
- Department of Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Thomas G Bowman
- Department of Athletic Training, College of Health Sciences, University of Lynchburg, Lynchburg, Virginia, USA
| | - Jessie R Oldham
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Kristin Wilmoth
- Departments of Psychiatry and of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Donna K Broshek
- Department of Psychiatry & Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Daniel J Rosenblum
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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Leahy R, Whyte E, Rochfort KD, Kontos AP, Collins MW, O'Connor S. Factors associated with concussion management behavior in Ladies Gaelic Football players. Brain Inj 2023; 37:1159-1166. [PMID: 37296158 DOI: 10.1080/02699052.2023.2222643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/07/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Sport-related concussion (SRC) management may be poor in community sports such as Ladies Gaelic Football (LGF). This study examined factors associated with SRC management behavior in adult LGF players. METHODS Participants (n = 657) answered an online survey on demographic factors, concussion knowledge, attitudes, and education, and SRC management behavior. Data from participants who reported sustaining an LGF-related SRC during the previous year (n = 115) were further analyzed. RESULTS Being diagnosed with SRC was the main factor influencing subacute management behavior. Players with diagnosed SRCs had increased odds of following a graded return-to-play (RTP) programme (OR = 4.89), following a medically supervised graded RTP programme (OR = 10.16), and being medically cleared before full RTP (OR = 13.45) compared with those with suspected SRCs. Concussion history was associated with increased odds of informing a coach of a possible SRC (OR = 2.86). Demographic factors, previous use of Ladies Gaelic Football Association concussion education resources, and concussion knowledge and attitudes had minimal or no influence on management behaviors. CONCLUSION Greater access to medical personnel at LGF training and matches is recommended. Due to limited medical resources in community sport, a clear referral pathway for players with SRC and comprehensive SRC education should be introduced to ensure players receive adequate medical care.
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Affiliation(s)
- Róisín Leahy
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Enda Whyte
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Keith D Rochfort
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Anthony P Kontos
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael W Collins
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Siobhán O'Connor
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
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Register-Mihalik J, Leeds DD, Kroshus E, Kerr ZY, Knight K, D'Lauro C, Lynall RC, Ahmed T, Hagiwara Y, Broglio SP, McCrea MA, McAllister TW, Schmidt JD. Optimizing Concussion Care Seeking: Identification of Factors Predicting Previous Concussion Diagnosis Status. Med Sci Sports Exerc 2022; 54:2087-2098. [PMID: 35881927 DOI: 10.1249/mss.0000000000003004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE There is limited understanding of factors affecting concussion diagnosis status using large sample sizes. The study objective was to identify factors that can accurately classify previous concussion diagnosis status among collegiate student-athletes and service academy cadets with concussion history. METHODS This retrospective study used support vector machine, Gaussian Naïve Bayes, and decision tree machine learning techniques to identify individual (e.g., sex) and institutional (e.g., academic caliber) factors that accurately classify previous concussion diagnosis status (all diagnosed vs 1+ undiagnosed) among Concussion Assessment, Research, and Education Consortium participants with concussion histories ( n = 7714). RESULTS Across all classifiers, the factors examined enable >50% classification between previous diagnosed and undiagnosed concussion histories. However, across 20-fold cross validation, ROC-AUC accuracy averaged between 56% and 65% using all factors. Similar performance is achieved considering individual risk factors alone. By contrast, classifications with institutional risk factors typically did not distinguish between those with all concussions diagnosed versus 1+ undiagnosed; average performances using only institutional risk factors were almost always <58%, including confidence intervals for many groups <50%. Participants with more extensive concussion histories were more commonly classified as having one or more of those previous concussions undiagnosed. CONCLUSIONS Although the current study provides preliminary evidence about factors to help classify concussion diagnosis status, more work is needed given the tested models' accuracy. Future work should include a broader set of theoretically indicated factors, at levels ranging from individual behavioral determinants to features of the setting in which the individual was injured.
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Affiliation(s)
- Johna Register-Mihalik
- Matthew Gfeller Center and STAR Heel Performance Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Daniel D Leeds
- Computer and Information Sciences, Fordham University, New York, NY
| | - Emily Kroshus
- Department of Pediatrics and Seattle Children's Research Institute, Center for Child, Development and Health, University of Washington, Seattle, WA
| | - Zachary Yukio Kerr
- Matthew Gfeller Center and Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Christopher D'Lauro
- Department of Behavioral Sciences and Leadership, United States Air Force Academy, Colorado Springs, CO
| | - Robert C Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA
| | - Tanvir Ahmed
- Computer and Information Sciences, Fordham University, New York, NY
| | - Yuta Hagiwara
- Computer and Information Sciences, Fordham University, New York, NY
| | - Steven P Broglio
- University of Michigan Concussion Center, University of Michigan, Ann Arbor, MI
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Julianne D Schmidt
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA
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Sidhar K, Baugh CM, Wilson JC, Spittler J, Walker GA, Armento AM, Howell DR. Socioeconomic status and injury history in adolescent athletes: Lower family affluence is associated with a history of concussion. J Clin Transl Res 2022; 8:292-298. [PMID: 35975186 PMCID: PMC9373721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 10/26/2022] Open
Abstract
Background While healthcare and health outcome disparities have been studied across a variety of different injuries, their relation to concussion incidence and management are relatively understudied. Aim The aim of this study was to evaluate the association between history of concussion or musculoskeletal injury, and family affluence and/or school-level measures of socioeconomic status. Methods We conducted a cross-sectional study of adolescent athletes in a local school district. Adolescent athletes (n = 192; mean age = 15.3, SD = 1.6 years; 49% female), who presented for a pre-participation physical evaluation reported concussion and injury history, and family affluence scale (FAS) scores. We also examined the percent of students on free/reduced lunch at each school compared to state averages. Independent variables, individual FAS score and school-based marker of socioeconomic status, were compared between those with and without a history of concussion and time-loss musculoskeletal injury. Results Of the participants, 40 (21%) reported a history of concussion. Athletes with a concussion history had significantly lower FAS scores than athletes without a history of concussion (mean difference = 0.7, 95%CI = 0.1, 1.4; P = 0.027). There was no significant difference in FAS scores between those with and without a history of time-loss musculoskeletal injury (mean difference = 0.0, 95% CI = -0.5, 0.5; P = 0.97). Athletes with a history of concussion had a higher proportion of a prior time-loss musculoskeletal injury (68% vs. 32%; P < 0.001). After adjusting for age, school free-reduced lunch rate, and history of musculoskeletal injury, a lower FAS score was associated with concussion history (adjusted odds ratio = 0.79; 95% CI = 0.64, 0.96; P = 0.019). Concussion and musculoskeletal injury were not associated with school-level markers of socioeconomic status. Conclusion Lower individual measures, but not school-level measures, of socioeconomic status were associated with a history of concussion in our sample of adolescent athletes. Relevance for Patients Enhance providers' understanding of how socioeconomic factors may impact concussion history and empower providers to adequately screen for and provide concussion education to mitigate disparities.
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Affiliation(s)
- Kartik Sidhar
- 1Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA,2Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christine M. Baugh
- 3Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA,4Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Julie C. Wilson
- 1Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA,2Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA,5Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jack Spittler
- 6Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gregory A. Walker
- 1Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA,2Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Aubrey M. Armento
- 1Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA,2Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - David R. Howell
- 1Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA,2Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA,Corresponding author: David R. Howell, Sports Medicine Center, Children’s Hospital Colorado; Department of Orthopedics, University of Colorado School of Medicine. Address: 13123 E. 16th Avenue, B060 Aurora, CO 80045. Tel: +1 7207771502. E-mail:
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McMurray N, Reinke E, Riboh J, Pyles C, Bytomski J. Medical Diagnoses in a University Athlete Training Room Clinic. Clin J Sport Med 2022; 32:e35-e39. [PMID: 33852438 DOI: 10.1097/jsm.0000000000000895] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/31/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Approximately 560 000 student-athletes participate in university athletic programs every year. These athletes develop a variety of medical injuries and illnesses during their time at the university. There is currently a paucity of data with regarding medical encounters in a dedicated university athlete training room clinic. OBJECTIVE This study aims to provide data regarding medical diagnoses from a university athlete training room clinic. STUDY DESIGN Descriptive epidemiology study. SETTING University athlete training room clinic. PATIENTS University athletes. METHODS The electronic medical record for a year-round, athlete-only training room clinic at a private US university was reviewed. Athlete age, sex, sport, date of medical encounter, and encounter diagnoses across 5 calendar years were recorded; medical diagnoses were then manually stratified into diagnostic categories and subgroups. RESULTS A total of 1258 university athletes were evaluated during 5303 medical encounters. Approximately two-thirds of athletes were evaluated one or more times per year. Average number of encounters per athlete per year was 2.2 (0.6-3.8, 95% confidence interval). The football team accounted for the greatest number of encounters (15.2% of total encounters). The most common medical diagnosis category was otorhinolaryngology (30.6% of total diagnoses). The most common diagnosis subgroup was upper respiratory infection (14.8% of total diagnoses). CONCLUSIONS Approximately two-thirds of athletes were evaluated annually with an average of 2 encounters per athlete per year. Upper respiratory infection represented the most common individual diagnosis. The results reported in this study may be useful in directing future care and research of university athletes.
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Affiliation(s)
- Nathan McMurray
- Duke Sports Science Institute, Duke Division of Sports Medicine. Duke Orthopedics Department. Duke University Health System. Durham, North Carolina
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8
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Sheehy DJ, Toohey LA, Panagodage Perera NK, Drew MK. Despite maintaining a high daily training availability, a quarter of athletes start the season injured and three quarters experience injury in an Australian State Academy of Sport. J Sci Med Sport 2021; 25:139-145. [PMID: 34556402 DOI: 10.1016/j.jsams.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To 1) investigate the incidence, prevalence, burden and characteristics of injuries; and 2) explore the frequency of physiotherapy and medical servicing for elite sports academy athletes over a 12-month season. DESIGN Prospective cohort study. METHODS Medical attention and time-loss injuries were prospectively recorded by Physiotherapy and Medical (Sports Physician) staff for 94 athletes (72.3% females). The number of linked physiotherapy and medical servicing appointments was also recorded. Injury incidence rates (IIR), point and period prevalence, and injury burden were calculated and compared by athlete gender, sport, and categorisation (performance level) using incidence rate ratios (IRR). RESULTS The number of injuries reported was 193 in 71 (75.5%) athletes. The IIR was 2.1 (95%CI: 1.8 to 2.4) injuries per 365 days, with no gender difference observed (IRR: 1.1, 0.8 to 1.4). The injury burden was 43.5 (95%CI: 37.8 to 50.1) days absent per 365 days. More than one-quarter (point prevalence, 26.6%) of athletes commenced the season with an injury. In-season injury risk was 2.5 fold greater in athletes who started the season with an injury compared to athletes who started the season without an injury (IRR: 2.5, 1.9 to 3.4). The majority (81.2%) of the 1164 appointments recorded were physiotherapy, with an overall 4.3:1.0 physiotherapy to medical appointment ratio. CONCLUSIONS One in four athletes began the elite pathway season with a pre-existing injury, while also demonstrating a 2.5 fold greater risk of subsequent injury in the scholarship period. Sports should not assume their athletes are uninjured at the beginning of their scholarship. Injury profiles, and physiotherapy and medical servicing varied across sports. To reduce health as a barrier in the successful transition of talented young athletes to elite athletes, injury management strategies at the commencement of recruitment and throughout the scholarship should be prioritised in the development pathway.
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Affiliation(s)
- Daniel J Sheehy
- ACT Academy of Sport, Australia; Sports Medicine, Australian Institute of Sport, Australia.
| | - Liam A Toohey
- Athlete Availability Program, Australian Institute of Sport, Australia
| | | | - Michael K Drew
- Athlete Availability Program, Australian Institute of Sport, Australia
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An Examination of Perceived Pressure From Stakeholders on Concussion Reporting Intentions and Behavior in Ice Hockey Athletes. J Head Trauma Rehabil 2021; 37:79-88. [PMID: 33782349 DOI: 10.1097/htr.0000000000000679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to assess whether perceived pressure predicts concussion reporting intentions and behavior in youth, high school, and collegiate ice hockey athletes, and, secondarily, whether perceived pressure from stakeholders differed between sex or level of play. SETTING Online survey. PARTICIPANTS One hundred fifty-two ice hockey athletes (males: n = 96, 63.2%; females: n = 55, 36.2%; missing: n = 1, 0.7%; age = 14.04 ± 3.6 years). DESIGN Cross-sectional. MAIN MEASURES Respondents answered a survey that elicited information about demography, perceived pressure from 6 stakeholders, and concussion reporting intentions and behavior. For the first aim, we used a generalized linear model to determine whether perceived pressure from any stakeholder predicted intention (symptom reporting, concussion reporting, and intention beliefs) or behavior ("all concussions," "not obvious concussions"; α < .05) while controlling for level of play. To determine whether pressure from any stakeholder predicted symptom reporting behavior, we used logistic regression while controlling for level of play. For the second aim, to examine sex differences in perceived pressure from each stakeholder, we employed Mann-Whitney tests and to examine level of play differences, we used Kruskal-Wallis tests. RESULTS Controlling for level of play, a 1-point increase in perceived pressure from parents and athletic administrators decreased concussion reporting intentions by 0.92 (P = .004) and 1.09 (P = .005) points, respectively. Perceived pressure from a sports medicine professional decreased intention beliefs by 0.17 (P = .029) points. Perceived pressure from stakeholders did not predict symptom reporting (P = .440) or "not obvious concussion" reporting (P = .655) behavior. We observed no difference in perceived pressure across stakeholders (all P values >.05); however, collegiate ice hockey respondents perceived greater pressure from coaches than youth or high school athletes (P < .001). We noted no other differences in perceived pressure across levels of play (all P values >.05). CONCLUSIONS Concussion reporting intentions were negatively influenced by perceived pressure from parents, athletic administrators, and sports medicine professionals, but these findings did not translate to reporting behavior.
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Master CL, Katz BP, Arbogast KB, McCrea MA, McAllister TW, Pasquina PF, Lapradd M, Zhou W, Broglio SP. Differences in sport-related concussion for female and male athletes in comparable collegiate sports: a study from the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium. Br J Sports Med 2020; 55:1387-1394. [PMID: 33355211 DOI: 10.1136/bjsports-2020-103316] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine sex differences in sport-related concussion (SRC) across comparable sports. METHODS Prospective cohort of collegiate athletes enrolled between 2014 and 2017 in the Concussion Assessment, Research and Education Consortium study. RESULTS Among 1071 concussions (females=615; 57.4%), there was no difference in recovery (median days to full return to play) (females=13.5 (IQR 9.0, 23.1) vs males=11.8 (IQR 8.1, 19.0), p=0.96). In subgroup analyses, female recovery was longer in contact (females=12.7 days (IQR 8.8, 21.4) vs males=11.0 days (IQR 7.9, 16.2), p=0.0021), while male recovery was longer in limited contact sports (males=16.9 days (IQR 9.7, 101.7) vs females=13.8 days (IQR 9.1, 22.0), p<0.0001). There was no overall difference in recovery among Division I schools (females=13.7 (IQR 9.0, 23.1) vs males=12.2 (IQR 8.2 19.7), p=0.5), but females had longer recovery at the Division II/III levels (females=13.0 (IQR 9.2, 22.7) vs males=10.6 (IQR 8.1, 13.9), p=0.0048). CONCLUSION Overall, no difference in recovery between sexes across comparable women's and men's sports in this collegiate cohort was found. However, females in contact and males in limited contact sports experienced longer recovery times, while females had longer recovery times at the Division II/III level. These disparate outcomes indicate that, while intrinsic biological sex differences in concussion recovery may exist, important, modifiable extrinsic factors may play a role in concussion outcomes.
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Affiliation(s)
- Christina L Master
- Orthopaedics and Sports Medicine, Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA .,Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Barry P Katz
- Biostatisics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Michael A McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thomas W McAllister
- Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Paul F Pasquina
- Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Michelle Lapradd
- Biostatisics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Wenxian Zhou
- Biostatisics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Baugh CM, Meehan WP, McGuire TG, Hatfield LA. Staffing, Financial, and Administrative Oversight Models and Rates of Injury in Collegiate Athletes. J Athl Train 2020; 55:580-586. [PMID: 32348154 DOI: 10.4085/1062-6050-0517.19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Structural features of health care environments are associated with patient health outcomes, but these relationships are not well understood in sports medicine. OBJECTIVE To evaluate the association between athlete injury outcomes and structural measures of health care at universities: (1) clinicians per athlete, (2) financial model of the sports medicine department, and (3) administrative reporting structure of the sports medicine department. DESIGN Descriptive epidemiology study. SETTING Collegiate sports medicine programs. PATIENTS OR OTHER PARTICIPANTS Colleges that contribute data to the National Collegiate Athletic Association (NCAA) Injury Surveillance Program. MAIN OUTCOME MEASURE(S) We combined injury data from the NCAA Injury Surveillance Program, sports medicine staffing data from NCAA Research, athletic department characteristics from the United States Department of Education, and financial and administrative oversight model data from a previous survey. Rates of injury, reinjury, concussion, and time loss (days) in NCAA athletes. RESULTS Compared with schools that had an average number of clinicians per athlete, schools 1 standard deviation above average had a 9.5% lower injury incidence (103.6 versus 93.7 per 10000 athlete-exposures [AEs]; incidence rate ratio [IRR] = 0.905, P < .001), 2.7% lower incidence of reinjury (10.6 versus 10.3 per 10000 AEs; IRR = 0.973, P = .004), and 6.7% lower incidence of concussion (6.1 versus 5.7 per 10000 AEs; IRR = 0.933, P < .001). Compared with the average, schools that had 1 standard deviation more clinicians per athlete had 16% greater injury time loss (5.0 days versus 4.2 days; IRR = 1.16, P < .001). At schools with sports medicine departments financed by or reporting to the athletics department (or both), athletes had higher injury incidences (31% and 9%, respectively). CONCLUSIONS The financial and reporting structures of collegiate sports medicine departments as well as the number of clinicians per athlete were associated with injury risk. Increasing the number of sports medicine clinicians on staff and structuring sports medicine departments such that they are financed by and report to a medical institution may reduce athlete injury incidence.
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Affiliation(s)
- Christine M Baugh
- Interfaculty Initiative in Health Policy, Harvard University, Boston, MA
| | - William P Meehan
- Division of Sports Medicine, Sports Concussion Clinic, Boston Children's Hospital, MA
| | - Thomas G McGuire
- Department of Health Care Policy, Harvard Medical School, Boston, MA. Dr Baugh is now at the Center for Bioethics and Humanities, School of Medicine, Department of Medicine, Division of General Internal Medicine, University of Colorado, Aurora
| | - Laura A Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, MA. Dr Baugh is now at the Center for Bioethics and Humanities, School of Medicine, Department of Medicine, Division of General Internal Medicine, University of Colorado, Aurora
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