1
|
Rotundo MP, Sokol-Randell D, Bleakley C, Donnelly P, Tierney G. Characteristics of potential concussive events in elite hurling: a video-analysis study. Ir J Med Sci 2023; 192:3175-3185. [PMID: 36800054 PMCID: PMC10692028 DOI: 10.1007/s11845-023-03307-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND High-impact sports such as hurling place participants at risk of sport-related concussion (SRC). AIMS This study will evaluate the characteristics of potential concussive events (PCEs) that occur in elite male hurling to acquire an understanding of how they occur. METHODS The authors recorded PCEs and their characteristics throughout two seasons of inter-county GAA competition using broadcast footage based on a previously validated protocol. RESULTS A total of 183 PCEs were identified over 82 inter-county matches (2.23 per match; 59.5 per 1000 h of exposure). PCEs that occurred in the 4th quarter were significantly more likely to result in signs of SRC. Players most often intended to receive/control the sliotar (36.4%, n = 64) prior to PCEs. The most frequently observed mechanism was shoulder-to-head (20.2%, n = 37). Impacts to the lateral aspect of the head were 2.7 times more likely to result in visible signs than impacts to anteroposterior regions. CONCLUSIONS Players appear to be at a higher risk of SRC later in the match or when receiving the sliotar. Strikes to the lateral aspect of the head and those involving the shoulder appear to produce severe events. These findings provide initial guidance for the development of targeted player protection strategies.
Collapse
Affiliation(s)
- Mario P Rotundo
- Sport and Exercise Science Research Institute, Ulster University, Belfast, UK.
- Department of Family Practice, University of British Columbia, Vancouver, Canada.
| | - Darek Sokol-Randell
- Sport and Exercise Science Research Institute, Ulster University, Belfast, UK
- Department of Neurology, Memorial University of Newfoundland, St John's, Canada
| | - Chris Bleakley
- Sport and Exercise Science Research Institute, Ulster University, Belfast, UK
| | - Paul Donnelly
- Sport and Exercise Science Research Institute, Ulster University, Belfast, UK
| | - Gregory Tierney
- Sport and Exercise Science Research Institute, Ulster University, Belfast, UK
| |
Collapse
|
2
|
Smoliga JM, Deshpande SK, Binney ZO. Interaction of Surface Type, Temperature, and Week of Season on Concussion Risk in the National Football League: A Bayesian Analysis. Epidemiology 2023; 34:807-816. [PMID: 37732833 DOI: 10.1097/ede.0000000000001657] [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: 09/22/2023]
Abstract
BACKGROUND Artificial turf fields and environmental conditions may influence sports concussion risk, but existing research is limited by uncontrolled confounding factors, limited sample size, and the assumption that risk factors are independent of one another. The purpose of this study was to examine how playing surface, time of season, and game temperature relate to diagnosed concussion risk in the National Football League (NFL). METHODS This retrospective cohort study examined data from the 2012 to the 2019 NFL regular season. We fit Bayesian negative binomial regression models to relate how playing surface, game temperature, and week of the season independently related to diagnosed concussion risk and any interactions among these factors. RESULTS We identified 1096 diagnosed concussions in 1830 games. There was a >99% probability that concussion risk was reduced on grass surface (median incidence rate ratio [IRR] = 0.78 [95% credible interval: 0.68, 0.89]), >99% probability that concussion risk was lower at higher temperatures (IRR = 0.85 [0.76,0.95] for each 7.9 °C), and >91% probability that concussion risk increased with each week of the season (IRR = 1.02 [1.00,1.04]). There was an >84% probability for a surface × temperature interaction (IRR = 1.01 [0.96, 1.28]) and >75% probability for a surface × week interaction (IRR = 1.02 [0.99, 1.05]). CONCLUSIONS Diagnosed concussion risk is increased on artificial turf compared with natural grass, and this is exacerbated in cold weather and, independently, later in the season. The complex interplay between these factors necessitates accounting for multiple factors and their interactions when investigating sports injury risk factors and devising mitigation methods.
Collapse
Affiliation(s)
- James M Smoliga
- From the Department of Physical Therapy, One University Parkway, High Point University, High Point, NC
- Doctor of Physical Therapy Program (Seattle), Tufts University School of Medicine, Boston, MA
| | - Sameer K Deshpande
- Department of Statistics, University of Wisconsin, 7225B Medical Sciences Center, Madison, WI
| | | |
Collapse
|
3
|
Dreyer NA, Mack CD. Tactical Considerations for Designing Real-World Studies: Fit-for-Purpose Designs That Bridge Research and Practice. Pragmat Obs Res 2023; 14:101-110. [PMID: 37786592 PMCID: PMC10541678 DOI: 10.2147/por.s396024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023] Open
Abstract
Real-world evidence (RWE) is being used to provide information on diverse groups of patients who may be highly impacted by disease but are not typically studied in traditional randomized clinical trials (RCT) and to obtain insights from everyday care settings and real-world adherence to inform clinical practice. RWE is derived from so-called real-world data (RWD), ie, information generated by clinicians in the course of everyday patient care, and is sometimes coupled with systematic input from patients in the form of patient-reported outcomes or from wearable biosensors. Studies using RWD are conducted to evaluate how well medical interventions, services, and diagnostics perform under conditions of real-world use, and may include long-term follow-up. Here, we describe the main types of studies used to generate RWE and offer pointers for clinicians interested in study design and execution. Our tactical guidance addresses (1) opportunistic study designs, (2) considerations about representativeness of study participants, (3) expectations for transparency about data provenance, handling and quality assessments, and (4) considerations for strengthening studies using record linkage and/or randomization in pragmatic clinical trials. We also discuss likely sources of bias and suggest mitigation strategies. We see a future where clinical records - patient-generated data and other RWD - are brought together and harnessed by robust study design with efficient data capture and strong data curation. Traditional RCT will remain the mainstay of drug development, but RWE will play a growing role in clinical, regulatory, and payer decision-making. The most meaningful RWE will come from collaboration with astute clinicians with deep practice experience and questioning minds working closely with patients and researchers experienced in the development of RWE.
Collapse
|
4
|
Jacobi J, Wasserman EB, D Mack C, Heinzelmann M, Cárdenas J, Rehberg R, Solomon G, Sills A, Vargas B. The National Football League Concussion Protocol: A Review. HSS J 2023; 19:269-276. [PMID: 37435134 PMCID: PMC10331260 DOI: 10.1177/15563316231177207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/30/2023] [Indexed: 07/13/2023]
Abstract
Sport-related concussion remains an area of high concern for contact sport athletes and their families, as well as for the medical and scientific communities. The National Football League (NFL), along with the NFL Players Association and experts in the field, has developed protocols for the detection and management of sport-related concussions. This article reviews the NFL's most recent concussion protocol including preseason education and baseline testing for players, concussion surveillance by gameday medical teams and neurotrauma consultants and athletic trainers, gameday concussion protocol and procedures, and return to participation guidelines.
Collapse
Affiliation(s)
| | | | | | | | - Javier Cárdenas
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Robb Rehberg
- William Paterson University, Wayne, NJ, USA
- Player Health & Safety Department, National Football League, New York, NY, USA
| | - Gary Solomon
- Player Health & Safety Department, National Football League, New York, NY, USA
| | - Allen Sills
- Player Health & Safety Department, National Football League, New York, NY, USA
| | - Bert Vargas
- Global Medical Response, Indianapolis, IN, USA
| |
Collapse
|
5
|
Return to Full Participation Following Concussion in the National Football League, 2015 Through 2020. Clin J Sport Med 2022; 32:e605-e613. [PMID: 36315827 DOI: 10.1097/jsm.0000000000001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 04/27/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Quantify days missed, games missed, injury burden, and time to return to full participation (RTFP) among National Football League (NFL) players who sustained a concussion. DESIGN Retrospective cohort study. SETTING 2015 through 2020 NFL seasons. PARTICIPANTS National Football League players diagnosed with a concussion from 2015 to 2020. INTERVENTIONS National Football League-mandated graduated RTFP protocol. MAIN OUTCOME MEASURES Days missed, games missed, burden, and time to RTFP, overall and by position. RESULTS An annual average of 3639 player-days of participation and 255 games were missed across NFL because of concussion. Concussed players missed a median of 9 days (mean = 15.0), a relatively stable metric over 6 years, with slight variation by position. Offensive linemen, tight ends, running backs, and linebackers missed the most days per concussion; defensive secondary, offensive linemen, and wide receivers sustained the highest injury burden. Postconcussion, 59% of players missed one or more scheduled games. Among players concussed in a Sunday game, 38% played in a Sunday game one week later. CONCLUSIONS The 9-day median time missed post-concussion may be related to emphasis on graduated phase-based concussion management. No concussed player returned to competition on the day of injury, and less than 40% participated in games the following week. Further work is needed to better understand characteristics of concussions that take longer to return and movement through stages of return.
Collapse
|
6
|
Norton AA, Wilson JJ. Use of the Independent Medical Spotter in Identifying Head Injuries in Division I Football Players. Clin J Sport Med 2022; 32:318-321. [PMID: 33852433 DOI: 10.1097/jsm.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/18/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Sport-related concussion (SRC) is a known risk of contact sports and strategies to minimize risk have been used. We aimed to determine if an independent medical spotter (IMS) identified more SRCs than would otherwise be detected by trained sideline medical staff (SMS). DESIGN Prospective review of SRCs during competition in the 2019 season and retrospective review of SRCs in the 2015 to 2018 seasons, which also used an IMS. SETTING Division I football games (home and away) of a Big 10 Conference institution. PARTICIPANTS All football team members who participated in competition. INDEPENDENT VARIABLES Occurrence of SRC during competition and whether the IMS or SMS directly visualized the injury. MAIN OUTCOME MEASURES The total number of SRCs that occurred during competition in the 2015 to 2019 football seasons and whom observed the SRC-SMS or IMS-or if a student athlete reported symptoms after competition. RESULTS Over the 5-year study period, 24 SRCs occurred during competition. Of those, 19 (79.2%) were observed by SMS, 2 (8.3%) by the IMS, and 3 (12.5%) were reported to SMS after competition ended. CONCLUSIONS Most SRCs are accurately identified by SMS, but a small number were apparent only to the IMS who seemed to add sensitivity in detecting a SRC. Instances remain in which SRC recognition and diagnosis were delayed despite trained SMS and IMS. CLINICAL RELEVANCE An IMS allows for a small-added player protection benefit using different vantage points to identify potential SRCs during competition.
Collapse
Affiliation(s)
- Adam A Norton
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | |
Collapse
|
7
|
Canseco JA, Franks RR, Karamian BA, Divi SN, Reyes AA, Mao JZ, Al Saiegh F, Donnally CJ, Schroeder GD, Harrop JS, Pepe MD, Vaccaro AR. Overview of Traumatic Brain Injury in American Football Athletes. Clin J Sport Med 2022; 32:236-247. [PMID: 33797476 DOI: 10.1097/jsm.0000000000000918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/17/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this review is to provide a summary of the epidemiology, clinical presentation, pathophysiology, and treatment of traumatic brain injury in collision athletes, particularly those participating in American football. DATA SOURCES A literature search was conducted using the PubMed/MEDLINE and Google Scholar databases for publications between 1990 and 2019. The following search phrases were used: "concussion," "professional athletes," "collision athletes," "mild traumatic brain injury," "severe traumatic brain injury," "management of concussion," "management of severe traumatic brain injury," and "chronic traumatic encephalopathy." Publications that did not present epidemiology, clinical presentation, pathophysiology, radiological evaluation, or management were omitted. Classic articles as per senior author recommendations were retrieved through reference review. RESULTS The results of the literature review yielded 147 references: 21 articles discussing epidemiology, 16 discussing clinical presentation, 34 discussing etiology and pathophysiology, 10 discussing radiological evaluation, 34 articles for on-field management, and 32 articles for medical and surgical management. CONCLUSION Traumatic brain injuries are frequent in professional collision athletes, and more severe injuries can have devastating and lasting consequences. Although sport-related concussions are well studied in professional American football, there is limited literature on the epidemiology and management of severe traumatic brain injuries. This article reviews the epidemiology, as well as the current practices in sideline evaluation, acute management, and surgical treatment of concussions and severe traumatic brain injury in professional collision athletes. Return-to-play decisions should be based on individual patient symptoms and recovery.
Collapse
Affiliation(s)
- Jose A Canseco
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - R Robert Franks
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
- Rothman Sports Concussion Institute, Rothman Institute, Philadelphia, Pennsylvania; and
| | - Brian A Karamian
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Srikanth N Divi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ariana A Reyes
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jennifer Z Mao
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Fadi Al Saiegh
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Chester J Donnally
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gregory D Schroeder
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James S Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew D Pepe
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|
8
|
Same-Year Repeat Concussions in the National Football League: Trends from 2015 through 2019. World Neurosurg 2022; 161:e441-e447. [PMID: 35176525 DOI: 10.1016/j.wneu.2022.02.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Sport-related concussion (SRC) prevention and management is a focus of the National Football League (NFL). While most prior reports evaluate SRC incidence, few have studied same-year repeat concussions. The objective of this study was to evaluate the frequency of same-year repeat concussions in the NFL. METHODS A retrospective, case-control study of same-year repeat concussion in the NFL from 2015-2019 was performed. The electronic health record of the NFL was reviewed for players sustaining concussions and same-year repeat concussions. Wilcoxon rank-sum tests were used to calculate same-year repeat concussion rates, and risk ratios and 95% confidence intervals (CIs) were estimated using log-binomial regression. RESULTS From 2015-2019, the risk of sustaining a same-year repeat concussion in the NFL ranged from 0.38% to 0.69% per season. Among players who sustained a concussion, the risk of a same-year repeat concussion ranged from 5.3% to 8.3%, which did not differ significantly from the risk of sustaining a single concussion, which ranged from 6.2% to 8.3%. There was a median of 38 participation days between initial and same-year repeat concussion. Players missed more time from same-year repeat concussion (median 12 days) compared to both single (median 9 days; p<0.0001) and initial (median 9.5 days, p=0.002) concussions. CONCLUSIONS The risk of a repeat concussion was similar to the risk of sustaining a single concussion among NFL players. More time was missed following a same-year repeat concussion compared to single or initial concussions. Further research is needed to maximize player safety and minimize same-year repeat concussions.
Collapse
|
9
|
Mack CD, Solomon G, Covassin T, Theodore N, Cárdenas J, Sills A. Epidemiology of Concussion in the National Football League, 2015-2019. Sports Health 2021; 13:423-430. [PMID: 33872087 DOI: 10.1177/19417381211011446] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Concussion in American football, and specifically the National Football League (NFL) is a major area of interest and key focus for injury prevention. Complete and accurate characterization of when, how, and to whom these injuries occur can facilitate injury reduction efforts. Existing studies of concussion in the NFL use publicly available data, potentially limiting data quality and the inferences that can be made. HYPOTHESIS Concussion incidence in the NFL decreased across the 2015-2019 seasons. STUDY DESIGN Descriptive epidemiology study. LEVEL OF EVIDENCE Level 4. METHODS Concussion incidence, including counts, one-season risk, and rates per game and player-plays, among active NFL players from 2015 to 2019 is described by year, season, play type, and roster position. RESULTS A total 1302 concussions were identified from 2015 to 2019 among 1004 players. Of these, 80% occurred in NFL games. The average annual incidence of in-season game concussions changed over the study period, from 230.7 per season (2015-2017) to 177.0 per season (2018-2019); this represented a 23% decrease in game settings (P < 0.01). Practice concussions fluctuated across the years of the study from 38 to 67 per season (average = 50.8/season). There were 70.6 concussions per 100 preseason games, which was slightly higher than the regular season rate per game of 61.7. Overall, there were 790 regular season game concussions across 4,657,243 player-plays and 114,428 player-games during the 5-year study. In regular season games, the majority of concussions were sustained on running and passing plays (n = 119/season), and the highest average rate per play occurred on kickoffs (0.69/100 plays). Defensive secondary (cornerbacks, safeties, and generic defensive backs) and offensive line incurred the most concussions, and the highest rates of concussion were among tight ends and wide receivers. CONCLUSION AND RELEVANCE Concussions in the NFL are a key focus for player safety. Concussion reduction strategies were implemented before 2018, after which there was a sustained 2-year decrease in concussion incidence, providing a new benchmark from which to work toward further injury reduction.
Collapse
Affiliation(s)
| | - Gary Solomon
- Department of Neurological Surgery and Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee.,National Football League Player Health and Safety Department, New York, New York
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing, Michigan
| | - Nicholas Theodore
- Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Javier Cárdenas
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona
| | - Allen Sills
- Department of Neurological Surgery and Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee.,National Football League Player Health and Safety Department, New York, New York
| |
Collapse
|
10
|
Concussion in the Athletic Training Room: a Team Physician Narrative. Curr Pain Headache Rep 2021; 25:24. [PMID: 33738547 DOI: 10.1007/s11916-021-00937-4] [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: 01/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF THE REVIEW Concussion evaluation and management has changed significantly. Understanding proper recognition, evaluation, and management allows for improved provision of care to patients. This paper will approach this topic from a sideline to training room management versus the traditional clinic evaluation RECENT FINDINGS: Research is continuing to refine and examine tools to assist in proper concussion evaluation. Concussion recovery protocols are becoming more conservative as patients are taking longer to recover than previously thought. Treatment of concussion is becoming more sophisticated and patient involved. Concussion research has increased dramatically over the last 30 years changing our approach to diagnosis and treatment. The area of concussion will continue to evolve as research continues to look at effective tools and markers for diagnosis and effective treatment protocols become substantiated through research.
Collapse
|
11
|
Anjum J, Johnson Krug R, Kindsvogel D. The role of AT-SLP collaborations in return to academics following mTBI: A scoping review. J Interprof Care 2020; 36:83-92. [PMID: 33228425 DOI: 10.1080/13561820.2020.1840339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Return-to-academics (RTA) for student-athletes with mild traumatic brain injury (mTBI) is crucial, but relatively understudied compared to return-to-play (RTP). The transient and unpredictable nature of symptoms surrounding mTBI often results in underreporting of neurocognitive symptoms, leading to a greater susceptibility for repeated TBIs, as well as posing impediments to the process of RTA. Athletic Trainers (ATs) and Speech-Language Pathologists (SLPs) are in a unique position to help student-athletes achieve a safe, timely, and effective RTA following mTBI. They typically work in middle/high schools and collegiate-level academic settings and often serve as members of concussion management teams. Compared to other allied health professions, ATs and SLPs are relatively new professions with evolving scopes of practice. Despite established guidelines and recommendations for their scope of practice in treating student-athletes with mTBI, there is a lacuna in research regarding their individual and collaborative roles in achieving RTA. The current scoping review was conducted with the main goal of exploring published literature pertaining to the roles of ATs and SLPs in achieving RTA for student-athletes with mTBI. Current implications, recommendations for integrating pre-service interprofessional education (IPE) experiences, and future directions for AT-SLP collaborations are discussed.
Collapse
Affiliation(s)
- Javad Anjum
- School of Health Sciences, University of Mary, Bismarck, ND, USA
| | | | | |
Collapse
|
12
|
Abstract
The diagnosis of sport-related concussion is still based primarily on history and physical examination. Use of a standardized history and examination form is recommended. There have been many tests investigated, but none have been proven to be sensitive and specific for the diagnosis of concussion. Sideline management is based on recognition, diagnosis, and initial treatment. It is clear that symptoms of a concussion can worsen with continued play, and so, if a concussion is suspected based on observation, history, and physical examination, then the athlete should be removed from play.
Collapse
Affiliation(s)
- Andrew Gregory
- Vanderbilt University Medical Center, Vanderbilt Sports Medicine, Medical Center East, Suite 3200, Nashville, TN 37232, USA.
| | - Sourav Poddar
- Family Medicine and Orthopedics, University of Colorado School of Medicine, CU Sports Medicine Center, 2000 South Colorado Boulevard, The Colorado Center Tower One, Suite 4500, Denver, CO 80222, USA
| |
Collapse
|
13
|
Zuckerman SL, Elbin RJ, Sills AK, Crandall JR, Lessley DJ, Moran CM, Moran CD, Solomon GS. Concussions in the National Football League: the evolution of video review for assessing the frequency and reliability of visible signs. PHYSICIAN SPORTSMED 2020; 48:424-429. [PMID: 32067541 DOI: 10.1080/00913847.2020.1731379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: The use of video review to document visible signs (VS) of sport-related concussion in the National Football League (NFL) is a novel method to recognize head injuries. Hypothesis/Purpose: The current pilot studies used varying methodologies to (1) examine the frequency of VS in concussed NFL players using the Australian Football League's (AFL) checklist, and (2) assess the reliability of VS between non-expert and expert raters. Study design: Cohort study Methods: In the first pilot study, two non-expert raters rated VS of SRC occurring in the 2015 NFL season (n = 96) using a single VS from the AFL checklist. Based on this pilot study, two expert raters then rated VS of SRC during the 2017 NFL season (n = 211) using all VS from the AFL checklist. The frequency, total percent agreement (TPA), and reliability (kappa coefficients) were calculated for all VS of concussion for the two seasons. Kappa agreement was classified as fair (.41-.60), moderate (.61-.80), or substantial (.81-1.00). Significance was set at p < .05. Results: The most frequent VS of concussion identified by both non-expert and expert raters were no behavior observed, slow to get up, and motor incoordination. The least frequent VS were impact seizure, blank/vacant look, and facial injury. For non-expert raters, the average TPA for VS ranged from 84% to 100% and kappa coefficients ranged from .52 to .68. For expert raters, the average TPA ranged from 83% to 100%, and kappa coefficients ranged from .56 to .86. Conclusion: In these preliminary analyses, use of multiple VS was a superior methodology, and the reliability of VS rating was stronger for experts. Due to the inherent differences in gameplay and protective equipment used in the NFL compared to other professional sports, it is our hope these data can generate new ways to improve existing practices and identify potentially novel VS of SRC.
Collapse
Affiliation(s)
- Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center , Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center , Nashville, TN, USA
| | - R J Elbin
- Department of Health Human Performance and Recreation/Office for Sport Concussion Research, University of Arkansas , Fayetteville, AK, USA
| | - Allen K Sills
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center , Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center , Nashville, TN, USA.,Player Health and Safety Department, National Football League , New York, NY, USA
| | - Jeff R Crandall
- Biomechanics Consulting and Research, LLC , Charlottesville, VA, USA
| | - David J Lessley
- Biomechanics Consulting and Research, LLC , Charlottesville, VA, USA
| | - Caitlin M Moran
- Player Health and Safety Department, National Football League , New York, NY, USA
| | - Caroline D Moran
- Player Health and Safety Department, National Football League , New York, NY, USA
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center , Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center , Nashville, TN, USA.,Player Health and Safety Department, National Football League , New York, NY, USA.,Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center , Nashville, TN, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center , Nashville, TN, USA
| |
Collapse
|
14
|
Frequent but limited assessment of potentially concussed players in Gaelic Football: an opportunity to learn from other sports. Ir J Med Sci 2020; 190:787-792. [PMID: 32997230 DOI: 10.1007/s11845-020-02390-5] [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] [Received: 08/09/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sport-related concussion (SRC) is a potential issue within Gaelic Football. Therefore, it is essential that concussion management guidelines are adhered to. HYPOTHESIS/PURPOSE The aim of this study is to determine if potential concussive events (PCEs) in the Gaelic Athletic Association (GAA) National Football League (NFL) are assessed in accordance with GAA concussion guidelines and compare this to other sports. METHODS A descriptive video analysis approach was undertaken to identify PCEs throughout two seasons of play. Subsequent assessment, return to play (RTP) decisions, and signs of concussion were evaluated. RESULTS A total of 242 PCEs were identified over 111 matches. Most PCEs (87.2%, n = 211) were assessed by medical personnel. However, 187 (88.6%) of assessments were under 2 min in duration. Of the 242 PCEs, 189 (78.1%) returned to play after on-pitch assessment, and 12 (5.0%) were removed following a PCE. Sixty-one (25.2%) players sustaining a PCE demonstrated one or more signs of concussion, of which 9 (14.8%) were removed from play. CONCLUSION In the GAA NFL, PCEs are often briefly assessed but rarely result in player removal. Introduction of video incident analysis and concussion substitutions, as in other sports, may reduce the long-term burden of SRC on Gaelic Football players.
Collapse
|
15
|
Chen J, Kouts J, Rippee MA, Lauer S, Smith D, McDonald T, Kurylo M, Filardi T. Developing a Comprehensive, Interdisciplinary Concussion Program. Health Serv Insights 2020; 13:1178632920938674. [PMID: 32782428 PMCID: PMC7385849 DOI: 10.1177/1178632920938674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/03/2020] [Indexed: 11/17/2022] Open
Abstract
There has been a growing trend of local and national coverage of and interest in concussion injuries over the past 2 decades. Increasing public concern over potential catastrophic and unknown long-term effects of sports-related concussion injuries has led to an acknowledgment of the strong public health need for addressing all concussion injuries, regardless of mechanism of injury. In efforts to address this need for concussion prevention and management, both in sports and nonsports, The University of Kansas Health System initiated the interdisciplinary Center for Concussion Management program in 2012. The program was created as a virtual clinic concept and includes voluntary participation from various providers across the institution, limited budget, and space obstacles. Since its inception, the program has continued to operate as its initial design of a multidisciplinary team model outside the sole ownership of 1 department, and has expanded to include education and outreach to local and regional schools and groups.
Collapse
Affiliation(s)
- Jamie Chen
- Center for Concussion Management, The University of Kansas Health System, Kansas City, KS, USA
| | - Jill Kouts
- Center for Concussion Management, The University of Kansas Health System, Kansas City, KS, USA
| | - Michael A Rippee
- Department of Neurology, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Stephen Lauer
- Department of Pediatrics, The University of Kansas Medical Center, Kansas City, KS, USA
| | - David Smith
- Department of Family Medicine, Department of Sports Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Tracy McDonald
- Department of Trauma/Acute Care Surgery, Burn, and Concussion Administration, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Monica Kurylo
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Tanya Filardi
- Department of Neurosurgery, The University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
16
|
Kent JB, Wood CL, Pugh K, Statuta SM, MacKnight JM. The medical observer in American football: a survey of use and efficacy. Brain Inj 2020; 34:1100-1105. [DOI: 10.1080/02699052.2020.1782473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Jeremy B. Kent
- Department of Family Medicine, Team Physician, UVa Sports Medicine, University of Virginia Health System, Charlottesville, Virginia, Virginia, USA
| | - Colton L. Wood
- Primary Care Sports Medicine Fellow, Department of Family Medicine, University of North Carolina, Chapel Hill, North Caroline, USA
| | - Kelli Pugh
- Associate Athletics Director for Sports Medicine, University of Virginia, Charlottesville, Charlottesville, Virginia, USA
| | - Siobhan M. Statuta
- Family Medicine and Physical Medicine and Rehabilitation, University of Virginia Health System, Charlottesville, Virginia, USA
| | - John M. MacKnight
- Internal Medicine & Orthopaedic Surgery, Team Physician and Medical Director, UVA Sports Medicine, University of Virginia Health System
| |
Collapse
|
17
|
Mack C, Sendor RR, Solomon G, Ellenbogen RG, Myers E, Berger M, Sills A. Enhancing Concussion Management in the National Football League: Evolution and Initial Results of the Unaffiliated Neurotrauma Consultants Program, 2012-2017. Neurosurgery 2019; 87:312-319. [DOI: 10.1093/neuros/nyz481] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/28/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The real-time detection of concussive injury in professional sports can be challenging for the healthcare provider on the sideline. It can be difficult to monitor all on-field players during active game play and diagnose complex injuries such as concussion during a fast-paced athletic event.
Objective
To enhance the in-game identification of potentially concussed professional athletes, the National Football League (NFL) initiated an Unaffiliated Neurotrauma Consultants (UNC) program in 2013, which, in tandem with other in-arena spotters and live video review systems, is designed to improve the safety of the players through enhanced concussion detection efforts.
Methods
This paper reports on the evolution of the UNC program, describes its participants and training requirements, details the role of UNC involvement, and delineates the systematic revisions and enhancements completed each year in the program.
Results
UNC reporting compliance has increased from 56% in 2014 to 100% in 2017. During the 2016 and 2017 seasons, (1) UNCs submitted an average of 1.9 evaluations per game, and (2) the UNC concussion assessments yielded sensitivity (93.4%-97.4%) and specificity (81.0%-88.3%) values.
Conclusion
The UNC program has enhanced the detection of concussion in NFL players. Directions for research and future program improvements are addressed.
Collapse
Affiliation(s)
| | | | - Gary Solomon
- Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
- National Football League, New York, New York
| | - Richard G Ellenbogen
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Emily Myers
- National Football League, New York, New York
| | - Mitchel Berger
- Department of Neurological Surgery, University of California-San Francisco School of Medicine, San Francisco, California
| | - Allen Sills
- Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
- National Football League, New York, New York
| |
Collapse
|