Access to athletic trainers and sex as modifiers of time to reach clinical milestones after sport-related concussion in collegiate athletes.

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.

Influential Factors and Preliminary Reference Data for a Clinically Feasible, Functional Reaction Time Assessment: The Standardized Assessment of Reaction Time.

CONTEXT: Clinical reaction-time (RT) measures are frequently used when examining patients with concussion but do not correlate with functional movement RT. We developed the Standardized Assessment of RT (StART) to emulate the rapid cognitive demands and whole-body movement needed in sport. OBJECTIVE: To assess StART differences across 6 cognitive-motor combinations, examine potential demographic and health history confounders, and provide preliminary reference data for healthy collegiate student-athletes. DESIGN: Prospective, cross-sectional study. SETTING: Clinical medicine facilities. PATIENTS OR OTHER PARTICIPANTS: A total of 89 student-athletes (56 [62.9%] men, 33 [37.1%] women; age = 19.5 ± 0.9 years, height = 178.2 ± 21.7 cm, mass = 80.4 ± 24 kg; no concussion history = 64 [71.9%]). MAIN OUTCOME MEASURE(S): Student-athletes completed health history questionnaires and StART during preseason testing. The StART consisted of 3 movements (standing, single-legged balance, and cutting) under 2 cognitive states (single task and dual task [subtracting by 6's or 7's]) for 3 trials under each condition. The StART trials were calculated as milliseconds between penlight illumination and initial movement. We used a 3 × 2 repeated-measures analysis of variance with post hoc t tests and 95% CIs to assess StART cognitive and movement differences, conducted univariable linear regressions to examine StART performance associations, and reported StART performance as percentiles. RESULTS: All StART conditions differed (P ≤ .03), except single-task standing versus single-task single-legged balance (P = .36). Every 1-year age increase was associated with an 18-millisecond (95% CI = 8, 27 milliseconds) slower single-task cutting RT (P < .001). Female athletes had slower single-task (15 milliseconds; 95% CI = 2, 28 milliseconds; P = .02) and dual-task (28 milliseconds; 95% CI = 2, 55 milliseconds; P = .03) standing RT than male athletes. No other demographic or health history factors were associated with any StART condition (P ≥ .056). CONCLUSIONS: The StART outcomes were unique across each cognitive-motor combination, suggesting minimal subtest redundancy. Only age and sex were associated with select outcomes. The StART composite scores may minimize confounding factors, but future researchers should consider age and sex when providing normative data.

Trouble Falling Asleep After Concussion Is Associated With Higher Symptom Burden Among Children and Adolescents.

Our objective was to identify factors associated with trouble falling asleep postconcussion. Patients seen for care after sport-related concussion were assessed ≤10 days postinjury and were between 6 and 19 years of age. Outcomes included symptoms (Post-Concussion Symptom Scale), postural steadiness, missed school, and medical history. There were 261 patients (49% female; mean age=14.8±2.5 years): 45% reported trouble falling asleep. A greater proportion of patients who reported trouble falling asleep missed ≥2 days of school (64% vs 49%; P = .02). Patients who reported trouble falling asleep endorsed more severe symptom severity than those who did not (median=38 vs 18; P < .001). After covariate adjustment, confusion (aOR = 1.95, 95% CI = 1.131-3.375), missing ≥2 days of school (aOR = 4.52, 95% CI = 1.553-13.16), and noise sensitivity (aOR = 1.48, 95% CI = 1.1.042-2.010) were independently associated with trouble falling asleep. Sleep disturbances are associated with poorer clinical outcomes after concussion. Inclusion of sleep assessments may help to provide early therapeutic pathways for pediatric concussion patients.

Normative Tandem Gait in Collegiate Student-Athletes: Implications for Clinical Concussion Assessment.

BACKGROUND: Impaired balance is common after concussion. The third edition of the Sport Concussion Assessment Tool (SCAT-3) recommends the Balance Error Scoring System (BESS) and/or tandem gait for postconcussion balance assessment. The limitations of the BESS are well documented; however, tandem gait has received little attention throughout concussion literature. The purpose of this study was to provide normative data for tandem gait in collegiate student-athletes based on sport type, concussion history, and gender. HYPOTHESIS: Tandem gait will be influenced by concussion history, sport, and gender. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Four hundred collegiate student-athletes from both collision/contact (n = 200) and limited contact/noncontact (n = 200) sports performed 4 tandem gait trials, consistent with SCAT-3 guidelines. The dependent variables included the best of the 4 trials (BEST), the mean of the 4 trials (MEAN), and the mean of each of the trials individually (ORDER). Separate multivariate analyses of variance were performed for each of the independent variables to determine effect on BEST and MEAN trial times. Significant main effects were followed up with a 1-way analysis of variance (ANOVA). A separate 1-way ANOVA was used to assess ORDER differences. RESULTS: The mean BEST was 10.37 ± 1.76 seconds, and the MEAN was 11.32 ± 0.70 seconds. There were no significant differences in BEST or MEAN tandem gait times, respectively, between those with and without concussion history ( P = 0.41 and P = 0.69, respectively), sport type ( P = 0.57 and P = 0.42, respectively), or gender ( P = 0.73 and P = 0.49, respectively). There were significant differences ( P < 0.05) between ORDER of the 4 tandem gait trials across the population, with improved times at each trial. CONCLUSION: The results of this study provide a normative data set for tandem gait in healthy collegiate student-athletes and suggest that common determinants of balance, including concussion history, collision sport participation, and gender do not appear to influence performance, but ORDER could have significant clinical implications. CLINICAL RELEVANCE: Clinicians may use these data to distinguish important determinants of tandem gait performance and improve awareness when returning an individual to play after a concussion.