RESUMO
OBJECTIVE: Concussions can occur at any level of ice hockey. Incidence estimates of concussions in ice hockey vary, and optimal prevention strategies and return-to-play (RTP) considerations have remained in evolution. The authors performed a mixed-methods study with the aim of elucidating the landscape of concussion in ice hockey and catalyzing initiatives to standardize preventative mechanisms and RTP considerations. METHODS: The authors performed a five-part mixed-methods study that includes: 1) an analysis of the impact of concussions on games missed and income for National Hockey League (NHL) players using a publicly available database, 2) a systematic review of the incidence of concussion in ice hockey, 3) a systematic review of preventative strategies, 4) a systematic review of RTP, and 5) a policy review of documents from major governing bodies related to concussions in sports with a focus on ice hockey. The PubMed, Embase, and Scopus databases were used for the systematic reviews and focused on any level of hockey. RESULTS: In the NHL, 689 players had 1054 concussions from the 2000-2001 to 2022-2023 seasons. A concussion led to a mean of 13.77 ± 19.23 (range 1-82) games missed during the same season. After cap hit per game data became available in 2008-2009, players missed 10,024 games due to 668 concussions (mean 15.13 ± 3.81 per concussion, range 8.81-22.60 per concussion), with a cap hit per game missed of $35,880.85 ± $25,010.48 (range $5792.68-$134,146.30). The total cap hit of all missed games was $385,960,790.00, equating to $577,635.91 per concussion and $25,724,052.70 per NHL season. On systematic review, the incidence of concussions was 0.54-1.18 per 1000 athlete-exposures. Prevention mechanisms involved education, behavioral and cognitive interventions, protective equipment, biomechanical studies, and policy/rule changes. Rules prohibiting body checking in youth players were most effective. Determination of RTP was variable. Concussion protocols from both North American governing bodies and two leagues mandated that a player suspected of having a concussion be removed from play and undergo a six-step RTP strategy. The 6th International Conference on Concussion in Sport recommended the use of mouthguards for children and adolescents and disallowing body checking for all children and most levels of adolescents. CONCLUSIONS: Concussions in ice hockey lead to substantial missed time from play. The authors strongly encourage all hockey leagues to adopt and adhere to age-appropriate rules to limit hits to the head, increase compliance in wearing protective equipment, and utilize high-quality concussion protocols.
Assuntos
Traumatismos em Atletas , Concussão Encefálica , Hóquei , Hóquei/lesões , Humanos , Concussão Encefálica/epidemiologia , Concussão Encefálica/prevenção & controle , Traumatismos em Atletas/epidemiologia , Incidência , Volta ao Esporte , MasculinoRESUMO
OBJECTIVES: To understand Canadian university athletic programme concussion management needs, and to describe development and content of a tailored online concussion education tool for Canadian university/college athletes. DESIGN: An integrated knowledge translation multiphased, multimethods approach was used. Phases included a needs assessment survey with university representatives and athletes, content selection, mapping behavioural goals to evidenced-based behaviour change techniques, script/storyboard development, engagement interviews with university athletes and tool development using user-centred design techniques. SETTING: Canadian U SPORTS universities (n=56). PARTICIPANTS: Overall, 64 university representatives (eg, administrators, clinicians) and 27 varsity athletes (52% male, 48% female) completed the needs assessment survey. Five athletes participated in engagement interviews. OUTCOME MEASURES: Surveys assessed previous athlete concussion education, recommendations for concussion topics and tool design, concussion management challenges and interest in implementing a new course. RESULTS: Institutions used a median (Med) of two (range 1-5) approaches when educating athletes about concussion. Common approaches were classroom-style education (50%), online training (41%) and informational handouts (39%). University representatives rated most important topics as: (1) what is a concussion, (2) how to recognise a concussion and (3) how to report a concussion (Medall=4.8/5). Athletes felt symptom recognition (96%) and effects on the brain (85%) were most important. The majority of athletes preferred learning via computer (81%) and preferred to learn alone (48%) versus group learning (7%). The final resource was designed to influence four behaviours: (1) report symptoms, (2) seek care, (3) encourage teammates to report symptoms and (4) support teammates through concussion recovery. Examples of behaviour change techniques included: knowledge/skills, problem-solving scenarios, verbal persuasion and social comparison. Athletes are guided through different interactions (eg, videos, flip cards, scenarios, testimonials) to maximise engagement (material review takes ~30 min). CONCLUSIONS: The Concussion Awareness Training Tool for athletes is the first Canadian education tool designed to address the needs of Canadian university/college athletes.
Assuntos
Traumatismos em Atletas , Concussão Encefálica , Humanos , Masculino , Feminino , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/prevenção & controle , Avaliação das Necessidades , Ciência Translacional Biomédica , Canadá , Concussão Encefálica/diagnóstico , Concussão Encefálica/prevenção & controle , Atletas , UniversidadesRESUMO
OBJECTIVES: To explore Australian cricket participants' knowledge of concussion assessment and management, and awareness of current concussion guidelines. DESIGN: Cross-sectional survey. METHODS: Novel and validated surveys were disseminated online, among over 16â¯year Australian cricket players and officials at the end of the 2018/19 cricket season. Data were collected on knowledge and awareness of concussion and analysed using descriptive statistics and crosstabulations. Further comparisons were made for the players between injured and non-injured, and helmet wearers and non-helmet wearers using Fisher's exact statistical test. RESULTS: Both players (nâ¯=â¯224, 93â¯%) and officials (nâ¯=â¯36, 100â¯%) demonstrated strong knowledge of the importance of immediately evaluating suspected concussions. In comparison with players without helmets (nâ¯=â¯11), those using helmets (nâ¯=â¯135) considered replacing their helmets after a concussion to be vital to concussion assessment (pâ¯=â¯0.02). Overall, 80-97â¯% of players and 81-97â¯% of officials understood the importance of many factors regarding concussion management. When concussion management knowledge was compared by injury status, injured players (nâ¯=â¯17, 94â¯%) believed someone with a concussion should be hospitalised immediately, in contrast to non-injured players (nâ¯=â¯154, 69â¯%) (pâ¯=â¯0.04). Players (63â¯%) were less aware of concussion guidelines than officials (81â¯%). CONCLUSIONS: Overall, the knowledge of concussion assessment and management was satisfactory. However, there were discrepancies among players on some aspects of awareness of concussion guidelines. Increasing players' familiarity and experience in using the concussion guidelines is warranted. Targeted campaigns are needed to further improve concussion recognition and treatment at community-level cricket, so all participants play a role in making cricket a safe sport.
Assuntos
Traumatismos em Atletas , Concussão Encefálica , Críquete , Futebol Americano , Humanos , Estudos Transversais , Austrália , Concussão Encefálica/diagnóstico , Concussão Encefálica/prevenção & controle , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/prevenção & controle , Futebol Americano/lesõesRESUMO
OBJECTIVE: To investigate the utilisation of additional permanent concussion substitutes (APCSs) and its efficacy with regards to rate and duration of medical assessment of head collision events (HCEs) in the 2020-2021 Premier League season. The present APCS rule allows players with a suspected concussion to be removed from a match without counting towards a team's allocated substitutions. METHODS: Eighty Premier League matches, 40 prior to additional permanent concussion substitutes implementation (Pre-APCS) and 40 after (Post-APCS), were randomly selected and analysed by a team of trained reviewers for HCEs. Data on HCE incidence, rates of medical assessment, duration of medical assessment and return to play were collected for each match. Data for the Pre-APCS and Post-APCS groups were compared to analyse differences in assessment of HCEs. RESULTS: During the 2020-2021 Premier League season, three APCSs were used. There were 38 HCEs identified in the Pre-APCS group (0.95 per match, 28.79 per 1000 athlete-hours of exposure) and 42 in the Post-APCS group (1.05 per match, 31.82 per 1000 athlete-hours of exposure). Incidence of HCEs (p=0.657), rates of medical assessment (23.7% Pre-APCS vs 21.4% Post-APCS; p=0.545) and duration of medical assessment (median 81 s Pre-APCS vs 102 s Post-APCS; p=0.466) did not significantly differ between the two groups. CONCLUSIONS: The implementation of APCSs in the Premier League did not impact the rate or duration of medical assessement of HCEs. Despite the introduction of APCSs, the consensus protocols for HCE assessment were rarely followed. We recommend changes to APCS and its implementation that would be aimed at protecting player health.
Assuntos
Traumatismos em Atletas , Concussão Encefálica , Futebol Americano , Futebol , Humanos , Futebol Americano/lesões , Traumatismos em Atletas/epidemiologia , Concussão Encefálica/diagnóstico , Concussão Encefálica/epidemiologia , Concussão Encefálica/prevenção & controle , Futebol/lesõesRESUMO
Importance: Concussion ranks among the most common injuries in football. Beyond the risks of concussion are growing concerns that repetitive head impact exposure (HIE) may increase risk for long-term neurologic health problems in football players. Objective: To investigate the pattern of concussion incidence and HIE across the football season in collegiate football players. Design, Setting, and Participants: In this observational cohort study conducted from 2015 to 2019 across 6 Division I National Collegiate Athletic Association (NCAA) football programs participating in the Concussion Assessment, Research, and Education (CARE) Consortium, a total of 658 collegiate football players were instrumented with the Head Impact Telemetry (HIT) System (46.5% of 1416 eligible football players enrolled in the CARE Advanced Research Core). Players were prioritized for instrumentation with the HIT System based on their level of participation (ie, starters prioritized over reserves). Exposure: Participation in collegiate football games and practices from 2015 to 2019. Main Outcomes and Measures: Incidence of diagnosed concussion and HIE from the HIT System. Results: Across 5 seasons, 528â¯684 head impacts recorded from 658 players (all male, mean age [SD], 19.02 [1.25] years) instrumented with the HIT System during football practices or games met quality standards for analysis. Players sustained a median of 415 (interquartile range [IQR], 190-727) recorded head impacts (ie, impacts) per season. Sixty-eight players sustained a diagnosed concussion. In total, 48.5% of concussions (n = 33) occurred during preseason training, despite preseason representing only 20.8% of the football season (0.059 preseason vs 0.016 regular-season concussions per team per day; mean difference, 0.042; 95% CI, 0.020-0.060; P = .001). Total HIE in the preseason occurred at twice the proportion of the regular season (324.9 vs 162.4 impacts per team per day; mean difference, 162.6; 95% CI, 110.9-214.3; P < .001). Every season, HIE per athlete was highest in August (preseason) (median, 146.0 impacts; IQR, 63.0-247.8) and lowest in November (median, 80.0 impacts; IQR, 35.0-148.0). Over 5 seasons, 72% of concussions (n = 49) (game proportion, 0.28; 95% CI, 0.18-0.40; P < .001) and 66.9% of HIE (262.4 practices vs 137.2 games impacts per player; mean difference, 125.3; 95% CI, 110.0-140.6; P < .001) occurred in practice. Even within the regular season, total HIE in practices (median, 175.0 impacts per player per season; IQR, 76.0-340.5) was 84.2% higher than in games (median, 95.0 impacts per player per season; IQR, 32.0-206.0). Conclusions and Relevance: Concussion incidence and HIE among college football players are disproportionately higher in the preseason than regular season, and most concussions and HIE occur during football practices, not games. These data point to a powerful opportunity for policy, education, and other prevention strategies to make the greatest overall reduction in concussion incidence and HIE in college football, particularly during preseason training and football practices throughout the season, without major modification to game play. Strategies to prevent concussion and HIE have important implications to protecting the safety and health of football players at all competitive levels.
Assuntos
Atletas , Pesquisa Biomédica/normas , Concussão Encefálica/epidemiologia , Concussão Encefálica/prevenção & controle , Futebol Americano/lesões , Universidades , Adolescente , Pesquisa Biomédica/métodos , Concussão Encefálica/diagnóstico por imagem , Estudos de Coortes , Humanos , Masculino , Adulto JovemRESUMO
CONTEXT: Injury surveillance has shown that concussions are the most common injury in youth ice hockey. Research examining the criteria for ensuring the correct fit of protective equipment and its potential relationship with concussion risk is very limited. OBJECTIVE: To evaluate the association between helmet fit and the odds of experiencing a concussion among youth ice hockey players. DESIGN: Nested case-control within a cohort study. SETTING: Calgary, Alberta, Canada. PATIENTS OR OTHER PARTICIPANTS: Data were collected for 72 concussed, 41 nonconcussion-injured, and 62 uninjured ice hockey players aged 11 to 18 years. MAIN OUTCOME MEASURE(S): Helmet-fit assessments were conducted across players and encompassed helmet specifications, condition, certification, and criteria measuring helmet fit. Using a validated injury-surveillance system, we identified participants as players with suspected concussions or physician-diagnosed concussions or both. One control group comprised players who sustained nonconcussion injuries, and a second control group comprised uninjured players. Helmet-fit criteria (maximum score = 16) were assessed for the concussed players and compared with each of the 2 control groups. The primary outcome was dichotomous (>1 helmet-fit criteria missing versus 0 or 1 criterion missing). Logistic and conditional logistic regression were used to investigate the effect of helmet fit on the odds of concussion. RESULTS: The primary analysis (54 pairs matched for age, sex, and level of play) suggested that inadequate helmet fit (>1 criterion missing) resulted in greater odds of sustaining a concussion when comparing concussed and uninjured players (odds ratio [OR] = 2.67 [95% CI = 1.04, 6.81], P = .040). However, a secondary unmatched analysis involving all participants indicated no significant association between helmet fit and the odds of sustaining a concussion when we compared concussed players with nonconcussion-injured players (OR = 0.98 [0.43, 2.24], P = .961) or uninjured players (OR = 1.66 [0.90, 3.05], P = .103). CONCLUSIONS: Inadequate helmet fit may affect the odds of sustaining a concussion in youth ice hockey players. Future investigators should continue to evaluate this relationship in larger samples to inform helmet-fit recommendations.
Assuntos
Traumatismos em Atletas , Concussão Encefálica , Dispositivos de Proteção da Cabeça , Hóquei , Adolescente , Alberta/epidemiologia , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/prevenção & controle , Concussão Encefálica/epidemiologia , Concussão Encefálica/prevenção & controle , Estudos de Casos e Controles , Criança , Estudos de Coortes , Feminino , Hóquei/lesões , Humanos , Masculino , Esportes Juvenis/lesõesRESUMO
This paper reports the development of a test device for replicating unique features of concussion-causing helmet-to-ground impacts. Helmet-to-ground impacts are characterized by an oblique impact velocity vector, preimpact rotational motion of the helmeted head, and an impact into a compliant frictional surface of unknown effective mass. No helmet assessment testing program replicates these impact characteristics, yet they influence brain injury risk and therefore may influence helmet design priorities. To replicate these mechanics, the carriage of a drop tower was modified by the addition of a curvilinear bearing track and a hinged torso-neck fixture to which a helmeted head of a Hybrid III anthropomorphic test device was mounted. Preimpact rotational motion of the head was imparted by forcing a link arm to follow the curvilinear path as the carriage fell under gravity. At impact, the rotating helmeted head struck a vertically mounted surface. The ground impact features of head kinematics are illustrated by comparing rear impacts into a rigid, low-friction surface against those into a compliant frictional surface simulating turf. With the rigid, low-friction surface, the head experienced a change in rotational rate of approximately 40 rad/s, which corresponded to a peak rotational acceleration of approximately αy = - 4000 rad/s2. In contrast, peak rotational acceleration with the compliant frictional surface was approximately αy = - 1000 rad/s2 while the helmet was in contact with the surface. Neck loads were significantly greater with the compliant frictional surface. Translational head acceleration was less sensitive to the surface characteristics, with the peak of the anterior-posterior component essentially unchanged.
Assuntos
Concussão Encefálica , Futebol Americano/lesões , Dispositivos de Proteção da Cabeça , Modelos Biológicos , Lesões do Pescoço , Aceleração , Concussão Encefálica/patologia , Concussão Encefálica/fisiopatologia , Concussão Encefálica/prevenção & controle , Cabeça/patologia , Humanos , Pescoço/patologia , Pescoço/fisiopatologia , Lesões do Pescoço/patologia , Lesões do Pescoço/fisiopatologia , Lesões do Pescoço/prevenção & controle , RotaçãoRESUMO
BACKGROUND: Existing studies analyzing the impact of state concussion laws have found an increase in concussion-related medical encounters post-law, in some instances, such increases were observed during the pre-law period due to a potential "spillover" effect. This study assessed the effects of Ohio's concussion law, while accounting for such a "spillover" effect, on the trends in monthly rates of concussion-related medical encounters in Medicaid insured children using autoregressive integrated moving average (ARIMA) analysis. METHODS: We analyzed claim data obtained from the Partners For Kids database, a pediatric accountable care organization in Ohio. Concussion-related medical encounters for Medicaid-insured children (ages 0-18 years) treated between April 1, 2008 to December 31, 2016 were selected and analyzed. We assessed pre- and post-law trends in concussion-related medical encounters using an ARIMA intervention model. We also used traditional regression methods to validate the study results. RESULTS: A total of 16,943 concussion-related medical encounters sustained by 15,545 unique patients were included. Monthly rates of concussion-related medical encounters significantly increased from 4.64 per 10,000 member months during the pre-law period to 6.69 per 10,000 member months in the post-law period (P < 0.0001). Three upward breaks in the monthly rates of concussion-related medical encounters were observed between 2009 and 2016, with two breaks observed during the pre-law period. Specifically, the increased breakpoint observed in July 2011 (P = 0.0186) was significantly associated with an estimated 7.3% increase (95% CI: 1.1-13.7) in the rate of concussion-related medical encounters. This finding was confirmed in the Poisson regression and curve fitting models. Furthermore, a seasonal trend in concussion-related medical encounters was observed with the highest rates in September and October of each year. CONCLUSIONS: Two of the three upward breaks identified in the monthly rate of concussion-related medical encounters occurred before the enactment of Ohio's concussion law, suggesting a potential "spillover" effect. Further research is needed to confirm such an effect in children with other types of medical insurance.
Assuntos
Concussão Encefálica/prevenção & controle , Jurisprudência , Adolescente , Concussão Encefálica/terapia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Revisão da Utilização de Seguros , Masculino , Medicaid/estatística & dados numéricos , Ohio , Estados UnidosRESUMO
Over the past 40 years, advocacy groups have been instrumental in raising awareness for neurodegenerative diseases such as Alzheimer's disease. More recently, advocates have emerged to educate about sports concussions and chronic traumatic encephalopathy (CTE), including the Concussion Legacy Foundation (CLF). CTE is a neurodegenerative disease caused in part by repetitive head impacts (RHI). While the majority of CTE research has focused on studying former American football players, CTE has also been found in military personnel, victims of domestic violence, and contact sport athletes from high school to professional levels of play. Advocates' many goals include creating a culture of brain donation and modifying youth contact sports to decrease RHI. Here, we provide the first review of CTE advocacy, summarize the accomplishments of the CLF, and consider the connections between CTE advocacy, research, and legislation over the last decade.
Assuntos
Traumatismos em Atletas , Pesquisa Biomédica , Concussão Encefálica , Encefalopatia Traumática Crônica , Fundações , Defesa do Paciente , Relações Públicas , Traumatismos em Atletas/prevenção & controle , Concussão Encefálica/prevenção & controle , Encefalopatia Traumática Crônica/prevenção & controle , HumanosAssuntos
Traumatismos em Atletas/prevenção & controle , Protetores Bucais , Esportes , Concussão Encefálica/prevenção & controle , Custos e Análise de Custo , Desenho de Equipamento , Traumatismos Faciais/prevenção & controle , Humanos , Boca/lesões , Protetores Bucais/economia , Traumatismos Dentários/prevenção & controleRESUMO
CONTEXT: Each year, approximately 2 million US children 18 years or younger sustain a concussion, a type of mild traumatic brain injury (TBI). Concussions can have detrimental effects on physical, cognitive, emotional, or sleep health. POLICY: Between 2009 and 2014, all 50 US states and Washington, District of Columbia, enacted state concussion laws aimed to increase awareness about concussion and reduce the prevalence and severity of this injury. Most state laws include the following core tenets: (1) immediate removal from play after an actual or suspected concussion; (2) medical clearance before an athlete can return to play (RTP); and (3) concussion education for athletes, parents, and coaches. IMPLEMENTATION: State concussion laws allow for substantial interpretation at the school level, resulting in considerable variation in the content of school written concussion policies and the level of implementation of state law requirements at the school level. EVALUATION: We assessed the degree of high school written concussion policy compliance with the respective state law and examined the relationship between concussion policy compliance and school-level implementation of concussion laws. Seventy-one school officials completed a semistructured telephone interview and submitted their school's written concussion policy. Of the 71 policies analyzed, most complied with the removal-from-play, RTP, and concussion education tenets (90.1%, 97.2%, and 76.1%, respectively). The majority of participants reported that their school implemented the removal-from-play (91.5%), RTP (93.0%), and concussion education (80.6%) tenets well or very well. No significant relationships were found between researcher-rated school policy compliance and school-reported implementation of state law requirements at the school level. DISCUSSION: Our findings suggest that most participating schools complied with their state concussion law and implemented law requirements well or very well. Future studies should identify facilitators and barriers to the implementation of state concussion laws at the school level.
Assuntos
Concussão Encefálica/prevenção & controle , Política de Saúde/tendências , Instituições Acadêmicas/normas , Governo Estadual , Pesquisa Translacional Biomédica/normas , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/prevenção & controle , Concussão Encefálica/epidemiologia , Política de Saúde/legislação & jurisprudência , Humanos , Instituições Acadêmicas/organização & administração , Instituições Acadêmicas/estatística & dados numéricos , Estados Unidos/epidemiologiaRESUMO
SYNOPSIS: The risk factors of concussion may be categorized as intrinsic (internal factors specific to the individual) or extrinsic (external factors related to the environment or sport). Identifying these factors is part of an individualized, patient-centered approach to prevention, assessment, and management of concussion. In most cases, the symptoms of concussion resolve in the initial few days following the injury, and a strategy involving a gradual return to sport and school is recommended. When symptoms persist for longer than 7 to 10 days, a multifaceted interdisciplinary assessment to guide treatment is recommended. This article applies the dynamic, recursive model of sport injury to sport-related concussion and summarizes the process of individualized assessment and management following concussion in athletes of all ages, with a focus on physical rehabilitation. J Orthop Sports Phys Ther 2019;49(11):799-810. doi:10.2519/jospt.2019.8926.
Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia , Medicina de Precisão , Traumatismos em Atletas/prevenção & controle , Concussão Encefálica/prevenção & controle , Humanos , Recuperação de Função Fisiológica , Volta ao Esporte , Fatores de RiscoRESUMO
This Note examines the NCAA's unwillingness to enforce the requirement that all NCAA institutions must implement a concussion management plan; the NCAA's refusal to apply its appropriate enforcement mechanism when member institutions violate their concussion management plans, which are instituted in order to protect student-athletes from concussions; how both of these failures result in more concussions and a higher probability of debilitating long-term effects; and solutions to remedy this grave injustice. Part II describes what a concussion is, the long-term effects of concussions, the NCAA's management of concussions, and lawsuits challenging the NCAA in relation to concussions. Part III analyzes the inefficiencies of the NCAA in its management of concussions, the previous and current lawsuits' failure to stimulate change within the NCAA, and the proposed solutions that will help create a safe environment for student-athletes.
Assuntos
Atletas/legislação & jurisprudência , Concussão Encefálica/epidemiologia , Concussão Encefálica/prevenção & controle , Legislação como Assunto , Volta ao Esporte , Estudantes/legislação & jurisprudência , Universidades/organização & administração , Traumatismos em Atletas/classificação , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/prevenção & controle , Concussão Encefálica/complicações , Encefalopatia Traumática Crônica/etiologia , Estudos Transversais , Humanos , Fatores de Risco , Gestão de Riscos/organização & administração , Planejamento Estratégico , Estados UnidosRESUMO
Concussion, or mild traumatic brain injury, especially among young children, teenagers, and young adults, is a significant problem in Ada County, Idaho, and the United States. Although much has been learned about concussion, considerable controversy and gaps in knowledge still exist in many areas of research, leading to variation in concussion assessment, treatment, and management protocols. Health systems can positively impact concussion outcomes through community education and outreach, and provision of timely, coordinated, evidence-based clinical care. Collectively, these measures serve to reduce concussion incidence (primary prevention), enable more timely recognition of concussion by parents, coaches, and teachers of youth athletes (secondary prevention), and improve treatment of concussion after it has occurred (tertiary prevention). Using the concussion prevention and clinical care coordination activities of St. Luke's Health System in Idaho as a benchmark, this analysis estimates the economic value of these preventive measures, in particular those preventive measures that target the pediatric population, for Ada County and the state of Idaho, and includes both year of injury and long-term costs of concussion. This study adopts a societal perspective, incorporating savings in direct medical, indirect, and quality of life costs.
Assuntos
Concussão Encefálica , Custos de Cuidados de Saúde/estatística & dados numéricos , Educação em Saúde , Qualidade de Vida , Adolescente , Concussão Encefálica/economia , Concussão Encefálica/epidemiologia , Concussão Encefálica/prevenção & controle , Concussão Encefálica/terapia , Criança , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Idaho/epidemiologiaRESUMO
BACKGROUND: The American Academy of Pediatrics has recommended that opportunities for non-tackling American football (e.g., flag football) be expanded, given concerns about the risks of brain trauma from tackle football. This study tested the hypothesis that flag football would be more accessible in communities characterised by higher socioeconomic status residents. METHODS: In July 2017, the locations of community-based organisations offering youth flag and tackle football for youth between the ages of 6 and 13 in two US states (Georgia and Washington) were aggregated (n=440). Organisations were coded in terms of the availability of tackle and/or flag football teams for youth at each year of age between 6 and 13. Multivariate logistic regression analyses were used to assess the odds of a community-based football organisation offering flag football, by community socioeconomic and demographic characteristics. RESULTS: In both states, communities with more educated residents were more likely to offer flag football for youth aged 6-12. For example, among 6 year-olds every 10% increase in the number of adult residents with a college education was associated with 1.51 times the odds of flag football availability (95% CI 1.22 to 1.86, P<0.001). CONCLUSION: These results suggest that youth living in communities characterised by low educational attainment are less likely than other youth to have the option of a lower contact alternative to tackle football. Relying on voluntary community-level adoption of lower contact alternatives to tackle football may result in inequitable access to such sport options. This may contribute to an inequitable burden of brain trauma from youth sport.
Assuntos
Traumatismos em Atletas/prevenção & controle , Concussão Encefálica/prevenção & controle , Lesões Encefálicas Traumáticas/prevenção & controle , Futebol Americano/classificação , Esportes Juvenis/classificação , Acesso à Informação , Adolescente , Traumatismos em Atletas/epidemiologia , Concussão Encefálica/epidemiologia , Lesões Encefálicas Traumáticas/epidemiologia , Criança , Feminino , Futebol Americano/lesões , Conhecimentos, Atitudes e Prática em Saúde , Disparidades nos Níveis de Saúde , Humanos , Masculino , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Esportes Juvenis/lesõesRESUMO
Beginning in 2009 with the passage of the Zackery Lystedt law in the state of Washington, all 50 states have passed concussion laws that implement a mandatory framework of care for high school and youth athletes. The structure of these laws generally shares the three primary components of the Lystedt law: (1) preseason concussion education; (2) mandatory removal from play with suspected concussion; and (3) clearance from a healthcare professional prior to return to play. These same three policy components are also found at the collegiate and professional levels of sport, either through established policy or labor contracts. This chapter explores concussion-specific legal and policy developments that currently inform concussion management practices across multiple levels of the US athletic system.
Assuntos
Atletas/legislação & jurisprudência , Traumatismos em Atletas/prevenção & controle , Concussão Encefálica/prevenção & controle , Política de Saúde/legislação & jurisprudência , Medicina Esportiva/legislação & jurisprudência , Traumatismos em Atletas/complicações , Concussão Encefálica/etiologia , Humanos , Volta ao EsporteRESUMO
CONTEXT:: Implementation of best-practice health and safety policies has been shown to be effective at reducing the risk of sudden death in sport; however, little is known about the extent to which these policies are required within secondary school athletics. OBJECTIVE:: To examine best-practice health and safety policies pertaining to the leading causes of sudden death and to concussion management in sport mandated at the state level for secondary school athletics. DESIGN:: Descriptive observational study. SETTING:: State high school athletic associations (SHSAAs), state departments of education, and enacted legislation. PATIENTS OR OTHER PARTICIPANTS:: United States (including the District of Columbia) SHSAAs. MAIN OUTCOME MEASURE(S):: A review of SHSAA health and safety policies for the 2016-2017 academic year, state department of education policies, and enacted legislation was undertaken to assess the polices related to the leading causes of sudden death and concussion management in sport. Current best-practice recommendations used to assess health and safety policies were specific to emergency action plans, automated external defibrillators, heat acclimatization, environmental monitoring and modification, and concussion management. The total number of best-practice recommendations required for each SHSAA's member schools for the aforementioned areas was quantified and presented as total number and percentage of recommendations required. RESULTS:: Four of 51 SHSAA member schools were required to follow best practices for emergency action plans, 7 of 51 for access to automated external defibrillators, 8 of 51 for heat acclimatization, and 3 of 51 for management of concussion. CONCLUSIONS:: At the time of this study, SHSAA member schools were not required to follow all best-practice recommendations for preventing the leading causes of sudden death and for concussion management in sport. Continued advocacy for the development and implementation of best practices at the state level to be required of all secondary schools is needed to appropriately serve the health and well-being of our young student-athletes.
Assuntos
Traumatismos em Atletas/prevenção & controle , Concussão Encefálica/terapia , Morte Súbita/prevenção & controle , Medicina Esportiva/normas , Adolescente , Atletas , Benchmarking , Concussão Encefálica/prevenção & controle , Morte Súbita/etiologia , Medicina Baseada em Evidências , Humanos , Políticas , Instituições Acadêmicas , Estudantes , Estados Unidos , Esportes JuvenisRESUMO
BACKGROUND: Sport-related concussion and repetitive head impact exposure in contact sports continue to receive increased attention in public and medical spheres. The Concussion Assessment, Research and Education (CARE) Consortium, a multicenter cooperative, was established to study the natural history of concussion in National Collegiate Athletic Association (NCAA) collegiate student-athletes across 29 colleges and universities in the United States. The purpose of this investigation is to provide normative data from the CARE Consortium and evaluate for differences between sport categories. METHODS: NCAA student-athletes were evaluated annually for general demographics and sport-specific characteristics before the start of the competitive season. We collected demographic and medical history information and evaluated each student-athlete's neurocognitive function, neurological status, postural stability, and self-reported symptoms. Sports were categorized by the amount of contact typically associated with the sport (i.e., contact, limited contact, non-contact). Comparisons between the three sport categories for the evaluated variables were made using linear or zero inflated negative binomial regression models adjusted for gender, concussion history, and household income. RESULTS: Over a 2-year period (August 2014-July 2016), 15,681 NCAA athletes completed preseason evaluations. Overall, 53% of the athletes were in the contact sport group, 31% were in the limited contact group and 17% were in the non-contact group. After adjusting for covariates, there were statistically significant differences found between athlete groups, although the differences and effect sizes were small and not clinically significant. The contact sport group had better scores on Immediate Post-Concussion Assessment Testing (ImPACT®) visual and verbal memory, Sport Concussion Assessment Tool (SCAT) symptom checklist, and Brief Symptom Inventory-18 (BSI-18), but slower ImPACT reaction time and worse scores on Standardized Assessment of Concussion (SAC). Further, the data indicate that some ImPACT score distributions were noticeably different from those presented in the technical manual. CONCLUSIONS: In this large, racially and socio-economically diverse cohort of male and female college athletes, we found no evidence that student-athletes participating in contact sports have clinically meaningful deficits in pre-season cognitive and balance testing. They also did not report significantly more symptoms of psychological distress when compared with student-athletes in non-contact or limited contact sports. In addition, the data suggest potential limitations when using published ImPACT norms when evaluating injured athletes.
Assuntos
Atletas , Traumatismos em Atletas/prevenção & controle , Concussão Encefálica/prevenção & controle , Feminino , Promoção da Saúde/métodos , Humanos , Masculino , Testes Neuropsicológicos , Estudantes , UniversidadesRESUMO
Although experts have noted that adolescent athletes should be educated about concussions to improve their safety, there is no agreement on the most effective strategy to disseminate concussion education. The purpose of this study was to develop, implement and assess a concussion education programme. More precisely, four interactive oral presentations were delivered to high school student-athletes (N = 35, Mage = 15.94, SD = 0.34) in a large urban centre. Participants completed a questionnaire at three time-points during the season to measure changes in their knowledge (CK) and attitudes (CA) of concussions, and focus group interviews were conducted following the concussion education programme. Questionnaire data revealed participants' post-intervention CK scores were higher than their pre-intervention scores. During the focus groups, the student-athletes said they acquired CK about the role of protective equipment and symptom variability, and in terms of CA, they intended to avoid dangerous in-game collisions in the future. Our study was the first to create and deliver a concussion education intervention across multiple time-points, and to use mixed-methods in its assessment. These findings may be of interest to researchers, practitioners and stakeholders in sport who are invested in making the sport environment safer through concussion education and awareness.