Diagnosis of Sports-Related Concussion Using Symptom Report or Standardized Assessment of Concussion.

Importance: The Sports Concussion Assessment Tool-5 (SCAT5) has been recommended for concussion evaluation and utilizes both a subjective reported symptom grading scale and objective measures of concussion including a cognitive evaluation: the Standardized Assessment of Concussion (SAC). The SAC includes testing for orientation, immediate memory, concentration, and delayed recall; a 10-word list is used to assess immediate memory and delayed recall. Objective: To determine the diagnostic accuracy of components of the SCAT5 and to provide a framework for clinical interpretation. Design, Setting, and Participants: This prospective case-control study of National Collegiate Athletic Association Division I athletes from any sport was conducted from July 2020 to December 2022 at 4 universities. Athletes completed baseline SCAT5 testing using the 10-word list. When an athlete presented acutely with suspected concussion (sideline or within 2 days), the tests were repeated. If a concussion was diagnosed, a control athlete underwent the same tests. Controls were identified and matched on comorbid conditions, sex and gender, sport, season, and baseline scores. Data analysis was conducted from August to October 2023. Main Outcomes and Measures: The primary outcomes were area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive and negative predictive value, and test-retest reliability of the symptom score; symptom severity score; the total SAC score; and the orientation, immediate memory, concentration, and delayed memory subcomponent scores on the SCAT5 compared with clinical diagnosis of concussion. Results: Baseline and postinjury data were collected on 92 athletes with concussion and 92 matched control athletes (96 men [52%] and 88 women [48%]; 110 who played a sport other than football [59%]). Diagnostic utility was considered excellent for symptom score (AUC, 0.93; 95% CI, 0.89-0.96) and symptom severity score (AUC, 0.94; 95% CI, 0.90-0.97). An increase of 2 points on the symptom score was associated with a sensitivity of 86% (95% CI, 78%-92%), specificity of 80% (95% CI, 70%-87I%), and positive predictive value of 81% (95% CI, 72%-88%). The total SAC score had poor to fair diagnostic utility (AUC, 0.70; 95% CI, 0.63-0.77); however, 41 athletes with concussion (45%) had a total SAC score at or above their baseline score (ie, within normal limits). The diagnostic utility was poor to fair for immediate memory (AUC, 0.68, 95%CI, 0.61-0.75) and delayed recall (AUC, 0.69; 95% CI, 0.62-0.77) and not useful for orientation (AUC, 0.49; 95% CI, 0.43-0.56) and concentration (AUC, 0.52 95% CI, 0.44-0.61). Test-retest reliability was fair for total SAC and poor for immediate memory and delayed recall, orientation, and concentration. Conclusions and Relevance: In this case-control study of the diagnostic accuracy of reported symptoms and the SAC, reported symptoms were the most accurate indicator of concussion while the 10-word SAC had limited sensitivity. These findings suggest that understanding the properties of the SAC is important when making the diagnosis of concussion.

Use of the concussion check protocol for concussion assessment in a female soccer team over two consecutive seasons in New Zealand.

AIM: Address deficiencies in access to sports sideline medical care by using a Concussion Check Protocol (CCP) for non-medically-trained people. METHOD: A prospective observational cohort study was undertaken on a single amateur female club-based soccer team over two consecutive years in New Zealand utilising a non-medically trained support person termed a Safety officer. CCP is an extension of the King-Devick test with features such as warning signs and symptoms of concussion built into the application. All players suspected of having a potential concussive injury were tested on the match sideline. RESULTS: The study overall incidence of match-related concussions was 20.8 (95% CI: 11.8 to 36.6) per 1000 match-hrs, with mean missed-match duration of 31 (95% CI: 27.9 to 34.1) days. Twelve players over the study had a significantly slower post-injury KD (49.9 [44.3 to 64.1]s; χ2(1) = 11.0; p = 0.0009; z = -2.9; p = 0.0033; d = 0.30) and/or reported symptoms, compared with their own baseline (47.2 [44.3 to 64.1]s). CCP had an overall sensitivity of 100% (95% CI: 73.5% to 100.0%), specificity of 100% (95% CI: 69.2% to 100.0%) and positive predictive value (PPV) of 100% (84.6% to 100.0%). CONCLUSION: Sideline use of CCP was undertaken successfully by non-medically trained people and provided a reliable platform for concussion identification.

Evaluation of the SCAT 5 tool in the assessment of concussion in Para athletes: a Delphi study.

OBJECTIVES: To investigate if the sport concussion assessment tool version 5 (SCAT5) could be suitable for application to Para athletes with a visual impairment, a spinal cord injury, or a limb deficiency. METHODS: A 16-member expert panel performed a Delphi technique protocol. The first round encompassed an open-ended questionnaire, with round 2 onwards being composed of a series of closed-ended statements requiring each expert's opinion using a five-point Likert scale. A predetermined threshold of 66% was used to decide whether agreement had been reached by the panel. RESULTS: The Delphi study resulted in a four-round process. After round 1, 92 initial statements were constructed with 91 statements obtaining the targeted level of agreement by round 4. The expert panellist completion rate of the full four-round process was 94%. In the case of athletes with a suspected concussion with either limb deficiencies or spinal cord injuries, the panel agreed that a baseline assessment would be needed on record is ideal before a modified SCAT5 assessment. With respect to visual impairments, it was conceded that some tests were either difficult, infeasible or should be omitted entirely depending on the type of visual impairment. CONCLUSION: It is proposed that the SCAT5 could be conducted on athletes with limb deficiencies or spinal cord injuries with some minor modifications and by establishing a baseline assessment to form a comparison. However, it cannot be recommended for athletes with visual impairment in its current form. Further research is needed to determine how potential concussions could be more effectively evaluated in athletes with different impairments.

The Sprint Mechanics Assessment Score: A Qualitative Screening Tool for the In-field Assessment of Sprint Running Mechanics.

BACKGROUND: Qualitative movement screening tools provide a practical method of assessing mechanical patterns associated with potential injury development. Biomechanics play a role in hamstring strain injury and are recommended as a consideration within injury screening and rehabilitation programs. However, no methods are available for the in-field assessment of sprint running mechanics associated with hamstring strain injuries. PURPOSE: To investigate the intra- and interrater reliability of a novel screening tool assessing in-field sprint running mechanics titled the Sprint Mechanics Assessment Score (S-MAS) and present normative S-MAS data to facilitate the interpretation of performance standards for future assessment uses. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Maximal sprint running trials (35 m) were recorded from 136 elite soccer players using a slow-motion camera. All videos were scored using the S-MAS by a single assessor. Videos from 36 players (18 men and 18 women) were rated by 2 independent assessors blinded to each other's results to establish interrater reliability. One assessor scored all videos in a randomized order 1 week later to establish intrarater reliability. Intraclass correlation coefficients (ICCs) based on single measures using a 2-way mixed-effects model, with absolute agreement with 95% CI and kappa coefficients with percentage agreements, were used to assess the reliability of the overall score and individual score items, respectively. T-scores were calculated from the means and standard deviations of the male and female groups to present normative data values. The Mann-Whitney U test and the Wilcoxon signed-rank test were used to assess between-sex differences and between-limb differences, respectively. RESULTS: The S-MAS showed good intrarater (ICC, 0.828 [95% CI, 0.688-0.908]) and interrater (ICC, 0.799 [95% CI, 0.642-0.892]) reliability, with a standard error of measurement of 1 point. Kappa coefficients for individual score items demonstrated moderate to substantial intra- and interrater agreement for most parameters, with percentage agreements ranging from 75% to 88.8% for intrarater and 66.6% to 88.8% for interrater reliability. No significant sex differences were observed for overall scores, with mean values of 4.2 and 3.8 for men and women, respectively (P = .27). CONCLUSION: The S-MAS is a new tool developed for assessing sprint running mechanics associated with lower limb injuries in male and female soccer players. The reliable and easy-to-use nature of the S-MAS means that this method can be integrated into practice, potentially aiding future injury screening and research looking to identify athletes who may demonstrate mechanical patterns potentially associated with hamstring strain injuries.

Sport-Related Concussion in Para Athletes: A Scoping Review of Concussion Incidence, Assessment, and Management.

ABSTRACT: Although research on sport-related concussion has grown substantially in the last decade, research on concussion in para sports remains limited. The aim of this scoping review is to synthesize and describe the current literature on the incidence, assessment, and management of sport-related concussion in para athletes. The literature search was conducted in CINAHL, Google Scholar, MEDLINE, SPORTDiscus, and Web of Science databases and identified 22 studies that addressed one of our research questions. A majority of studies addressed concussion in elite athletes; youth and collegiate para athletes were largely underrepresented. Fewer studies addressed concussion assessment and management, in part due to limitations in accessibility of current assessment tools for athletes with varying disabilities. Moving forward, there is a need to capture a larger range of incidence data, create modified assessment tools with para-specific normative data, and develop risk prevention strategies for para athletes.

Level of Agreement Between Child and Parent Reporting on the Child Sport Concussion Assessment Tool (SCAT5).

CONTEXT: The Child Sport Concussion Assessment Tool, fifth edition (SCAT5), remains the consensus instrument for concussion evaluation in youth athletes. Both child and parent are recommended to complete the athlete background and symptom reporting. OBJECTIVE: To determine the level of agreement between child and parent medical history and symptom reporting and quantify their performance on the Child SCAT5 in male football athletes. DESIGN: Cross-sectional study. SETTING: National Collegiate Athletic Association Division I college football facility. PATIENTS OR OTHER PARTICIPANTS: A total of 157 youth male football athletes (age = 10.7 ± 1.3 years) participating in a university-sanctioned youth football camp and their parent or legal guardian. MAIN OUTCOME MEASURE(S): Youth athletes and their parent completed the athlete background (demographics, diagnosed medical history) and symptom evaluation (symptom items, total number of symptoms, and symptom severity score) of the Child SCAT5 and were instructed not to discuss reporting with each other during testing. Cronbach α tests were conducted to determine the internal consistency, and descriptive statistics determined the level of agreement between medical history, symptom reporting, and baseline performance. RESULTS: The internal consistency of the symptom items was high for both child (Cronbach α = 0.91) and parent (α = 0.92). Agreement on medical history ranged from 67% (learning disability or dyslexia) to 85% (attention-deficit/hyperactivity disorder), with 82% agreement on sustaining a previous concussion. Fourteen youth athletes reported having been hospitalized for a head injury, with zero matched parent confirmations. Individual symptom agreement ranged from 70.7% (gets distracted easily) to 94.9% (going to faint). Agreement was 35% on total number of symptoms and severity. Abnormal scoring ranged from 2% (going to faint) to 25% (headache) for child and 2% (double vision) to 28% (gets distracted easily) for parent reporting. CONCLUSIONS: Fair agreement was shown between children and their parent on medical history and self-reported symptoms on the Child SCAT5 at baseline. When available, child and parent reporting should be used for concussion assessment and clinical decision-making.

On-Field and Pitch-Side (Sideline) Assessment of Sports Concussion in Collision Sports: An Expert Consensus Statement Using the Modified Delphi Technique.

PURPOSE: To perform a Delphi consensus for on-field and pitch-side assessment of sports-related concussion (SRC). METHODS: Open-ended questions in rounds 1 and 2 were answered. The results of the first 2 rounds were used to develop a Likert-style questionnaire for round 3. If agreement at round 3 was ≤80% for an item, if panel members were outside consensus, or there were >30% neither agree/disagree responses, the results were carried forward into round 4. The level of agreement and consensus was defined as 90%. RESULTS: Loss of consciousness (LOC) or suspected LOC, motor incoordination/ataxia, balance disturbance, confusion/disorientation, memory disturbance/amnesia, blurred vision/light sensitivity, irritability, slurred speech, slow reaction time, lying motionless, dizziness, headaches/pressure in the head, falling to the ground with no protective action, slow to get up after a hit, dazed look, and posturing/seizures were clinical signs of SRC and indicate removal from play. Video assessment is helpful but should not replace clinical judgment. LOC/unresponsiveness, signs of cervical spine injury, suspicion of other fractures (skull/maxillo-facial), seizures, Glasgow Coma Scale score <14 and abnormal neurologic examination findings are indications for hospitalization. Return to play should only be considered when no clinical signs of SRC are present. Every suspected concussion should be referred to an experienced physician. CONCLUSIONS: Consensus was achieved for 85% of the clinical signs indicating concussion. On-field and pitch-side assessment should include the observation of the mechanism, a clinical examination, and cervical spine assessment. Of the 19 signs and red flags requiring removal from play, consensus was reached for 74%. Normal clinical examination and HIA with no signs of concussion allow return to play. Video assessment should be mandatory for professional games but should not replace clinical decision-making. Sports Concussion Assessment Tool, Glasgow Coma Scale, vestibular/ocular motor screening, Head Injury Assessment Criteria 1, and Maddocks questions are useful tools. Guidelines are helpful for non-health professionals. LEVEL OF EVIDENCE: Level V, expert opinion.

Initial Assessment and Management of Select Musculoskeletal Injuries: A Team Physician Consensus Statement.

ABSTRACT: Musculoskeletal injuries occur frequently in sport during practice, training, and competition. Injury assessment and management are common responsibilities for the team physician. Initial Assessment and Management of Musculoskeletal Injury-A Team Physician Consensus Statement is title 23 in a series of annual consensus documents written for the practicing team physician. This statement was developed by the Team Physician Consensus Conference, an annual project-based alliance of six major professional associations. The goal of this document is to help the team physician improve the care and treatment of the athlete by understanding the initial assessment and management of selected musculoskeletal injuries.

Youth Preseason Performance on the Sport Concussion Assessment Tool 5 Across Multiple Sports.

OBJECTIVE: To examine preseason Sport Concussion Assessment Tool 5 (SCAT5) performance of adolescent sport participants by environment (in-person/virtual), sex, age, concussion history, collision/noncollision sport participation, and self-reported medical diagnoses. DESIGN: Cross-sectional. SETTING: Canadian community and high-school sport settings. PARTICIPANTS: Three thousand eight hundred five adolescent (2493 male, 1275 female, and 37 did not disclose; 11- to 19-year-old) sport participants. ASSESSMENT OF RISK FACTORS: Sport Concussion Assessment Tool 5 administration method (in-person/virtual), sex (male/female/unreported), age (years), concussion history (0/1/2/3+), collision/noncollision sport participant, and self-reported medical diagnoses [attention deficit disorder or attention-deficit/hyperactivity disorder, headache/migraine, learning disability, and psychiatric disorder (ie, anxiety/depression/other)]. OUTCOME MEASURES: Preseason SCAT5 outcomes including total number of symptoms (TNS; /22), symptom severity score (SSS; /132), Standardized Assessment of Concussion (SAC; /50), and modified Balance Error Scoring System (mBESS; /30). RESULTS: Multiple multilevel linear or Poisson regression complete case analyses adjusting for clustering and robust standard errors, with ß-coefficients (95% CI) back-transformed to indicate an increase/decrease in SCAT5 subdomains when relevant for clinical interpretation. Virtual (V) performance was associated with fewer symptoms reported [TNS Difference V-IP = -1.53 (95% CI, -2.22 to -0.85)], lower SSS [-2.49 (95% CI, -4.41 to -0.58)], and fewer mBESS errors (IP) [-0.52 (95% CI, -0.77 to -0.27)] compared with in-person. For every one-year increase in age, more symptoms [TNS = 0.22 (95% CI, 0.01-0.44)], higher SSS [0.52 (95% CI, 0.01-1.06)], higher SAC [0.27 (95% CI, 0.15-0.38), and poorer balance [mBESS = -0.19 (-0.28 to -0.09)] were observed. Differences between males and females were also seen across all SCAT5 outcomes. Individuals reporting any medical diagnosis or 3+ concussion history also reported more symptoms (TNS) and higher SSS than those who did not. CONCLUSIONS: Administration environment, sex, age, concussion history, and medical diagnoses were associated with SCAT5 subdomains and are important considerations when interpreting the SCAT5 results.

Development of a tailored concussion education program for athletes: a pragmatic multimethods design and integrated knowledge translation approach from needs assessment to design.

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.

Longitudinal Assessment of Postconcussion Driving: Evidence of Acute Driving Impairment.

BACKGROUND: Current medical practices and recommendations largely ignore the safety of postconcussion driving, even though commonly used measures of neurocognition, balance, and vestibulo-ocular function show impairment. PURPOSE: To compare simulated driving between patients with concussion and controls throughout concussion recovery using a case-control design. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 26 concussed and 23 control Division I collegiate athletes completed a driving simulation assessment at 3 time points (within 72 hours, asymptomatic, and return to sport). Cumulative driving simulation outcome variables included total number of collisions, speed exceedances, stop signs missed, lane excursions, total drive time, percentage of time over the speed limit, and percentage of time out of the lane. The mean speed, standard deviation of speed (SDS), lateral lane position, and standard deviation of lateral lane position (SDLP) were examined for each of the 11 drive segments. Outcomes were compared using generalized linear mixed models with random intercepts by participant with Poisson or normal distributions. RESULTS: Within 72 hours of injury, the concussion group committed more lane excursions (median difference, 2; P = .003), exhibited greater SDS while avoiding a child pedestrian crossing the road (Cohen d = 0.73; P = .011), drove ~7 inches (~18 cm) closer to the centerline during a residential left curve (d = 0.90; P = .015), and had greater SDLP while navigating around a car crash compared with controls (d = 0.72; P = .016). When asymptomatic, the concussion group committed fewer speed exceedances (median difference, 2; P = .002) and had lower SDLP while navigating through a traffic light compared with controls (d = 0.60; P = .045). No differences were evident at return to sport. Groups did not differ in total collisions at any time point. CONCLUSION: The concussion group showed more impaired driving patterns within 72 hours of injury, drove more conservatively once asymptomatic, and had similar driving performance at the time they returned fully to sport. Clinicians should consider these findings when discussing driving with patients acutely after concussion. Further research is needed to determine whether on-road collision risk is elevated after concussion.

Concussion assessment and management - What do community-level cricket participants know?

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 16 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 (n = 224, 93 %) and officials (n = 36, 100 %) demonstrated strong knowledge of the importance of immediately evaluating suspected concussions. In comparison with players without helmets (n = 11), those using helmets (n = 135) considered replacing their helmets after a concussion to be vital to concussion assessment (p = 0.02). Overall, 80-97 % of players and 81-97 % of officials understood the importance of many factors regarding concussion management. When concussion management knowledge was compared by injury status, injured players (n = 17, 94 %) believed someone with a concussion should be hospitalised immediately, in contrast to non-injured players (n = 154, 69 %) (p = 0.04). Players (63 %) were less aware of concussion guidelines than officials (81 %). 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.

Functional Assessment of Concussion Tool Application in a Pediatric Concussion Clinic.

BACKGROUND: Traditional concussion symptom scales do not assess function. We piloted a mobile app-based assessment that aims to measure the functional impact of symptoms. METHODS: Patients with concussion completed the Functional Assessment of Concussion Tool and traditional symptom scales postinjury. RESULTS: Linear regression assessed the predictive value of the Functional Assessment of Concussion Tool symptom number and function rating compared to scores on 2 traditional symptom scales across 4 symptom domains. The mobile app symptom number predicted scores on traditional symptom scales across domains. The rating score predicted traditional scale scores in 2 domains. The mobile health tool did not predict recovery. DISCUSSION: This mobile health concussion symptom assessment may measure the functional impact of symptoms, though further study is needed.

Acute and Emergent Spinal Injury Assessment and Treatment.

Sports participation is a leading cause of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. Planning the process of transport for home venues before the start of the season and ensuring that a medical time out occurs at home and away games can reduce complications of transport decisions on the field of play and expedite transport of the spine-injured athlete.

Predicting early versus late recovery from sport-related concussion using decision tree analysis.

OBJECTIVE: Accurately predicting early (≤ 14 days) versus typical (15-27 days) or delayed (≥ 28 days) recovery from sport-related concussion (SRC) may allow for improved resource utilization and precision in planning and carrying out rehabilitation. In this study, the authors sought to develop an algorithm that enables accurate differentiation of recovery periods and duration after SRC. The authors hypothesized that data regarding initial symptom burden as quantified by a Post-Concussion Symptom Scale (PCSS) score, time to presentation, and number of prior concussions would be the most useful for analyzing predictive factors for concussion recovery duration. METHODS: A retrospective case-control study was conducted to assess the primary outcome of days to clinical recovery following SRC in pediatric patients. Data from patients 12-18 years old presenting within 28 days of injury to an SRC clinic between November 11, 2017, and October 10, 2020, were analyzed. Patients with positive evidence of injury on head imaging or incomplete records were excluded. The primary outcome was duration of clinical recovery, grouped as early (≤ 14 days), typical (15-27 days), or delayed (≥ 28 days). Recovery was defined as follows: 1) symptom resolution or return to baseline, or 2) initiation of graduated return to play. CHAID (chi-square automatic interaction detection) analysis was used to optimize a decision tree based on 16 input factors, including age, sex, initial PCSS score, time to clinic presentation, number of prior concussions, and presence of defined symptom clusters. The cohort was randomized into training (70%) and test (30%) samples for algorithm validation. RESULTS: A total of 493 patients met the inclusion criteria (mean age 15.7 ± 1.5 years, 68.2% male, 70.0% White). The median time to presentation was 5 days (IQR 2-10 days). Most patients (52.3%) recovered within 14 days of injury, 21.5% recovered within 15-27 days, and 26.2% had a recovery period of 28 days or longer. The variables most predictive of recovery were initial PCSS score (cutoffs ≤ 6, 7-28, or ≥ 29), time to presentation (≤ 7 vs > 7 days), or prior concussions (0 vs ≥ 1). The model accurately discriminated between early versus typical or delayed recovery duration groupings (area under the curve 0.80, Youden index 0.44), and correctly classified > 90% of patients who recovered early. CONCLUSIONS: This novel three-factor predictive tool enabled accurate discrimination of early versus typical or delayed SRC recovery to better allocate resources, counsel patients, and make timely referrals.

Neck Strength Assessment Offers No Clinical Value in Predicting Concussion in Male Professional Rugby Players: A Prospective Cohort Study.

OBJECTIVE: To determine if neck muscle strength and endurance are associated with concussion injuries in professional, male rugby players. Playing position, history of previous concussion, and age were also considered. DESIGN: Prospective cohort study METHODS: One hundred thirty-six male, professional rugby players completed neck strength testing that comprised a peak isometric test, an endurance test, and a concussion screening questionnaire. Electronic medical records were analyzed for head injury data. RESULTS: Out of 136 players (mean age, 25.3 ± 3.4 years; height, 186 ± 7 cm; weight, 103 ± 13.2 kg), 40 players suffered from 51 concussions in the 2017/18 playing season. A history of concussion was reported by 65% of the cohort. Multiple logistic regression analysis found that peak isometric flexion strength was not associated with concussion risk. Increased peak isometric extension strength was associated with significantly greater odds of sustaining a concussion (odds ratio [OR] = 1.01; 95% CI: 1.00, 1.01, does not include 1; P = .04) that is likely too small to be clinically relevant. Players with a self-reported history of concussion had over 2 times greater odds of sustaining a concussion (OR = 2.25; 95% CI: 0.73, 6.22). More than 2 concussions in the past 12 months was associated with almost tenfold greater odds of concussion (OR = 9.51; 95% CI: 1.66, 54.55). Age, playing position, and neck muscle endurance were not associated with concussion. CONCLUSION: The strongest predictor of concussion injury was previous concussion. Players who sustained concussions in season had similar neck muscle strength to players who had not sustained a concussion. J Orthop Sports Phys Ther 2023;53(5):1-7. Epub: 5 April 2023. doi:10.2519/jospt.2023.11723.