Sex Differences Across Concussion Characteristics in US Service Academy Cadets: A CARE Consortium Study.

OBJECTIVE: To describe sex differences in concussion characteristics in US Service Academy cadets. DESIGN: Descriptive epidemiology study. SETTING: Four US service academies. PARTICIPANTS: 2209 cadets (n = 867 females, n = 1342 males). INDEPENDENT VARIABLE: Sex. OUTCOME MEASURES: Injury proportion ratios (IPR) compared the proportion of injuries by sex (females referent) for injury situation, certainty of diagnosis, prolonged recovery, recurrent injuries, mental status alterations, loss of consciousness (LOC), posttraumatic amnesia (PTA), retrograde amnesia (RGA), motor impairments, delayed symptom presentation, and immediate reporting. MAIN RESULTS: Concussions from varsity/intercollegiate sports [IPR of 1.73, 95% confidence interval (CI) 1.43-2.10] and intramurals (IPR of 1.53, 95% CI 1.02-2.32) accounted for a larger proportion in males, whereas concussions outside of sport and military activities accounted for a smaller proportion among males (IPR of 0.70, 95% CI 0.58-0.85). The proportion of concussions with prolonged recovery was lower among males (IPR of 0.69, 95% CI 0.60-0.78), while concussions with altered mental status (IPR of 1.23, 95% CI 1.09-1.38), LOC (IPR of 1.67, 95% CI 1.17-2.37), PTA (IPR of 1.94, 95% CI 1.43-2.62), and RGA (IPR of 2.14, 95% CI 1.38-3.31) accounted for a larger proportion among males. A larger proportion of concussions that were immediately reported was observed in males (IPR of 1.15, 95% CI 1.00-2.31). Proportions of other characteristics (e.g., recurrent injuries) were not different between sexes. CONCLUSIONS: A higher proportion of concussions occurred outside of sport and military training for female cadets, who also displayed proportionally longer recovery times than males, despite males demonstrating a higher proportion of LOC, PTA, and RGA. Possible factors may include different mechanisms of injury outside of sport and military training, different biopsychosocial states associated with sex or injury context, and delayed injury reporting when outside of an observed environment, possibly secondary to perceived stigma about reporting injuries.

Baseline concussion assessment performance by sex in military service academy rugby players: findings from the CARE Consortium.

BACKGROUND: Normative student-athlete concussion assessment data may not be appropriate for service academy members (SAMs), particularly rugby players, because of the uniqueness of their academic/military training environment. Having accurate baseline data for this population is important because of their high risk for concussion and frequent lack of assigned sports medicine professional. The primary purpose of this study was to characterise baseline performance on a concussion assessment battery, with secondary purpose to determine effect of sex and concussion history on these measures among SAM rugby players. METHODS: 601 rugby-playing SAMs (19.3±1.5 years, 37.9% female) completed baseline concussion assessments: the Sport Concussion Assessment Tool (SCAT) Symptom and Symptom Severity Checklist, Standard Assessment of Concussion (SAC) and a neuropsychological test (either ImPACT (Immediate Post Concussion Assessment and Cognitive Testing) or ANAM (Automated Neuropsychological Assessment Metrics)). Groups were compared using an independent samples t-test or Mann-Whitney U test. A 2 (sex) × 2 (concussion history) ANOVA was conducted to determine the effects of sex and concussion history on outcomes. RESULTS: Women reported greater SCAT total symptoms (3.3 vs 2.8, p<0.001, r=0.143) and symptom severities (5.7 vs 4.3, p<0.001, r=0.139), and performed worse on ImPACT Visual Memory (79.3 vs 82.6, p=0.002, r=0.144) than men. Women performed better than men on SAC (28.0 vs 27.7, p=0.03, r=0.088), ImPACT Reaction Time Composite (0.59 vs 0.61, p=0.04, r=0.092) and ANAM Code Substitution Delayed (64.3 vs 61.5, p=0.04, d=0.433). Individuals with a history of concussion reported lower ImPACT Symptom Severity (2.6 vs 4.2, p=0.02, r=0.110). There was no interaction between concussion history and sex on outcomes. CONCLUSIONS: These findings provide reference data for SAM rugby players on baseline assessments and to help in clinical decision-making when managing sports-related concussion in absence of baseline data.

Persistent prolongation of simple reaction time in sports concussion.

A baseline computerized cognitive assessment was completed by 483 military cadets before their initial school year. Fourteen cadets concussed during physical education boxing were retested <1 hour after injury and again on return to full activity 4 days later. Compared with baseline testing, postinjury performance on simple reaction time and continuous performance tests was significantly slowed, even after cadets experienced resolution of physical symptoms and were cleared to resume full activity. These findings may be relevant to current concussion management guidelines.

A standardized protocol for the initial evaluation and documentation of mild brain injury.

OBJECTIVE: To present a protocol for the initial assessment and documentation of mild brain injury, a protocol that is used within the Department of Physical Education at the United States Military Academy. BACKGROUND: Recently, much attention has been given to the assessment and management of mild brain injury by the sports medicine community. Although the classification of and management strategies for mild brain injury have been well disputed, most experts agree on the essentials of the sideline or initial evaluation. According to leading experts, if an athlete has experienced an episode of mild brain injury, the initial signs and symptoms, as well as the course of those signs and symptoms, should be documented. DESCRIPTION: Although many athletic training texts formerly discussed techniques for evaluating an episode of mild brain injury, few present an objective protocol to follow. Our protocol includes 3 components. The first component is the initial evaluation, which incorporates serial observations during the first 20 minutes after injury, with neurologic checks every 5 minutes. The second component includes a take-home sheet for athletes not referred to a physician for further evaluation. The third part of the protocol is a 24-hour postinjury follow-up examination for any signs or symptoms of postconcussion syndrome. Finally, we present the indications for referral to a physician for further evaluation. CLINICAL ADVANTAGES/RECOMMENDATIONS: Using a standard protocol to guide evaluation and to document the initial course of signs and symptoms after mild brain injury allows the sports medicine staff to make better management decisions. In addition, patient instructions and the course of follow-up evaluations can be improved if a standard protocol is employed. Our protocol has been developed to meet the needs both of athletes who are exposed to mild brain injury on a daily basis and of the certified athletic trainers who initially evaluate them; the protocol can be adapted to the individual needs of each athletic training setting.

Avulsion of the inferior canaliculus in a collegiate wrestler: a case study.

OBJECTIVE: The purpose of this case study is to aid sports health care personnel in understanding the accurate identification and treatment of traumatic sports injuries involving structures of the lacrimal system. BACKGROUND: A 21-year-old, 118-pound wrestler sustained an avulsion of the inferior canaliculus of the right eye during a match. The injury resulted when the athlete was struck on the right cheek by the opponent's head, producing an inferior and lateral force. Following the initial control of hemorrhage, the athlete was permitted to complete the match. Upon initial evaluation, it was determined that the medial aspect of the lower right lid had been avulsed. The injury was approximately 1 cm in length. The athlete completed the match before being referred to the hospital for further evaluation. DIFFERENTIAL DIAGNOSIS: Avulsion of the medial one-sixth of the lower right eyelid, involving damage to the inferior canaliculus lus and complete avulsion of the inferior medial canthal tendon. TREATMENT: Surgical intervention was indicated in order to restore the lacrimal drainage system and to ensure patency of the inferior canaliculus. A bicanalicular silicon intubation procedure edure was utilized by the physician. Initial postoperative treatment included the application of topical antibiotics for seven days. The athlete was permitted to return to full participation within 1 week with the use of a wrestling face mask. The superficial sutures were removed 14 days following surgery and at that time the athlete was cleared for unrestricted activity. The silicon-reinforced medial canthal tendon suture was removed 6 weeks following surgical repair. The bicanalicular silicon stent was removed 6 months following initial injury and surgical intervention. No complications were noted throughout the 6-month postoperative stage or at the time of a follow-up interview 2 years postinjury. UNIQUENESS: This is a relatively uncommon injury to encounter in athletics and one that has not been well addressed in the existing sports medicine literature. CONCLUSIONS: When injury to the medial aspect of the eye occurs, recognition of the potential for lacrimal system involvement is essential. Therefore, the athletic trainer should be familiar with the anatomy of the lacrimal system and the potential for such injuries.

Bishop tuff revisited: new rare Earth element data consistent with crystal fractionation.

The Bishop Tuff of eastern California is the type example of a high-silica rhyolite that, according to Hildreth, supposedly evolved by liquid-state differentiation. New analyses establish that the Bishop Tuff "earlyllate" rare earth element trend reported by Hildreth mimics the relations between groundmass glasses and whole rocks for allanite-bearing pumice. Differences in elemental concentrations between whole rock and groundmass are the result of phenocryst precipitation; thus the data of Hildreth are precisely those expected to result from crystal fractionation.