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1.
Cureus ; 13(11): e19247, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34877221

RESUMO

BACKGROUND:  Sickle cell trait (SCT) has received attention as a cause of death in college athletes, leading to mandatory lab SCT screening in National Collegiate Athletic Association (NCAA) athletes. High-school athletes are commonly screened by self-report. There are no known studies for evaluating whether this method is effective as a screening tool. HYPOTHESIS:  The local prevalence rate of SCT as self-reported on the preparticipation evaluation (PPE) forms would be lower than the national accepted average. METHODS: PPE forms from the Department of Orthopedics and Rehabilitation of the University of Florida (UF) were reviewed between January 1, 2017, and April 30, 2018. The Florida High School PPE form includes a yes/no question to assess the diagnosis of SCT. The prevalence established by self-report was then compared with the national prevalence for SCT in the comparable race/ethnicity groups reported by the CDC. The response rate of SCT questions was also compared to other common cardiac screening questions. RESULTS:  A total of 401 forms were reviewed. Six (1.5%) students answered "yes," 351 answered "no," and 44 left the SCT question blank. All six athletes who self-reported "yes" were Black and made up 3.7% of the 162 known Black respondents. This self-report rate for Black/African Americans was well below the expected 7.3% described by the CDC. Response rates were also lower than the comparable cardiac screening questions. CONCLUSIONS:  Self-report SCT status rates are lower than the accepted prevalence in a similar population. Significant inconsistencies in reporting were also determined. CLINICAL RELEVANCE:  This is a rare study to evaluate the self-reported prevalence of SCT in high-school athletes. Below average reporting of SCT and inconsistency in completion of the forms increase the concern for accuracy and effectiveness of current high-school SCT screening methods relying on self-report.

2.
J Athl Train ; 2021 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-34709396

RESUMO

CONTEXT: The King-Devick (K-D) is used to identify oculomotor impairment following concussion. However, the diagnostic accuracy of the K-D over time has not been evaluated. OBJECTIVE: (a) Examine the sensitivity and specificity of the K-D test at 0-6 hours of injury, 24-48 hours, asymptomatic, return-to-play, and 6-months following concussion and (b) compare outcomes for differentiating athletes with a concussion from non-concussed across confounding factors (sex, age, contact level, school year, learning disorder, ADHD, concussion history, migraine history, administration mode). DESIGN: Retrospective, cross-sectional design. SETTING: Multisite institutions within the Concussion Assessment, Research, and Education (CARE) Consortium. PATIENTS OR OTHER PARTICIPANTS: 1239 total collegiate athletes without a concussion (age=20.31±1.18, male=52.2%) were compared to 320 athletes with a concussion (age=19.80±1.41, male=51.3%). MAIN OUTCOME MEASURE(S): We calculated K-D time difference (sec) by subtracting baseline from the most recent time. Receiver operator characteristics (ROC) and area under the curve (AUC) analyses were used to determine the diagnostic accuracy across timepoints. We identified cutoff scores and corresponding specificity at 80% and 70% sensitivity levels. We repeated ROC with AUC outcomes by confounding factors. RESULTS: King-Devick predicted positive results at 0-6 hours (AUC=0.724, p<0.001), 24-48 hours (AUC=0.701, p<0.001), return-to-play (AUC=0.640, P<0.001), and 6-months (AUC=0.615, P<0.001), but not at asymptomatic (AUC=0.513, P=0.497). The 0-6 and 24-48-hour timepoints yielded an 80% sensitivity cutoff score of -2.6 and -3.2 seconds (faster) respectively, but 46% and 41% specificity. The K-D test had significantly better AUC when administered on an iPad (AUC=0.800, 95%CI:0.747,0.854) compared to the spiral card system (AUC=0.646, 95%CI:0.600,0.692; p<0.001). CONCLUSIONS: The K-D test has the greatest diagnostic accuracy at 0-6 and 24-48 hours of concussion, but declines across subsequent post-injury timepoints. AUCs did not significantly differentiate between groups for confounding factors. Our negative cutoff scores indicate that practice effects contribute to improved performance, requiring athletes to outperform their baseline.

4.
J Int Neuropsychol Soc ; 27(8): 790-804, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34548116

RESUMO

OBJECTIVE: The purpose of this study was to pilot safety and tolerability of a 1-week aerobic exercise program during the post-acute phase of concussion (14-25 days post-injury) by examining adherence, symptom response, and key functional outcomes (e.g., cognition, mood, sleep, postural stability, and neurocognitive performance) in young adults. METHOD: A randomized, non-blinded pilot clinical trial was performed to compare the effects of aerobic versus non-aerobic exercise (placebo) in concussion patients. The study enrolled three groups: 1) patients with concussion/mild traumatic brain injury (mTBI) randomized to an aerobic exercise intervention performed daily for 1-week, 2) patients with concussion/mTBI randomized to a non-aerobic (stretching and calisthenics) exercise program performed daily for 1-week, and 3) non-injured, no intervention reference group. RESULTS: Mixed-model analysis of variance results indicated a significant decrease in symptom severity scores from pre- to post-intervention (mean difference = -7.44, 95% CI [-12.37, -2.20]) for both concussion groups. However, the pre- to post-change was not different between groups. Secondary outcomes all showed improvements by post-intervention, but no differences in trajectory between the groups. By three months post-injury, all outcomes in the concussion groups were within ranges of the non-injured reference group. CONCLUSIONS: Results from this study indicate that the feasibility and tolerability of administering aerobic exercise via stationary cycling in the post-acute time frame following post-concussion (14-25 days) period are tentatively favorable. Aerobic exercise does not appear to negatively impact recovery trajectories of neurobehavioral outcomes; however, tolerability may be poorer for patients with high symptom burden.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Síndrome Pós-Concussão , Traumatismos em Atletas/complicações , Exercício Físico , Terapia por Exercício , Humanos , Síndrome Pós-Concussão/etiologia , Síndrome Pós-Concussão/terapia , Adulto Jovem
5.
J Am Coll Health ; : 1-5, 2021 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-34133912

RESUMO

PURPOSE: To describe the clinical presentation and prevalence of COVID-19 in a collegiate population at the time of initial recognition and testing. Methods: A retrospective chart review was performed of all students tested for COVID-19 at the University of Florida Student Health Care Center between March 9th and April 17th, 2020, comprising the first 6 weeks after spring break. Results: Twenty-five of 296 students (8.4%) tested positive for COVID-19. No significant differences were seen between positive and negative students regarding travel history or known exposures. Students who tested positive more commonly experienced fatigue, congestion, nausea, chest pain, anosmia, ageusia, anorexia, abdominal discomfort, and new problems sleeping over the course of illness. Conclusion: Initial symptoms unreliably clinically distinguish COVID-19 from other viral illnesses amongst college students. Providers should continue to have a low threshold for testing, especially as universities have seen large surges in cases related to students returning to campus.

6.
Am J Sports Med ; 49(8): 2211-2217, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33979240

RESUMO

BACKGROUND: Vestibular and ocular motor screening tools, such as the Vestibular/Ocular Motor Screening (VOMS), are recognized as important components of a multifaceted evaluation of sport-related concussion. Previous research has supported the predictive utility of the VOMS in identifying concussion, but researchers have yet to examine the predictive utility of the VOMS among collegiate athletes in the first few days after injury. PURPOSE: To determine the discriminative validity of individual VOMS item scores and an overall VOMS score for identifying collegiate athletes with an acute sport-related concussion (≤72 hours) from healthy controls matched by age, sex, and concussion history. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Participants (N = 570) aged 17 to 25 years were included from 8 institutions of the National Collegiate Athletic Association-Department of Defense CARE Consortium (Concussion Assessment, Research, and Education): 285 athletes who were concussed (per current consensus guidelines) and 285 healthy controls matched by age, sex, and concussion history. Participants completed the VOMS within 3 days of injury (concussion) or during preseason (ie, baseline; control). Symptoms are totaled for each VOMS item for an item score (maximum, 40) and totaled across items for an overall score (maximum, 280), and distance (centimeters) for near point of convergence (NPC) is averaged across 3 trials. Receiver operating characteristic analysis of the area under the curve (AUC) was performed on cutoff scores using Youden index (J) for each VOMS item, overall VOMS score, and NPC distance average. A logistic regression was conducted to identify which VOMS scores identified concussed status. RESULTS: A symptom score ≥1 on each VOMS item and horizontal vestibular/ocular reflex ≥2 significantly discriminated concussion from control (AUC, 0.89-0.90). NPC distance did not significantly identify concussion from control (AUC, 0.51). The VOMS overall score had the highest accuracy (AUC, 0.91) for identifying sport-related concussion from control. Among the individual items, vertical saccades ≥1 and horizontal vestibular/ocular reflex ≥2 best discriminated concussion from control. CONCLUSION: The findings indicate that individual VOMS items and overall VOMS scores are useful in identifying concussion in collegiate athletes within 3 days of injury. Clinicians can use the cutoffs from this study to help identify concussion in collegiate athletes.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Esportes , Atletas , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Estudos de Casos e Controles , Humanos
7.
Am J Sports Med ; 49(4): 1040-1048, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33600216

RESUMO

BACKGROUND: Vestibular and ocular symptoms in sport-related concussions are common. The Vestibular/Ocular-Motor Screening (VOMS) tool is a rapid, free, pen-and-paper tool that directly assesses these symptoms and shows consistent utility in concussion identification, prognosis, and management. However, a VOMS validation study in the acute concussion period of a large sample is lacking. PURPOSE: To examine VOMS validity among collegiate student-athletes, concussed and nonconcussed, from the multisite National Collegiate Athletic Association-Department of Defense Concussion Assessment, Research and Education (CARE) Consortium. A secondary aim was to utilize multidimensional machine learning pattern classifiers to deduce the additive power of the VOMS in relation to components of the Sport Concussion Assessment Tool 3 (SCAT3). STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Preseason and acute concussion assessments were analyzed for 419 student-athletes. Variables in the analysis included the VOMS, Balance Error Scoring System, Standardized Assessment of Concussion, and SCAT3 symptom evaluation score. Descriptive statistics were calculated for all tools, including Kolmogorov-Smirnov significance and Cohen d effect size. Correlations between tools were analyzed with Spearman r, and predictive accuracy was evaluated through an Ada Boosted Tree machine learning model's generated receiver operating characteristic curves. RESULTS: Total VOMS scores and SCAT3 symptom scores demonstrated significant increases in the acute concussion time frame (Cohen d = 1.23 and 1.06; P < .0001), whereas the Balance Error Scoring System lacked clinical significance (Cohen d = 0.17). Incorporation of VOMS into the full SCAT3 significantly boosted overall diagnostic ability by 4.4% to an area under the curve of 0.848 (P < .0001) and produced a 9% improvement in test sensitivity over the existing SCAT3 battery. CONCLUSION: The results from this study highlight the relevance of the vestibular and oculomotor systems to concussion and the utility of the VOMS tool. Given the 3.8 million sports-related and 45,121 military-related concussions per year, the addition of VOMS to the SCAT3 is poised to identify up to an additional 304,000 athletes and 3610 servicemembers annually who are concussed, thereby improving concussion assessment and diagnostic rates. Health care providers should consider the addition of VOMS to their concussion assessment toolkits, as its use can positively affect assessment and management of concussions, which may ultimately improve outcomes for this complex and common injury.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Esportes , Atletas , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Estudos de Coortes , Humanos , Testes Neuropsicológicos , Universidades
8.
Sports Med ; 51(5): 1087-1105, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33428120

RESUMO

BACKGROUND: Symptom resolution is a key marker in determining fitness for return to activity following concussion, but in some cases, distinguishing persistent symptoms due to concussion versus symptoms related to other factors can be challenging. OBJECTIVE: To determine base rates of postconcussional syndrome (PCS) diagnostic categorization in healthy cadets and student athletes with no recent concussion. METHODS: 13,009 cadets and 21,006 student athletes completed baseline preseason testing. After inclusion/exclusion criteria were applied, the final sample included 12,039 cadets [9123 men (75.8%); 2916 women (24.2%)] and 18,548 student athletes [10,192 men (54.9%); 8356 women (45.1%)]. Participants completed the Sport Concussion Assessment Tool-3rd Edition (SCAT3) symptom evaluation as part of baseline preseason testing. The PCS diagnostic categorization was classified by the International Classification of Diseases, 10th Revision (ICD-10) symptom criteria for PCS. RESULTS: In the absence of recent concussion, subgroups of cadets (17.8% of men; 27.6% of women) and student athletes (11.4% of men; 20.0% of women) reported a cluster of symptoms that would meet the ICD-10 symptom criteria for PCS. Participants with insufficient sleep and/or preexisting conditions (e.g., mental health problems), freshmen cadets, and cadets at the U.S. Coast Guard Academy and at the U.S. Air Force Academy (freshmen were tested during basic cadet training) were more likely to report a cluster of symptoms that would meet the ICD-10 symptom criteria for PCS. CONCLUSION: The ICD-10 symptom criteria for PCS can be mimicked by preexisting conditions, insufficient sleep, and/or stress. Findings support person-specific assessment and management of symptoms following concussion.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Síndrome Pós-Concussão , Atletas , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Feminino , Humanos , Masculino , Estudantes
9.
J Sport Health Sci ; 10(2): 154-161, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33188963

RESUMO

This review presents a conceptual framework and supporting evidence that links impaired motor control after sport-related concussion (SRC) to increased risk for musculoskeletal injury. Multiple studies have found that athletes who are post-SRC have higher risk for musculoskeletal injury compared to their counterparts. A small body of research suggests that impairments in motor control are associated with musculoskeletal injury risk. Motor control involves the perception and processing of sensory information and subsequent coordination of motor output within the central nervous system to perform a motor task. Motor control is inclusive of motor planning and motor learning. If sensory information is not accurately perceived or there is interference with sensory information processing and cognition, motor function will be altered, and an athlete may become vulnerable to injury during sport participation. Athletes with SRC show neuroanatomic and neurophysiological changes relevant to motor control even after meeting return to sport criteria, including a normal neurological examination, resolution of symptoms, and return to baseline function on traditional concussion testing. In conjunction, altered motor function is demonstrated after SRC in muscle activation and force production, movement patterns, balance/postural stability, and motor task performance, especially performance of a motor task paired with a cognitive task (i.e., dual-task condition). The clinical implications of this conceptual framework include a need to intentionally address motor control impairments after SRC to mitigate musculoskeletal injury risk and to monitor motor control as the athlete progresses through the return to sport continuum.


Assuntos
Traumatismos em Atletas/complicações , Concussão Encefálica/complicações , Sistema Musculoesquelético/lesões , Transtornos da Percepção/etiologia , Desempenho Psicomotor/fisiologia , Atletas , Encéfalo/diagnóstico por imagem , Concussão Encefálica/reabilitação , Retroalimentação Sensorial/fisiologia , Humanos , Movimento/fisiologia , Força Muscular/fisiologia , Músculo Esquelético/fisiopatologia , Exame Neurológico , Monitorização Neurofisiológica/métodos , Transtornos da Percepção/terapia , Equilíbrio Postural/fisiologia , Volta ao Esporte , Análise e Desempenho de Tarefas
10.
Am J Cardiol ; 140: 134-139, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33144161

RESUMO

Knowledge of cardiovascular adaptations in athletes has predominantly focused on males, with limited data available on females who compromise a substantial percentage of all collegiate athletes. A multicenter retrospective cohort review of preparticipation cardiovascular screening data of 329 National Collegiate Athletic Association Division I female athletes was performed. This included physical exams, electrocardiograms, and echocardiograms. Female athletes in class IB sports had elevated systolic blood pressure (p = 0.01). For electrocardiograms, 7 (2%) had abnormal findings: 100% were white; 6 of 7 (86%) participated in IIC sports. Black athletes had longer PR intervals (p ≤ 0.001), whereas white athletes had longer QTc and QRS durations (p = 0.02 and 0.01, respectively). Athletes in IC and IIC sports had longer QTc intervals (p = 0.01). For echocardiographic parameters, no differences were noted based on race. However, significant differences were noted based on classification of sport: athletes in class IC sports had higher left-atrial volume indexes and E/A ratios. Athletes in class IB and IIC had increased left-ventricular wall thicknesses and aortic root dimensions. In conclusion, among one of the largest cohorts of collegiate female athlete preparticipation cardiac screening data to date, significant differences in various parameters based on classification of sport and race were observed. These categorizations should be considered when interpreting cardiovascular screening in female collegiate athletes to improve screening and guide future research.


Assuntos
Atletas , Doenças Cardiovasculares/diagnóstico , Ecocardiografia/métodos , Eletrocardiografia/métodos , Programas de Rastreamento/métodos , Universidades , Adolescente , Feminino , Seguimentos , Humanos , Estudos Retrospectivos
11.
Clin J Sport Med ; 31(4): e213-e215, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31860544

RESUMO

CASE: A 20-year-old male collegiate basketball player was evaluated for sudden chest pain, shortness of breath, dizziness, and blurry vision, following an elbow to the anterior chest by another player. His symptoms improved over 10 minutes of observation, but rhythm strip performed onsite showed atrial fibrillation, and the athlete was transmitted to the emergency department for further evaluation. Electrocardiogram in the ER confirmed atrial fibrillation with a rate of 85 bpm. Electrocardioversion was being arranged when he spontaneously converted to normal sinus rhythm, 2.5 hours from the traumatic event. CONCLUSIONS: Our case illustrates an unusual example of atrial fibrillation induced by commotio cordis (AFCC). Although less acutely life threatening and much less frequently described than ventricular fibrillation induced by commotio cordis, AFCC should be considered in the differential after blunt chest wall trauma. Currently, there are little data regarding management of patients with AFCC.


Assuntos
Traumatismos em Atletas/complicações , Fibrilação Atrial , Commotio Cordis , Traumatismos Torácicos , Fibrilação Atrial/etiologia , Commotio Cordis/diagnóstico , Commotio Cordis/etiologia , Humanos , Masculino , Traumatismos Torácicos/complicações , Fibrilação Ventricular , Adulto Jovem
12.
Cureus ; 12(9): e10526, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-33094067

RESUMO

Intracranial hypotension can be a common sequela of a cerebrospinal fluid (CSF) leak. However, evidence of such a condition related to an injury in American football is currently lacking in the literature. While a positional or orthostatic headache is the most classic symptom of headaches due to intracranial hypotension, a variety of nonspecific symptoms such as neck pain, nausea, vomiting, photophobia, phonophobia, and visual changes can also be present. We present two cases where collegiate American football players developed protracted headaches after a concussive injury and were subsequently diagnosed with intracranial hypotension thought secondary to spinal CSF leaks.  Both players underwent multiple procedures of fluoroscopic-guided autologous blood patching, with improvement in their headaches. Recovery varied between the athletes. Case 1 achieved full resolution of his headaches and returned to full activity. Case 2 continued to have intermittent headaches after blood patching, but the positional nature had resolved and he was cleared for full participation in football and was closely followed during the remainder of his collegiate career. Both these cases emphasize the importance of including CSF leak as a cause of post-traumatic headache in an American football player.

13.
Neurology ; 95(21): e2935-e2944, 2020 11 24.
Artigo em Inglês | MEDLINE | ID: mdl-32907967

RESUMO

OBJECTIVE: To examine the association between estimated age at first exposure (eAFE) to American football and clinical measures throughout recovery following concussion. METHODS: Participants were recruited across 30 colleges and universities as part of the National Collegiate Athletic Association (NCAA)-Department of Defense Concussion Assessment, Research and Education Consortium. There were 294 NCAA American football players (age 19 ± 1 years) evaluated 24-48 hours following concussion with valid baseline data and 327 (age 19 ± 1 years) evaluated at the time they were asymptomatic with valid baseline data. Participants sustained a medically diagnosed concussion between baseline testing and postconcussion assessments. Outcome measures included the number of days until asymptomatic, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) composite scores, Balance Error Scoring System (BESS) total score, and Brief Symptom Inventory 18 (BSI-18) subscores. The eAFE was defined as participant's age at the time of assessment minus self-reported number of years playing football. RESULTS: In unadjusted regression models, younger eAFE was associated with lower (worse) ImPACT Visual Motor Speed (R 2 = 0.031, p = 0.012) at 24-48 hours following injury and lower (better) BSI-18 Somatization subscores (R 2 = 0.014, p = 0.038) when the athletes were asymptomatic. The effect sizes were very small. The eAFE was not associated with the number of days until asymptomatic, other ImPACT composite scores, BESS total score, or other BSI-18 subscores. CONCLUSION: Earlier eAFE to American football was not associated with longer symptom recovery, worse balance, worse cognitive performance, or greater psychological distress following concussion. In these NCAA football players, longer duration of exposure to football during childhood and adolescence appears to be unrelated to clinical recovery following concussion.


Assuntos
Traumatismos em Atletas/terapia , Concussão Encefálica/terapia , Futebol Americano/lesões , Adolescente , Adulto , Distribuição por Idade , Atletas , Traumatismos em Atletas/complicações , Concussão Encefálica/diagnóstico , Humanos , Masculino , Testes Neuropsicológicos , Estudantes , Estados Unidos , Universidades , Adulto Jovem
14.
Am J Sports Med ; 48(11): 2783-2795, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32809856

RESUMO

BACKGROUND: Identifying separate dimensions of concussion symptoms may inform a precision medicine approach to treatment. It was previously reported that a bifactor model identified distinct acute postconcussion symptom dimensions. PURPOSE: To replicate previous findings of a bifactor structure of concussion symptoms in the Concussion Assessment Research and Education (CARE) Consortium sample, examine measurement invariance from pre- to postinjury, and evaluate whether factors are associated with other clinical and biomarker measures. STUDY DESIGN: Cohort study (Diagnosis); Level of evidence, 2. METHODS: Collegiate athletes were prospectively evaluated using the Sport Concussion Assessment Tool-3 (SCAT-3) during preseason (N = 31,557); 2789 were followed at <6 hours and 24 to 48 hours after concussion. Item-level SCAT-3 ratings were analyzed using exploratory and confirmatory factor analyses. Bifactor and higher-order models were compared for their fit and interpretability. Measurement invariance tested the stability of the identified factor structure across time. The association between factors and criterion measures (clinical and blood-based markers of concussion severity, symptom duration) was evaluated. RESULTS: The optimal structure for each time point was a 7-factor bifactor model: a General factor, on which all items loaded, and 6 specific factors-Vestibulo-ocular, Headache, Sensory, Fatigue, Cognitive, and Emotional. The model manifested strict invariance across the 2 postinjury time points but only configural invariance from baseline to postinjury. From <6 to 24-48 hours, some dimensions increased in severity (Sensory, Fatigue, Emotional), while others decreased (General, Headache, Vestibulo-ocular). The factors correlated with differing clinical and biomarker criterion measures and showed differing patterns of association with symptom duration at different time points. CONCLUSION: Bifactor modeling supported the predominant unidimensionality of concussion symptoms while revealing multidimensional properties, including a large dominant General factor and 6 independent factors: Headache, Vestibulo-ocular, Sensory, Cognitive, Fatigue, and Emotional. Unlike the widely used SCAT-3 symptom severity score, which declines gradually after injury, the bifactor model revealed separable symptom dimensions that have distinct trajectories in the acute postinjury period and different patterns of association with other markers of injury severity and outcome. CLINICAL RELEVANCE: The SCAT-3 total score remains a valuable, robust index of overall concussion symptom severity, and the specific factors identified may inform management strategies. Because some symptom dimensions continue to worsen in the first 24 to 48 hours after injury (ie, Sensory, Fatigue, Emotional), routine follow-up in this time frame may be valuable to ensure that symptoms are managed effectively.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Adolescente , Concussão Encefálica/diagnóstico , Lista de Checagem , Estudos de Coortes , Feminino , Humanos , Masculino , Fatores de Tempo , Adulto Jovem
15.
Sports Med ; 50(10): 1843-1855, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32557231

RESUMO

BACKGROUND: The absence of evidence-based guidelines make medical disqualification (MDQ) following concussion one of the most challenging decision-making processes faced by sports medicine professionals. OBJECTIVE: We aimed to compare premorbid and postmorbid factors between student-athletes that were and were not medically disqualified from sport following a concussion. METHODS: Among 1832 student-athletes diagnosed with concussion within the CARE Consortium, 53 (2.9%) were medically disqualified (MDQ +) and 1779 (97.1%) were not medically disqualified (MDQ-). We used contingency tables and descriptive statistics for an initial evaluation of a broad list of premorbid and postmorbid factors. For those factors showing association with MDQ status, we calculated odds ratios and 95% confidence intervals for the odds of being MDQ + in the presence of the identified factor. RESULTS: History of 2 (OR: 3.2, 95% CI 1.5, 6.9) or 3 + (OR: 7.4, 95% CI 3.4, 15.9) previous concussions; 1 + headaches in past 3 months (OR: 1.8, 95% CI 1.0, 3.2); immediate removal from play (OR: 2.4, 95% CI 1.2, 4.9); alcohol (OR: 2.6, 95% CI 1.2, 5.4), tobacco (OR: 3.3, 95% CI 1.1, 9.5), or marijuana use since injury (OR: 5.4, 95% CI 1.5, 19.0); as well as prolonged recovery due to mental health alterations (OR: 5.3, 95% CI 2.0, 14.1) or motivation/malingering (OR: 7.5, 95% CI 3.3, 17.0) increased odds of being MDQ + . The MDQ + group took longer to become asymptomatic relative to the MDQ- group (MDQ + : 23.5 days, 95% CI 15.8, 31.2; MDQ-: 10.6 days, 95% CI 9.5, 11.6; p < 0.001). CONCLUSIONS: MDQ following concussion was relatively rare. We identified three patterns related to MDQ following concussion: (1) concussion and headache history were the only premorbid factors that differed (2) initial concussion presentation was more severe and more immediate in the MDQ + group, and (3) post-concussion recovery outcomes expressed the greatest differences between groups.


Assuntos
Traumatismos em Atletas/fisiopatologia , Concussão Encefálica/fisiopatologia , Tomada de Decisão Clínica , Volta ao Esporte , Feminino , Humanos , Masculino , Fatores de Risco , Universidades
16.
Am J Sports Med ; 48(6): 1476-1484, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32298132

RESUMO

BACKGROUND: Organizations recommend that athletes should be asymptomatic or symptom-limited before initiating a graduated return-to-play (GRTP) protocol after sports-related concussion, although asymptomatic or symptom-limited is not well-defined. HYPOTHESES: (1) There will be a range (ie, beyond zero as indicator of "symptom-free") in symptom severity endorsement when athletes are deemed ready to initiate a GRTP protocol. (2) Baseline symptom severity scores and demographic/preinjury medical history factors influence symptom severity scores at the commencement of the GRTP protocol. (3) Greater symptom severity scores at GRTP protocol initiation will result in longer protocol duration. (4) Symptom severity scores will not differ between those who did and did not sustain a repeat injury within 90 days of their initial injury. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Across 30 universities, athletes (N = 1531) completed assessments at baseline and before beginning the GRTP protocol, as determined by local medical staff. Symptom severity scores were recorded with the symptom checklist of the Sport Concussion Assessment Tool-3rd Edition. Nonparametric comparisons were used to examine the effect of medical, demographic, and injury factors on symptom endorsement at GRTP protocol initiation, as well as differences in symptom severity scores between those who did and did not sustain a repeat injury within 90 days. A Cox regression was used to examine the association between symptom severity scores at GRTP protocol initiation and protocol duration. RESULTS: Symptom severity scores at the time when the GRTP protocol was initiated were as follows: 0 to 5 (n = 1378; 90.0%), 6 to 10 (n = 76; 5.0%), 11 to 20 (n = 42; 3.0%), and ≥21 (n = 35; 2.0%). Demographic (sex and age), medical (psychiatric disorders, attention-deficit/hyperactivity disorder, learning disorder), and other factors (baseline symptom endorsement and sleep) were significantly associated with higher symptom severity scores at the GRTP initiation (P < .05). The 4 GRTP initiation time point symptom severity score groups did not significantly differ in total time to unrestricted RTP, χ2(3) = 1.4; P = .73. When days until the initiation of the GRTP protocol was included as a covariate, symptom severity scores between 11 and 20 (P = .02; hazard ratio = 1.44; 95% CI, 1.06-1.96) and ≥21 (P < .001; hazard ratio = 1.88; 95% CI, 1.34-2.63) were significantly associated with a longer GRTP protocol duration as compared with symptom severity scores between 0 and 5. Symptom severity scores at GRTP initiation did not significantly differ between those who sustained a repeat injury within 90 days and those who did not (U = 29,893.5; P = .75). CONCLUSION: A range of symptom severity endorsement was observed at GRTP protocol initiation, with higher endorsement among those with higher baseline symptom endorsement and select demographic and medical history factors. Findings suggest that initiation of a GRTP protocol before an absolute absence of all symptoms is not associated with longer progression of the GRTP protocol, although symptom severity scores >10 were associated with longer duration of a GRTP protocol. Results can be utilized to guide clinicians toward optimal GRTP initiation (ie, balancing active recovery with avoidance of premature return to activity).


Assuntos
Atletas/psicologia , Traumatismos em Atletas/reabilitação , Concussão Encefálica/reabilitação , Síndrome Pós-Concussão/psicologia , Volta ao Esporte , Esportes , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/psicologia , Concussão Encefálica/diagnóstico , Concussão Encefálica/psicologia , Estudos de Coortes , Humanos , Testes Neuropsicológicos , Qualidade de Vida , Universidades
17.
Sports Med ; 50(8): 1549, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32125667

RESUMO

Unfortunately, in the published article the symbol "% ile" has incorrectly been published as "‰". We have now corrected this in all the occurrences.

18.
J Neurotrauma ; 37(13): 1537-1545, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32024456

RESUMO

We prospectively evaluated serum concentrations of glial fibrillary acidic protein (GFAP), ubiquitin c-terminal hydrolase L1 (UCH-L1), total tau (T-Tau), and neurofilament light (NF-L) from collegiate athletes at baseline and acutely after sport-related concussion (SRC) using the Quanterix Neurology 4Plex "B" (N4PB) multiplex assay. Uninjured controls were matched on age, sex, race, sport, and concussion history. Clinical outcomes included acute symptom severity, balance, rapid automated naming, computerized cognitive testing, and recovery duration. Baseline (n = 110; median [interquartile range] age = 19 [18-20] years, 54% male, 61% white/Caucasian) and post-SRC (n = 36; median [interquartile range] age = 19 [18-20] years, 50% male, 61% white/Caucasian) blood samples were analyzed. We observed post-SRC elevations from baseline for GFAP (p = 0.001, d = 1.7), T-Tau (p = 0.004, d = 1.3), and NF-L (p = 0.010, d = 1.1). GFAP (area under the curve [AUC] = 0.958, 95% confidence interval [CI] 0.927-0.989, p < 0.001) and NF-L (AUC = 0.904, 95% CI 0.851-0.957, p < 0.001) accurately discriminated SRC from control cases. There were no associations between biomarker concentrations and clinical measurements post-SRC or recovery duration. These findings suggest that, using the multiplex assay, GFAP, T-Tau, and NF-L elevate from baseline acutely after SRC, and both GFAP and NF-L excellently distinguished concussed from control cases. Serum biomarker changes do not necessarily correspond with clinical measurements or recovery duration.


Assuntos
Traumatismos em Atletas/sangue , Concussão Encefálica/sangue , Proteína Glial Fibrilar Ácida/sangue , Proteínas de Neurofilamentos/sangue , Ubiquitina Tiolesterase/sangue , Proteínas tau/sangue , Adolescente , Traumatismos em Atletas/diagnóstico , Bioensaio/métodos , Biomarcadores/sangue , Concussão Encefálica/diagnóstico , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Estudos Prospectivos , Esportes , Fatores de Tempo , Adulto Jovem
19.
Prim Care ; 47(1): 177-188, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32014133

RESUMO

Injuries from sports-related head trauma are commonly encountered by primary care providers. These injuries vary in clinical presentation, severity, and outcome, with sports-related concussion (SRC) being the most common and more severe sports-related head trauma, such as hemorrhage, and "second impact syndrome" occurring rarely. Understanding the importance of immediate recognition, removal from play, multimodal evaluation, and typical patterns of recovery is necessary to safely manage an athlete with SRC. Proper care of athletes with severe sports-related head trauma requires a high index of suspicion and appropriate initial management to maximize survival and minimize morbidity.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia , Traumatismos Craniocerebrais , Doença Aguda , Concussão Encefálica/complicações , Feminino , Humanos , Masculino
20.
Sports Med ; 50(8): 1533-1547, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32034702

RESUMO

BACKGROUND: Sports medicine clinicians routinely use computerized neurocognitive testing in sport-related concussion management programs. Debates continue regarding the appropriateness of normative reference comparisons versus obtaining individual baseline assessments, particularly for populations with greater likelihood of having below- or above-average cognitive abilities. Improving normative reference methods could offer alternatives to perceived logistical and financial burdens imposed by universal baseline testing. OBJECTIVES: To develop and validate the Concussion Assessment, Research, and Education (CARE) Consortium Multiple Variable Prediction (MVP) norms for the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT). METHODS: We developed the CARE-MVP norms for ImPACT composite scores using regression-based equations. Predictor variables included sex, race (white/Caucasian, black/African American, Asian, or Multiple Races), medical history [attention-deficit/hyperactivity disorder (ADHD), learning disorder (LD), prior concussion(s), prior psychiatric diagnosis], and an estimate of premorbid intellect (Wechsler Test of Adult Reading). CARE-MVP norms were first validated in an independent sample of healthy collegiate athletes by comparing predicted and actual baseline test scores using independent-samples t-tests and Cohen's d effect sizes. We then evaluated base rates of low scores in athletes self-reporting ADHD/LD (vs. non-ADHD/LD) and black/African American race (vs. white/Caucasian) across multiple normative reference methods (Chi square, Cramer's V effect size). Lastly, we validated the CARE-MVP norms in a concussed sample (dependent samples t test, Cohen's d effect size). RESULTS: A total of 5233 collegiate athletes (18.8 ± 1.2 years, 70.5% white/Caucasian, 39.1% female) contributed to the CARE-MVP norms (development N = 2616; internal validation N = 2617). Race and WTAR score were the strongest and most consistent ImPACT score predictors. There were negligible mean differences between observed and predicted (CARE-MVP) baseline scores (Cohen's d < 0.1) for all ImPACT composite scores except Reaction Time (predicted ~ 20 ms faster than observed, d = - 0.28). Low score base rates were similar for athletes across subpopulations when using CARE-MVP norms (ADHD/LD, V = 0.017-0.028; black/African American, V = 0.043-0.053); while, other normative reference methods resulted in disproportionately higher rates of low scores (ADHD/LD, V = 0.062-0.101; black/African American race, V = 0.163-0.221). Acute (24-48 h) postconcussion ImPACT scores were significantly worse than CARE-MVP norms but notably varied as a function of concussion symptom severity. CONCLUSIONS: Results support CARE-MVP norm use in populations typically underrepresented or not adjusted for in traditional normative reference samples, such as those self-reporting ADHD/LD or black/African American race. CARE-MVP norms improve upon prior normative methods and may offer a practical, simple alternative for collegiate institutions concerned about logistical and financial burden associated with baseline testing. An automated scoring program is provided.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Testes Neuropsicológicos/normas , Medicina Esportiva/normas , Adolescente , Atletas , Transtorno do Deficit de Atenção com Hiperatividade , Cognição , Feminino , Humanos , Inteligência , Masculino , Valores de Referência , Adulto Jovem
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