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Unrecognised ringside concussive injury in amateur boxers
  1. James M Moriarity1,
  2. Robert H Pietrzak2,
  3. Jeffrey S Kutcher3,
  4. Margaretha Helen Clausen4,
  5. Kevin McAward1,
  6. David G Darby5
  1. 1Athletics Department, University of Notre Dame, Notre Dame, Indiana, USA
  2. 2Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
  3. 3Neurosport, University of Michigan, Ann Arbor, Michigan, USA
  4. 4Centre for Health, Exercise and Sports Medici, University of Melbourne, Melbourne, Australia
  5. 5Mental Health Research Institute, University of Melbourne, Parkville, Australia
  1. Correspondence to David Darby, Mental Health Research Institute, National Neuroscience Facility, Level 3, Alan Gilbert Building, University of Melbourne, Parkville, Victoria 3010, Australia; ddarby{at}


Objectives Concussion is common in contact sports such as boxing. Diagnosis of concussion depends on symptom report or recognition of clinical features, and true incidence may be underestimated. Persistent morbidity is a possible risk of repeated or unrecognised concussion. This study aimed to evaluate pre and postbout cognitive performance in motivated amateur boxers in order to detect objective evidence of unrecognised cognitive impairment suggestive of concussive injury.

Methods The study employed a prospective and observational design. Participants were amateur boxers who won at least one bout in a single elimination competition. Optimal preparticipation performance using a computerised cognitive assessment tool (CCAT, Axon Sports) and no significant deterioration in cognitive performance within 24 h postbout were required to compete. All boxers were screened for clinical evidence of concussion by a ringside physician.

Results Of approximately 200 competing boxers, 96 were eligible having won at least one of the total 160 bouts. Mean age was 21.3 (SD 1.9) years (range 18.5–29.7). Of these, 17 (10.6%) failed their first postbout CCAT, with 12 (71%) passing a repeat test. Of the five remaining boxers, there were two boxers (1.3% of bouts) not suspected of a concussion after their bouts, who showed evolving slowing in cognitive performance typical of a concussion.

Conclusions Cognitive impairment, as detected by subtle deterioration in reaction time measures, can occur in amateur boxers postbout that is not recognised at ringside. Although the vast majority of bouts were conducted safely, unrecognised injury may occur and be detectable using objective computerised cognitive assessment.

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  • Competing interests Dr Darby is a shareholder and consultant for CogState Ltd, and neurologist employed in academic and private practice. Dr Moriarity is a sports physician employed at the University of Notre Dame, and consultant for Axon Sports. Dr McCrory is a neurologist, and received research and educational funding from Cogstate Ltd. Dr Pietrzak is a neuropsychologist and consultant for CogState Ltd. Dr Kutcher is Sports Section Chair for the American Academy of Neurology. Dr Clausen is a neuropsychologist. Dr McAward is a sports physician employed at the University of Notre Dame.

  • Ethics approval University of Notre Dame.

  • Provenance and peer review Not commissioned; externally peer reviewed.