Article Text
Abstract
Objective We compared data from the National Collegiate Athletic Association (NCAA) Concussion Study (1999–2001) and the NCAA-Department of Defense Concussion Assessment, Research and Education (CARE) Consortium (2014–2017) to examine how clinical management, return to play (RTP) and risk of repeat concussion in collegiate football players have changed over the past 15 years.
Methods We analysed data on reported duration of symptoms, symptom-free waiting period (SFWP), RTP and occurrence of within-season repeat concussion in collegiate football players with diagnosed concussion from the NCAA Study (n=184) and CARE (n=701).
Results CARE athletes had significantly longer symptom duration (CARE median=5.92 days, IQR=3.02–9.98 days; NCAA median=2.00 days, IQR=1.00–4.00 days), SFWP (CARE median=6.00 days, IQR=3.49–9.00 days; NCAA median=0.98 days, IQR=0.00–4.00 days) and RTP (CARE median=12.23 days, IQR=8.04–18.92 days; NCAA median=3.00 days, IQR=1.00–8.00 days) than NCAA Study athletes (all p<0.0001). In CARE, there was only one case of repeat concussion within 10 days of initial injury (3.7% of within-season repeat concussions), whereas 92% of repeat concussions occurred within 10 days in the NCAA Study (p<0.001). The average interval between first and repeat concussion in CARE was 56.41 days, compared with 5.59 days in the NCAA Study (M difference=50.82 days; 95% CI 38.37 to 63.27; p<0.0001).
Conclusion Our findings indicate that concussion in collegiate football is managed more conservatively than 15 years ago. These changes in clinical management appear to have reduced the risk of repetitive concussion during the critical period of cerebral vulnerability after sport-related concussion (SRC). These data support international guidelines recommending additional time for brain recovery before athletes RTP after SRC.
- concussion
- sports injuries
- mild traumatic brain injury
- injury prevention
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Footnotes
Correction notice This article has been corrected since it published Online First. The author group 'CARE Consortium Investigators' has been added.
Contributors The authors thank Jody Harland, Janetta Matesan, Larry Riggen (Indiana University); Ashley Rettmann (University of Michigan); Melissa Koschnitzke (Medical College of Wisconsin); Michael Jarrett, Vibeke Brinck and Bianca Byrne (Quesgen); Melissa Niceley Baker and Sara Dalton (Datalys Center for Sports Injury Research and Prevention); and the research and medical staff at each of the CARE participation sites. Contributing CARE Consortium Investigators are listed alphabetically by institution: April Marie (Reed) Hoy, MS, ATC (Azusa Pacific University); Joseph B Hazzard Jr, EdD, ATC (Bloomsburg University); Louise A Kelly, PhD (California Lutheran University); Justus D Ortega, PhD (Humboldt State University); Nicholas Port, PhD (Indiana University); Margot Putukian, MD (Princeton University); T Dianne Langford, PhD, and Ryan Tierney, PhD, ATC (Temple University); Paul Pasquina, MD (Uniformed Services University of Health Sciences); Darren E Campbell, MD, Jonathan Jackson, MD, and Gerald McGinty, DPT (US Air Force Academy); Patrick O’Donnell, MHA (US Coast Guard Academy); Kenneth Cameron, MPH, PhD, ATC, Megan Houston, PhD, and Steven Svoboda, MD (US Military Academy); Christopher Giza, MD, Joshua Goldman, MD, and Jon DiFiori, MD (University of California-Los Angeles); Holly J Benjamin MD (University of Chicago); Thomas Buckley, EdD, ATC, and Thomas W Kaminski, PhD, ATC (University of Delaware); James R Clugston, MD, MS (University of Florida); Julianne D Schmidt, PhD, ATC (University of Georgia); Luis A Feigenbaum, PT, DPT, ATC, LAT (University of Miami); James T Eckner, MD, MS (University of Michigan); Jason P Mihalik, PhD, CAT(C), ATC (University of North Carolina at Chapel Hill); Jessica Dysart Miles, PhD, ATC (University of North Georgia); Scott Anderson, ATC (University of Oklahoma); Kristy Arbogast, PhD, and Christina L Master, MD (University of Pennsylvania); Micky Collins, PhD, and Anthony P Kontos, PhD (University of Pittsburgh Medical Center); Jeffrey J Bazarian, MD, MPH (University of Rochester); Sara PD Chrisman, MD, MPH (University of Washington); M Alison Brooks, MD, MPH (University of Wisconsin); Stefan Duma, PhD, and Steven Rowson, PhD (Virginia Tech); Christopher M Miles, MD (Wake Forest University); Brian H Dykhuizen, MS, ATC (Wilmington College); Laura Lintner, DO (Winston-Salem State University).
Funding This publication was made possible, in part, with support from the Grand Alliance Concussion Assessment, Research and Education (CARE) Consortium, funded, in part by the National Collegiate Athletic Association (NCAA) and the Department of Defense (DOD). The US Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702-5014 is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under Award No W81XWH-14-2-0151.
Disclaimer Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Department of Defense (DHP funds).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The NCAA Concussion Study was approved by the institutional review boards for protection of human research subjects at the University of North Carolina (KMG) and Waukesha Memorial Hospital (MMC). For the CARE Consortium, the University of Michigan Institutional Review Board, the US Army Medical Research and Materiel Command Human Research Protection Office, and the local institutional review board at each of the study sites reviewed all study procedures. The study was performed in accordance with the standards of ethics outlined in the Declaration of Helsinki. All participants in both studies granted written informed consent prior to participation in the study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data for this study from the NCAA Concussion Study are available upon reasonable request from the corresponding author. Data for this study from the CARE Consortium are publicly available from the National Institute of Health (NIH) Federal Interagency Traumatic Brain Injury (TBI) Research (FITBIR) Informatics System (https://fitbir.nih.gov).