Recovery duration and concussion severity in sport- and non-sport-related concussion among Pac-12 collegiate athletes: a retrospective cohort study.

To examine non-sport- and sport-related concussion severity, clinical care frequency and delayed reporting in relation to recovery duration among collegiate athletes. Retrospective cohort study. Pac-12 varsity collegiate athletes. 461 collegiate male and female athletes PRIMARY AND SECONDARY OUTCOME MEASURES: The incidence of sport-related concussion (SRC) and non-sport-related concussion (NRC) were collected as well as times to recovery and return-to-play (RTP), symptom score and symptom severity and reported a loss of consciousness (LOC), retrograde amnesia (RGA) and post-traumatic amnesia (PTA) following concussion incidence. Among 461 concussions, 388 (84%) occurred within sport and 73 (16%) occurred outside of sport. NRC, on average, required 3.5 more days to become asymptomatic (HR: 0.73, 95%confidence interval: 0.56 to 0.96, p=0.02) and 7 more days to RTP (HR: 0.64, 95% confidence interval: 0.49 to 0.85, p<0.01) compared with SRC. NRC were associated with an increase of 1.83 (p=0.07) symptoms reported at the time of diagnosis, an increase of 6.95 (p=0.06) in symptom severity and a higher prevalence of reported LOC (22% NRC vs. 3% SRC, p<0.001), PTA (15% NRC vs. 5% SRC, p<0.01) and RGA (10% NRC vs. 4% SRC, p=0.06), compared with SRC. There was no significant difference in clinical care (p=0.28) or immediate reporting (p=0.35) between NRC and SRC. NRC were associated with greater severity and longer recovery duration when compared with SRC in a cohort of collegiate athletes.

Konstantinides N ，Geraghty E ，Harmon K ，Whelan BM ，Poddar SK ，Bohr A ... -  《BMJ Open》

Prior Concussion History and Clinical Recovery Following Sport-Related Concussion in College Athletes.

The aim of this study was to assess whether a history of prior concussions, and especially multiple prior concussions, is associated with clinical recovery following a subsequent sport-related concussion among collegiate student athletes. A naturalistic observational cohort study. Eleven National Collegiate Athletics Association Division III colleges. Collegiate athletes sustaining concussions from September 2014 through March 2020. Participants were divided into 3 groups, athletes with: (1) no prior concussion history, (2) one prior concussion, and (3) 2 or more prior concussions. Survival analyses were used to compare time to return to school and sports among athletes with a history of 0, 1, or ≥2 prior concussions. Among the 1132 college athletes, there were no statistically significant group differences between those with 0, 1, or ≥2 prior concussions in total time to return to school or sports. There was a statistically significant difference in the proportion of athletes with ≥2 prior concussions that had not fully returned to school, without accommodations, at 28 days (6.0%) compared to athletes with no prior concussions (2.2%; odds ratio = 2.80, 95% confidence interval 1.29-6.04). In summary, concussion history was not associated with time to return to sports following a subsequent sport-related concussion in these college athletes. On average, athletes with prior concussions did not take longer to return to school, although a slightly greater proportion of college athletes with ≥2 prior concussions had not fully returned to school, without accommodations, by 28 days following injury.

Gaudet CE ，Iverson GL ，Zafonte R ，Berkner PD ，Cook NE ... -  《-》

Factors Associated With Return to Activity After Concussion Among Female Service Academy Members: Findings From the NCAA-DoD CARE Consortium.

Service academy members are at high risk for concussions as a result of participation in both sports and military-specific training activities. Approximately 17% of active duty service members are female, and they face unique challenges in achieving timely recovery from concussions. Understanding the unique characteristics affecting return to unrestricted activity (RTA) among female service academy members is imperative for the ever-growing proportion of females across the U.S. military. The goal of this analysis was to determine how specific injury and individual characteristics of concussion affect 2 RTA protocol events in female service academy members: time to protocol initiation and time to protocol completion. All data were collected as part of the National Collegiate Athletic Association (NCAA) and the DoD Concussion Assessment, Research and Education Consortium. We examined data from female U.S. military service academy members at the 4 U.S. Service Academy sites who sustained a concussion between Fall 2014 and Spring 2020 (N = 752). Return to unrestricted activity protocol initiation time was defined as the time from injury to when cadets were cleared to begin gradual RTA, while RTA protocol completion time was defined as the time from injury to when cadets were cleared to RTA. Multivariable Cox regression analyses were used to determine the effect of 4 characteristics on RTA event times: (1) service academy members' NCAA status (e.g., student athlete), (2) prior history of concussion, (3) reporting time of concussion, and (4) sport-related concussion (SRC) or non-SRC. Because of missing data, 520 cadets were included in the model of RTA protocol initiation and 556 were included in the model of RTA protocol completion. Chi-squared analyses assessed interactions between reporting time, NCAA status, and SRC or non-SRC. Service academy members who were NCAA athletes (hazard ratio [95% CI](HR [95% CI]): 1.58 [1.32, 1.90]), immediately reported their injury (HR [95% CI]: 1.40 [1.18, 1.67]), or had an SRC (HR [95% CI]: 1.29 [1.08, 1.54]) were significantly more likely to have initiated or completed the RTA protocol on any given day post-concussion compared to those who were not NCAA athletes, delayed reporting their injury, or had a non-SRC, respectively. We observed that among those with SRCs, a greater proportion of NCAA service academy members immediately reported their injury (53.9%) compared to non-NCAA (37.3%, P < .001); there was no difference in the proportion of NCAA and non-NCAA service academy members with non-SRCs who immediately reported their injury (P = .18). A greater proportion of female service academy members who sustained SRCs and were NCAA athletes reported their injuries immediately, which was associated with a greater likelihood of RTA protocol initiation and completion on any given day after injury. This may be attributable to easy and timely access to medical personnel (e.g., athletic trainers) or the presence of individuals trained in identifying concussion (e.g., coaches). Future initiatives among female service academy members should include improved access to medical care across a variety of injury settings and education on the importance of early reporting after concussion.

Jain D ，Caccese JB ，Boltz AJ ，Buckley T ，Cameron KL ，Chrisman SPD ，Clugston JR ，Eckner JT ，Ermer E ，Scott FG ，Harcum S ，Hunt TN ，Jannace KC ，Kelly LA ，Lempke LB ，McDevitt J ，Memmini A ，Mozel A ，Putukian M ，Robb JB ，Susmarski AJ ，Syrydiuk RA ，Broglio SP ，McAllister TW ，McCrea MA ，Pasquina PF ，Master CL ，Esopenko C ... -  《-》

SCAT Symptom Evolution in the Acute Concussion Phase: Findings from the NCAA-DoD CARE Consortium.

Syrydiuk RA ，Boltz AJ ，Lempke LB ，Caccese JB ，McAllister TW ，McCrea MA ，Pasquina PF ，Broglio SP ，and CARE Consortium Investigators† ... -  《-》

The Influence of Race on Time to Symptom Resolution Following Sport Concussion in Collegiate Athletes.

Domena AM ，Rosenblum DJ ，Donahue CC ，Resch JE ... -  《-》