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Papers by Christina Master

Orthopaedic Journal of Sports Medicine

Background: Repeated head impacts sustained by athletes have been linked to short-term neurophysi... more Background: Repeated head impacts sustained by athletes have been linked to short-term neurophysiologic deficits; thus, there is growing concern about the number of head impacts sustained in sports. Accurate head impact exposure data obtained via head impact sensors may help identify appropriate strategies across sports and between genders to mitigate repetitive head impacts. Purpose: To quantify sport- and gender-based differences in head impact rate and mechanism for adolescents. Study Design: Cohort study; Level of evidence, 2. Methods: High school female and male varsity soccer, basketball, lacrosse, and field hockey (female only) teams were instrumented with headband-mounted impact sensors during games over 2 seasons of soccer and 1 season of basketball, lacrosse, and field hockey. Video review was used to remove false-positive sensor-recorded events, and the head impact rate per athlete-exposure (AE) was calculated. Impact mechanism was categorized as equipment to head, fall, ...

The Physician and Sportsmedicine

Clinical Journal of Sport Medicine

The American Journal of Sports Medicine

Background: Organizations recommend that athletes should be asymptomatic or symptom-limited befor... more 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 th...

Council on Injury, Violence, and Poison Prevention Program

The Journal of School Nursing

Concussion is a common injury among adolescents. It is unknown how a concussion affects driving b... more Concussion is a common injury among adolescents. It is unknown how a concussion affects driving behavior and performance in adolescents. Although there are guidelines for return to learn, exercise, and sports that school nurses can help support in school, little is known about return to driving after concussion. The goal of this integrative review was to summarize the current literature on return to driving after concussion in adolescents. Six articles published between 2016 and 2020 were included in the review. Physicians and nurse practitioners find providing driving recommendations to adolescents to be appropriate; however, they are unclear what metrics to use to determine whether a patient is fit to drive. Future studies should explore clinical predictors of readiness to return to driving in adolescents. School nurses have an opportunity to support adolescents in their resumption of typical activities after concussion including school, sports, and, as more evidence becomes avail...

American Journal of Lifestyle Medicine

Sports-related concussion (SRC) is a common sports injury in children and adolescents. With the v... more Sports-related concussion (SRC) is a common sports injury in children and adolescents. With the vast amount of youth sports participation, an increase in awareness of concussion and evidence that the injury can lead to consequences for school, sports and overall quality of life, it has become increasingly important to properly diagnose and manage concussion. SRC in the student athlete is a unique and complex injury, and it is important to highlight the differences in the management of child and adolescent concussion compared with adults. This review focuses on the importance of developing a multimodal systematic approach to diagnosing and managing pediatric sports-related concussion, from the sidelines through recovery.

Clinics in Sports Medicine

British Journal of Sports Medicine

ObjectivesTo examine sex differences in sport-related concussion (SRC) across comparable sports.M... more ObjectivesTo examine sex differences in sport-related concussion (SRC) across comparable sports.MethodsProspective cohort of collegiate athletes enrolled between 2014 and 2017 in the Concussion Assessment, Research and Education Consortium study.ResultsAmong 1071 concussions (females=615; 57.4%), there was no difference in recovery (median days to full return to play) (females=13.5 (IQR 9.0, 23.1) vs males=11.8 (IQR 8.1, 19.0), p=0.96). In subgroup analyses, female recovery was longer in contact (females=12.7 days (IQR 8.8, 21.4) vs males=11.0 days (IQR 7.9, 16.2), p=0.0021), while male recovery was longer in limited contact sports (males=16.9 days (IQR 9.7, 101.7) vs females=13.8 days (IQR 9.1, 22.0), p<0.0001). There was no overall difference in recovery among Division I schools (females=13.7 (IQR 9.0, 23.1) vs males=12.2 (IQR 8.2 19.7), p=0.5), but females had longer recovery at the Division II/III levels (females=13.0 (IQR 9.2, 22.7) vs males=10.6 (IQR 8.1, 13.9), p=0.0048).C...

The Journal of Pediatrics

Medicine & Science in Sports & Exercise

Orthopaedic Journal of Sports Medicine

Background: Despite advancements, concussion diagnosis remains reliant on subjective symptom repo... more Background: Despite advancements, concussion diagnosis remains reliant on subjective symptom report and clinical assessments. Visual deficits and autonomic dysfunction have been described following concussion. Testing of the pupillary light reflex (PLR) is a simple, portable, non-invasive, and objective means of quantifying pupillary function. Purpose: The aim of this study was to objectively evaluate pupillary responses to a light stimulus in concussed adolescent athletes and to determine whether clinical assessments correlated with PLR responses after a diagnosed concussion when compared to pre-injury responses. Methods: In this prospective cohort study, PLR and clinical measures [PCSI and/or SCAT symptom scales, near point of convergence (NPC) and accommodation amplitude (AA) of both eyes] were assessed in 93 (45 female), non-concussed adolescent athletes (ages 14-18) during their pre-season. PLR was obtained in response to a brief white light stimulus using a hand-held pupillome...

Medicine & Science in Sports & Exercise

International Journal of Molecular Sciences

Traumatic brain injury (TBI) can cause biochemical and metabolomic alterations in the brain tissu... more Traumatic brain injury (TBI) can cause biochemical and metabolomic alterations in the brain tissue and serum. These alterations can be used for diagnosis and prognosis of TBI. Here, the serum concentrations of seventeen amino acids (AA) were studied for their potential utility as biomarkers of TBI. Twenty-five female, 4-week-old piglets received diffuse (n = 13) or focal (n = 12) TBI. Blood samples were obtained both pre-injury and at either 24-h or 4-days post-TBI. To find a robust panel of biomarkers, the results of focal and diffuse TBIs were combined and multivariate logistic regression analysis, coupled with the best subset selection technique and repeated k-fold cross-validation method, was used to perform a thorough search of all possible subsets of AAs. The combination of serum glycine, taurine, and ornithine was optimal for TBI diagnosis, with 80% sensitivity and 86% overall prediction rate, and showed excellent TBI diagnostic performance, with 100% sensitivity and 78% over...

Neurology

ObjectiveTo examine the association between estimated age of first exposure (eAFE) to American fo... more ObjectiveTo examine the association between estimated age of first exposure (eAFE) to American football and clinical measures throughout recovery following concussion.BackgroundIn collegiate football players, we reported no association between eAFE and baseline neurocognitive function. It is possible that neurocognitive deficits from earlier eAFE to American football, if present, are sufficiently compensated for in otherwise healthy individuals, but when faced with concussion, earlier eAFE may associate with longer symptom recovery, worse cognitive performance, or greater psychological distress.Design/MethodsParticipants were recruited as part of the NCAA–DoD Concussion Assessment, Research and Education (CARE) Consortium. There were 340 NCAA football players (age = 18.9 ± 1.4 years) who were evaluated 24–48 hours following concussion and had valid baseline data and 360 (age = 19.0 ± 1.3 years) who were evaluated at the time they were asymptomatic and had valid baseline data. Partic...

Orthopaedic Journal of Sports Medicine

Background: Repeated head impacts sustained by athletes have been linked to short-term neurophysi... more Background: Repeated head impacts sustained by athletes have been linked to short-term neurophysiologic deficits; thus, there is growing concern about the number of head impacts sustained in sports. Accurate head impact exposure data obtained via head impact sensors may help identify appropriate strategies across sports and between genders to mitigate repetitive head impacts. Purpose: To quantify sport- and gender-based differences in head impact rate and mechanism for adolescents. Study Design: Cohort study; Level of evidence, 2. Methods: High school female and male varsity soccer, basketball, lacrosse, and field hockey (female only) teams were instrumented with headband-mounted impact sensors during games over 2 seasons of soccer and 1 season of basketball, lacrosse, and field hockey. Video review was used to remove false-positive sensor-recorded events, and the head impact rate per athlete-exposure (AE) was calculated. Impact mechanism was categorized as equipment to head, fall, ...

The Physician and Sportsmedicine

Clinical Journal of Sport Medicine

The American Journal of Sports Medicine

Background: Organizations recommend that athletes should be asymptomatic or symptom-limited befor... more 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 th...

Council on Injury, Violence, and Poison Prevention Program

The Journal of School Nursing

Concussion is a common injury among adolescents. It is unknown how a concussion affects driving b... more Concussion is a common injury among adolescents. It is unknown how a concussion affects driving behavior and performance in adolescents. Although there are guidelines for return to learn, exercise, and sports that school nurses can help support in school, little is known about return to driving after concussion. The goal of this integrative review was to summarize the current literature on return to driving after concussion in adolescents. Six articles published between 2016 and 2020 were included in the review. Physicians and nurse practitioners find providing driving recommendations to adolescents to be appropriate; however, they are unclear what metrics to use to determine whether a patient is fit to drive. Future studies should explore clinical predictors of readiness to return to driving in adolescents. School nurses have an opportunity to support adolescents in their resumption of typical activities after concussion including school, sports, and, as more evidence becomes avail...

American Journal of Lifestyle Medicine

Sports-related concussion (SRC) is a common sports injury in children and adolescents. With the v... more Sports-related concussion (SRC) is a common sports injury in children and adolescents. With the vast amount of youth sports participation, an increase in awareness of concussion and evidence that the injury can lead to consequences for school, sports and overall quality of life, it has become increasingly important to properly diagnose and manage concussion. SRC in the student athlete is a unique and complex injury, and it is important to highlight the differences in the management of child and adolescent concussion compared with adults. This review focuses on the importance of developing a multimodal systematic approach to diagnosing and managing pediatric sports-related concussion, from the sidelines through recovery.

Clinics in Sports Medicine

British Journal of Sports Medicine

ObjectivesTo examine sex differences in sport-related concussion (SRC) across comparable sports.M... more ObjectivesTo examine sex differences in sport-related concussion (SRC) across comparable sports.MethodsProspective cohort of collegiate athletes enrolled between 2014 and 2017 in the Concussion Assessment, Research and Education Consortium study.ResultsAmong 1071 concussions (females=615; 57.4%), there was no difference in recovery (median days to full return to play) (females=13.5 (IQR 9.0, 23.1) vs males=11.8 (IQR 8.1, 19.0), p=0.96). In subgroup analyses, female recovery was longer in contact (females=12.7 days (IQR 8.8, 21.4) vs males=11.0 days (IQR 7.9, 16.2), p=0.0021), while male recovery was longer in limited contact sports (males=16.9 days (IQR 9.7, 101.7) vs females=13.8 days (IQR 9.1, 22.0), p<0.0001). There was no overall difference in recovery among Division I schools (females=13.7 (IQR 9.0, 23.1) vs males=12.2 (IQR 8.2 19.7), p=0.5), but females had longer recovery at the Division II/III levels (females=13.0 (IQR 9.2, 22.7) vs males=10.6 (IQR 8.1, 13.9), p=0.0048).C...

The Journal of Pediatrics

Medicine & Science in Sports & Exercise

Orthopaedic Journal of Sports Medicine

Background: Despite advancements, concussion diagnosis remains reliant on subjective symptom repo... more Background: Despite advancements, concussion diagnosis remains reliant on subjective symptom report and clinical assessments. Visual deficits and autonomic dysfunction have been described following concussion. Testing of the pupillary light reflex (PLR) is a simple, portable, non-invasive, and objective means of quantifying pupillary function. Purpose: The aim of this study was to objectively evaluate pupillary responses to a light stimulus in concussed adolescent athletes and to determine whether clinical assessments correlated with PLR responses after a diagnosed concussion when compared to pre-injury responses. Methods: In this prospective cohort study, PLR and clinical measures [PCSI and/or SCAT symptom scales, near point of convergence (NPC) and accommodation amplitude (AA) of both eyes] were assessed in 93 (45 female), non-concussed adolescent athletes (ages 14-18) during their pre-season. PLR was obtained in response to a brief white light stimulus using a hand-held pupillome...

Medicine & Science in Sports & Exercise

International Journal of Molecular Sciences

Traumatic brain injury (TBI) can cause biochemical and metabolomic alterations in the brain tissu... more Traumatic brain injury (TBI) can cause biochemical and metabolomic alterations in the brain tissue and serum. These alterations can be used for diagnosis and prognosis of TBI. Here, the serum concentrations of seventeen amino acids (AA) were studied for their potential utility as biomarkers of TBI. Twenty-five female, 4-week-old piglets received diffuse (n = 13) or focal (n = 12) TBI. Blood samples were obtained both pre-injury and at either 24-h or 4-days post-TBI. To find a robust panel of biomarkers, the results of focal and diffuse TBIs were combined and multivariate logistic regression analysis, coupled with the best subset selection technique and repeated k-fold cross-validation method, was used to perform a thorough search of all possible subsets of AAs. The combination of serum glycine, taurine, and ornithine was optimal for TBI diagnosis, with 80% sensitivity and 86% overall prediction rate, and showed excellent TBI diagnostic performance, with 100% sensitivity and 78% over...

Neurology

ObjectiveTo examine the association between estimated age of first exposure (eAFE) to American fo... more ObjectiveTo examine the association between estimated age of first exposure (eAFE) to American football and clinical measures throughout recovery following concussion.BackgroundIn collegiate football players, we reported no association between eAFE and baseline neurocognitive function. It is possible that neurocognitive deficits from earlier eAFE to American football, if present, are sufficiently compensated for in otherwise healthy individuals, but when faced with concussion, earlier eAFE may associate with longer symptom recovery, worse cognitive performance, or greater psychological distress.Design/MethodsParticipants were recruited as part of the NCAA–DoD Concussion Assessment, Research and Education (CARE) Consortium. There were 340 NCAA football players (age = 18.9 ± 1.4 years) who were evaluated 24–48 hours following concussion and had valid baseline data and 360 (age = 19.0 ± 1.3 years) who were evaluated at the time they were asymptomatic and had valid baseline data. Partic...