Association Between Previous Concussion History and Symptom Endorsement During Preseason Baseline Testing in High School and Collegiate Athletes (original) (raw)

Early indicators of enduring symptoms in high school athletes with multiple previous concussions

Neurosurgery, 2011

BACKGROUND: Despite recent findings of cognitive, emotional, physical, and behavioral symptomatology in retired professional athletes with a history of multiple concussions, there is little systematic research examining these symptoms in high school athletes with a history of concussion. OBJECTIVE: To identify cognitive, emotional, and physical symptoms at baseline in nonconcussed high school athletes based on concussion history. METHODS: A multicenter sample of 616 high school athletes who completed baseline evaluations were assigned to groups based on history of concussion (none, 1, 2, or more previous concussions). The Post-Concussion Symptom Scale was administered as part of a computerized neuropsychological test battery during athletes' preseason baseline evaluations. Cross-sectional analyses were used to examine symptoms reported at the time of baseline neuropsychological testing. RESULTS: High school athletes with a history of 2 or more concussions showed significantly higher ratings of concussion-related symptoms (cognitive, physical, sleep difficulties) than athletes with a history of one or no previous concussions. CONCLUSION: It appears that youth athletes who sustain multiple concussions experience a variety of subtle effects, which may be possible precursors of the future onset of concussion-related difficulties.

Cumulative Effects of Concussion in High School and College Athletes

Clinical Journal of Sport Medicine, 2004

Objective: It is a common assumption in sports medicine that prior history of concussion is predictive of lowered threshold and worse outcome following subsequent concussive injury. The current study was conducted to investigate the relationship between concussion history in high school athletes and the on-field presentation of symptoms following subsequent concussion. Methods: 173 athletes experiencing sports concussion comprised the initial study group. Binary groups were subsequently created based upon concussion history. Sixty athletes with no prior concussion history were compared to 28 athletes with a history of three or more concussions. Groups were compared in terms of on-field presentation of symptoms following an in-study concussion. Dependent variables included the post-injury presence of loss of consciousness, anterograde amnesia, retrograde amnesia, and confusion. Results: Athletes with three or more prior concussions were more likely to experience on-field positive loss of consciousness (X 2 = 8.0; P = .005), anterograde amnesia (X 2 = 5.5; P = .019), and confusion (X 2 = 5.1; P = .024) following a subsequent cerebral concussion. An odds ratio revealed that athletes with a history of three concussions were 9.3 times more likely to demonstrate 3-4 abnormal on-field markers of concussion severity. Conclusion: This is the first study to suggest a cumulative effect of concussion in high school athletes. A more severe, on-field presentation of concussion markers is evidenced in high school athletes with a pronounced history of concussion. Findings highlight the need for more long-term outcome studies in high school athletes sustaining concussion.

Factors Associated With Concussion-like Symptom Reporting in High School Athletes

JAMA Pediatrics, 2015

IMPORTANCE Every state in the United States has passed legislation for sport-related concussion, making this health issue important for physicians and other health care professionals. Safely returning athletes to sport after concussion relies on accurately determining when their symptoms resolve. OBJECTIVE To evaluate baseline concussion-like symptom reporting in uninjured adolescent student athletes. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional, observational study, we studied 31 958 high school athletes from Maine with no concussion in the past 6 months who completed a preseason baseline testing program between 2009 and 2013. RESULTS Symptom reporting was more common in girls than boys. Most students with preexisting conditions reported one or more symptoms (60%-82% of boys and 73%-97% of girls). Nineteen percent of boys and 28% of girls reported having a symptom burden resembling an International Classification of Diseases, 10th Revision (ICD-10) diagnosis of postconcussional syndrome (PCS). Students with preexisting conditions were even more likely to endorse a symptom burden that resembled PCS (21%-47% for boys and 33%-72% for girls). Prior treatment of a psychiatric condition was the strongest independent predictor for symptom reporting in boys, followed by a history of migraines. For girls, the strongest independent predictors were prior treatment of a psychiatric condition or substance abuse and attention-deficit/hyperactivity disorder. The weakest independent predictor of symptoms for both sexes was history of prior concussions. CONCLUSIONS AND RELEVANCE In the absence of a recent concussion, symptom reporting is related to sex and preexisting conditions. Consideration of sex and preexisting health conditions can help prevent misinterpretation of symptoms in student athletes who sustain a concussion.

Prolonged Effects of Concussion in High School Athletes

Neurosurgery, 2005

To identify enduring prolonged neuropsychological effects of cerebral concussion in high school youth athletes. METHODS: High school athletes (n ϭ 223) underwent baseline neuropsychological evaluation between 1999 and 2000, assigned to independent groups on the basis of concussion history: athletes with no concussion history or present medical and/or neuropsychological complaints (n ϭ 82), symptom-free athletes who experienced one (n ϭ 56) or two or more (n ϭ 45) concussions (not in the prior 6 mo), and those who experienced a concussion 1 week before testing (n ϭ 40). Main outcome measures included a structured clinical interview, demographic form, symptom checklist, the Repeatable Battery for the Assessment of Neuropsychological Status, and the Trail Making Tests A and B. Analyses of variance were used to determine between-group differences. RESULTS: Athletes with recent concussions performed significantly worse on measures of attention and concentration than youth athletes with no concussion history. Symptom-free athletes with a history of two or more concussions performed similar on testing to youth athletes who had just experienced a recent concussion. Similarly, cumulative academic grade point averages were significantly lower not only for youth athletes with two or more previous concussion groups, but for youth athletes who experienced recent concussions, suggesting that athletes with lower grade point averages may be more prone to concussion. CONCLUSION: There seem to be subtle yet significant prolonged neuropsychological effects in youth athletes with a history of two or more previous concussions.

Effects of repetitive head trauma on symptomatology of subsequent sport-related concussion

Journal of Neurosurgery: Pediatrics

OBJECTIVE Adolescent participation in athletics continues to grow, leading to an increasing incidence of sports-related concussion (SRC). The current literature suggests that a greater number of prior concussions positively correlates with a greater number of total symptoms, but the specific concussion-related symptoms are not as well defined. The current study investigated the effects of prior recurrent head injury on the symptom profiles of student-athletes after another suspected concussion. METHODS A multicenter database consisting of 25,815 Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) results was filtered for student-athletes aged 12–22 years old who competed in 21 different sports. Patients were separated into 2 cohorts: athletes reporting a single prior concussion (SRC1) and athletes reporting 2 or more prior concussions (SRC2+). Comparisons were assessed for differences in 22 symptoms and 4 symptom clusters at baseline, first postinjury test (PI1), and...

Grade 1 or" Ding" Concussions In High School Athletes

… Journal of Sports …, 2004

Background: Recent concussion management guidelines have suggested that athletes with mild (grade 1) concussions may be returned to play if asymptomatic for 15 minutes. The purpose of this study was to assess the utility of a current concussion management guideline in classifying and managing mild concussion. Hypothesis: High school athletes diagnosed with a grade 1 concussion will demonstrate measurable decline in neuropsychological functioning that persists during the 1st week of recovery. Study Design: Prospective study designed to evaluate neuropsychological functioning both prior to and following concussion. Methods: Forty-three high school athletes completed neuropsychological test performance and symptom ratings prior to the season and at two times during the 1st week following mild concussion. Results: Thirty-six hours after injury, mildly concussed high school athletes demonstrated a decline in memory (P < 0.003) and a dramatic increase in self-reported symptoms (P < 0.00001) compared to baseline performance. Conclusions: Athletes with grade 1 concussion demonstrated memory deficits and symptoms that persisted beyond the context in which they were injured. These data suggest that current grade 1 return-to-play recommendations that allow for immediate return to play may be too liberal. Clinical Relevance: A reconsideration of current concussion grading systems appears to be warranted.

Incidence and Risk Factors for Concussion in High School Athletes, North Carolina, 1996-1999

American Journal of Epidemiology, 2004

A prospective cohort study was used to quantify risk factors for sports concussions. Analysis was based on a stratified cluster sample of North Carolina high school athletes followed during 1996-1999. Clustering was by school and sport, and the sample included 15,802 athletes with 1-8 seasons of follow-up per athlete. Concussion rates were estimated for 12 sports, and risk factors were quantified using generalized Poisson regression. Concussion rates ranged from 9.36 (95% confidence interval: 1.93, 16.80) per 100,000 athlete-exposures in cheerleading to 33.09 (95% confidence interval: 24.74, 41.44) per 100,000 athlete-exposures in football, where "athlete-exposure" is one athlete participating in one practice or game. The overall rate of concussion was 17.15 (95% confidence interval: 13.30, 21.00) per 100,000 athlete-exposures. Cheerleading was the only sport for which the practice rate was greater than the game rate. Almost two thirds of cheerleading concussions involved two-level pyramids. Concussion rates were elevated for athletes with a history of concussion, and they increased with the increasing level of body contact permitted in the sport. After adjustment for sport, body mass index, and year in school, history of concussion(s) remained a moderately strong risk factor for concussion (rate ratio = 2.28, 95% confidence interval: 1.24, 4.19). The fact that concussion history is an important predictor of concussion incidence, even in this young population, underscores the importance of primary prevention efforts, timely identification, and careful clinical management of these injuries.

A Retrospective Clinical Analysis of Moderate to Severe Athletic Concussions

Pm&r, 2010

Objective: To investigate differences in clinical outcomes on the basis of gender and age after a moderate or severe concussion in a cohort of physically active subjects examined by a single clinician. Design: A descriptive, cross-sectional, retrospective chart review of consecutive patients. Setting: Outpatient assessments by a single clinician with expertise in sports concussion. Patients: Physically active subjects seen for evaluation after a concussion experienced while participating in sports (N ϭ 194; 215 concussions; age mean Ϯ standard deviation ϭ 19.19 Ϯ 8.53 years) were included. Interventions (Independent Variables): Intergroup differences and associations were examined by gender, age group (Ͻ18 years and 18ϩ years), and concussion grade for all outcome measures. Main Outcome Measurements: Separate 2 tests were used to assess associations between gender, age group, and symptom duration group (Յ7 days, 8-90 days, Ͼ90 days), the presence of depression, the presence of loss of consciousness, altered school or work, and concussion grade. Separate independent samples t-tests was used to examine differences in symptom reporting and time to recovery. Results: No association was observed between gender and any measured characteristics (P Ͼ .05). Subjects 18 years or older took longer to recover (315.77 days), compared with younger subjects (91.31 days) (t 213 ϭ Ϫ2.01, P ϭ .049). Older subjects also reported more concussions than did younger ones, 4.33 and 2.37, respectively (t 213 ϭ Ϫ3.77, P Ͻ .001). Conclusions: All concussions included in this study were moderate to severe in nature as defined by the Revised Cantu Grading Scale. Contrary to existing literature regarding gender differences in concussion of a lesser severity, no gender differences were observed in this sample. Age differences were observed, with the population of subjects who were 18 years and older experiencing a greater number and duration of concussion symptoms than the younger group. Developing evidence-based return-to-play progressions and rehabilitation strategies in this population is the next frontier for concussion researchers.

Factors Associated With Self-Reported Concussion History in Middle School Athletes

Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 2018

Identifying personal characteristics associated with sustaining a concussion is of great interest, yet only a few have examined this in children. The purpose of this study was to examine the association between sex, neurodevelopmental disorders, health history, and lifetime history of self-reported concussion in 12- and 13-year-old athletes. Cross-sectional study. Middle schools. Participants were 1744 twelve- and thirteen-year-old student athletes who completed preseason Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) testing, including a self-report questionnaire about previous concussions, developmental diagnoses, and previous medical treatment. Age, sex, attention-deficit/hyperactivity disorder (ADHD), learning disabilities (LDs), and previous treatment for migraine. Self-reported history of concussion. A minority of athletes (13.7%) reported previous concussions (1 concussion, n = 181; 2 concussions, n = 41; and 3+ concussions, n = 17). A small proportion re...