EFFECTS OF A SEASON OF SUBCONCUSSIVE CONTACT ON CHILD- SCAT3 SCORES IN 8-12 YEAR-OLD MALE ATHLETES. Cognition in the days following concussion: comparison of symptomatic versus asymptomatic athletes. Comparison of Mouth Guard Designs and Concussion Prevention in Contact Sports: A Multicenter Randomized Controlled Trial Subject-Specific Increases in Serum S-100B Distinguish Sports-Related Concussion from Sports-Related Exertion Is neuropsychological testing useful in the management of sport-related concussion? Epidemiology of sports-related concussion in seven US high school and collegiate sports Effectiveness of an educational video on concussion knowledge in minor league hockey players: a cluster randomised controlled trial Predicting Slow Recovery From Sport-Related Concussion: The New Simple-Complex Distinction Descriptive epidemiology of collegiate women's ice hockey injuries: National Collegiate Athletic Association Injury Surveillance System, 2000-2001 through 2003-2004. Evaluating the cognitive consequences of mild traumatic brain injury and concussion by using electrophysiology. The assessment of orientation following concussion in athletes. Does padded headgear prevent head injury in rugby union football? Acute Effects and Recovery After Sport‐Related Concussion: A Neurocognitive and Quantitative Brain Electrical Activity Study Injuries in youth amateur soccer and rugby players—comparison of incidence and characteristics Immediate Neurocognitive Effects of Concussion Serum Tau Fragments Predict Return to Play in Concussed Professional Ice Hockey Players. The “Value Added” of Neurocognitive Testing after Sports-Related Concussion A prospective study of physician-observed concussions during junior ice hockey: implications for incidence rates. Persistent motor system abnormalities in formerly concussed athletes. Concussions in amateur rugby union identified with the use of a rapid visual screening tool Recovery of cerebral blood flow following sports-related concussion. Predictors of delayed recovery following pediatric sports-related concussion: a case-control study. Examining Sport Concussion Assessment Tool ratings for male and female youth hockey players with and without a history of concussion
BACKGROUND Each year , over 173,000 children and adolescents visit emergency departments due to sports and recreation related concussions , an increase of 60 % over the last decade due to the rise in the number of children participating in sport . While numerous authors have sought to address the epidemiology of concussions across multiple age groups who participate in contact sports , a recent review of literature did not reveal a substantial amount of published articles that addressed the issue of subconcussive contact . Multiple tools have been developed to assess acute episodes of concussion . Among the assessment protocol s many include an assessment of balance , short and long term memory recall , and balance . The Child-SCAT3 was design ed specifically to evaluate concussions in children 5 - 12 years of age . OBJECTIVE The purpose of this study was to determine the effect of a season of subconcussive contact on  Child-SCAT3  scores in 8 - 12 year old males compared to their age matched peers who participated in non-contact sports .  A secondary purpose was to evaluate how scores of the sub- components of the Child-SCAT3 compare between contact and non-contact athletes . DESIGN A prospect i ve cohort study was performed of 71 male athletes ( 58 football , 13 baseball ) ages 8 - 12 ( contact mean age 10.30 years , SD 1.20 ; non-contact mean age 10.03 years , SD 1.26 ) over the course of a season . METHODS Portions of The Child-SCAT3 were administered and scored in pre-adolescent athletes prior to and following a season of participation in football ( contact sport group ) and baseball ( non-contact sport group ) . The outcome measures of interest included the portions related to Cognitive ability , Balance , and Coordination . RESULTS No statistically significant differences were found in group , time or time and group interaction for any of the utilized portions of the Child-SCAT3 . Statistically significant differences were found between groups for preseason cognitive orientation and postseason immediate memory . Cognitive orientation and coordination were also found to be statistically significantly improved across both groups over the course of the season . LIMITATIONS This study was potentially limited by the number of control subjects tested . CONCLUSIONS A season of subconcussive contact in football was not detrimental to cognitive and balance scores on the Child-SCAT3 . LEVEL OF EVIDENCE 3 BACKGROUND Concussion is a common neurological injury occurring during contact sport . Current guidelines recommend that no athlete should return to play while symptomatic or displaying cognitive dysfunction . This study compared post-concussion cognitive function in recently concussed athletes who were symptomatic/asymptomatic at the time of assessment with that of non-injured ( control ) athletes . METHODS Prospect i ve study of 615 male Australian Rules footballers . Before the season , all participants ( while healthy ) completed a battery of baseline computerised ( CogSport ) and paper and pencil cognitive tasks .  Sixty one injured athletes ( symptomatic = 25 and asymptomatic = 36 ) were reassessed within 11 days of being concussed ; 84 controls were also reassessed . The serial cognitive function of the three groups was compared using analysis of variance . RESULTS The performance of the symptomatic group declined at the post-concussion assessment on computerised tests of simple , choice , and complex reaction times compared with the asymptomatic and control groups . The magnitude of changes was large according to conventional statistical criteria . On paper and pencil tests , the symptomatic group displayed no change at re assessment , whereas large improvements were seen in the other two groups . CONCLUSION Injured athletes experiencing symptoms of concussion displayed impaired motor function and attention , although their learning and memory were preserved . These athletes displayed no change in performance on paper and pencil tests in contrast with the improvement observed in asymptomatic and non-injured athletes . Athletes experiencing symptoms of concussion should be withheld from training and competition until both symptoms and cognitive dysfunction have resolved Objectives : To compare the effectiveness of the WIPSS mouth guard to other currently used mouth guards in the prevention of concussion injuries in athletes participating in varsity football and rugby . Design : Multicenter , cluster-r and omized , controlled trial comparing the WIPSS Brain-Pad mouth guard against the st and ard use mouth guard of choice . Teams were monitored by their respective athletic therapist , trainer , or sports physician for 1 playing season to diagnose and record incident concussion injuries and dental trauma . Concussion symptoms were also recorded at the time of injury . Setting : Five Ontario universities . Participants : University male football ( 394 ) and university male ( 129 ) and female ( 123 ) rugby athletes reporting to 2003 fall training camps . Main Outcome Measurements : The primary end point was the incidence of any diagnosed concussion events during the 2003 playing season as defined by the American Academy of Neurology Concussion Guidelines . Secondary endpoints included the incidence of dental trauma events and observed concussion symptoms . Results : There was no significant difference in the number of concussions observed between the intervention and control arms of this trial ( P = 0.79 ; odds ratio , 1.06 , in favor of controls ; 95 % CI , 0.51 , ≪1.61 ) . No dental trauma events occurred . The 5 most common symptoms experienced by concussed athletes were dizziness , general headache , nausea , loss of visual focus , and personality changes . Conclusions : In this study , concussion rates were not significantly different for varsity football and rugby players who wore the WIPSS Brain-Pad mouth guard compared with other types of mouth guards Background The on-field diagnosis of sports-related concussion ( SRC ) is complicated by the lack of an accurate and objective marker of brain injury . Purpose To compare subject-specific changes in the astroglial protein , S100B , before and after SRC among collegiate and semi-professional contact sport athletes , and compare these changes to differences in S100B before and after non-contact exertion . Study Design Longitudinal cohort study . Methods From 2009–2011 , we performed a prospect i ve study of athletes from Munich , Germany , and Rochester , New York , USA .  Serum S100B was measured in all SRC athletes at pre-season baseline , within 3 hours of injury , and at days 2 , 3 and 7 post-SRC . Among a subset of athletes , S100B was measured after non-contact exertion but before injury . All sample s were collected identically and analyzed using an automated electrochemiluminescent assay to quantify serum S100B levels . Results Forty-six athletes ( 30 Munich , 16 Rochester ) underwent baseline testing . Thirty underwent additional post-exertion S100B testing . Twenty-two athletes ( 16 Rochester , 6 Munich ) sustained a SRC , and 17 had S100B testing within 3 hours post-injury . The mean 3-hour post-SRC S100B was significantly higher than pre-season baseline ( 0.099±0.008 µg/L vs. 0.058±0.006 µg/L , p = 0.0002 ) . Mean post-exertion S100B was not significantly different than the preseason baseline . S100B levels at post-injury days 2 , 3 and 7 were significantly lower than the 3-hour level , and not different than baseline . Both the absolute change and proportional increase in S100B 3-hour post-injury were accurate discriminators of SRC from non-contact exertion without SRC ( AUC 0.772 and 0.904 , respectively ) . A 3-hour post-concussion S100B > 0.122 µg/L and a proportional S100B increase of > 45.9 % over baseline were both 96.7 % specific for SRC . Conclusions Relative and absolute increases in serum S100B can accurately distinguish SRC from sports-related exertion , and may be a useful adjunct to the diagnosis of SRC OBJECTIVE Neuropsychological ( NP ) testing has been used for several years as a way of detecting the effects of sport-related concussion in order to aid in return-to-play determinations . In addition to st and ard pencil- and -paper tests , computerized NP tests are being commercially marketed for this purpose to professional , collegiate , high school , and elementary school programs . However , a number of important questions regarding the clinical validity and utility of these tests remain unanswered , and these questions present serious challenges to the applicability of NP testing for the management of sport-related concussion . Our purpose is to outline the criteria that should be met in order to establish the utility of NP instruments as a tool in the management of sport-related concussion and to review the degree to which existing tests have met these criteria . DATA SOURCES A comprehensive literature review of MEDLINE and PsychLit from 1990 to 2004 , including all prospect i ve , controlled studies of NP testing in sport-related concussion . DATA SYNTHESIS The effects of concussion on NP test performance are so subtle even during the acute phase of injury ( 1 - 3 days postinjury ) that they often fail to reach statistical significance in group studies . Thus , this method may lack utility in individual decision making because of a lack of sensitivity . In addition , most of these tests fail to meet other psychometric criteria ( eg , adequate reliability ) necessary for this purpose . Finally , it is unclear that NP testing can detect impairment in players once concussion-related symptoms ( eg , headache ) have resolved . Because no current guideline for the management of sport-related concussion allows a symptomatic player to return to sport , the incremental utility of NP testing remains question able . CONCLUSIONS / RECOMMENDATIONS Despite the theoretic rationale for the use of NP testing in the management of sport-related concussion , no NP tests have met the necessary criteria to support a clinical application at this time . Additional research is necessary to establish the utility of these tests before they can be considered part of a routine st and ard of care , and concussion recovery should be monitored via the st and ard clinical examination and subjective symptom checklists until NP testing or other methods are proven effective for this purpose Background The epidemiology of sports-related concussion is not well-described in the literature . This paper presents a descriptive epidemiology of concussion in seven high school and collegiate sports . Methods We used the data from Concussion Prevention Initiative ( CPI ) , which enrolled 8905 athletes at 210 high schools and 26 colleges in a prospect i ve cohort study of 7 sports ( football , men ’s and women ’s soccer , men ’s and women ’s lacrosse , and men ’s and women ’s ice hockey ) between 1999 and 2001 . Injury risks and injury rates were used to characterize the incidence of concussion , and changes in symptoms over time were described . Results A total of 375 concussions were observed . The incidence of concussion was highest in football , followed by women ’s lacrosse , men ’s lacrosse , men ’s soccer , and women ’s soccer ( only 10 ice hockey teams were included , too few to quantify incidence ) . The rate of incident concussion was strongly associated with history of concussion in the previous 24 months ( rate ratio = 5.5 ; 95 % CI : 3.9 , 7.8 , for 2 or more concussions relative to no previous concussion ) . The most common symptoms at time of injury were headache ( 87 % ) , balance problems/dizziness ( 77 % ) , and feeling “ in a fog ” ( 62 % ) . Loss of consciousness and amnesia were present in relatively few cases ( 9 and 30 % ) . The most common mechanism of injury was collision with another player . Conclusions Sports-related concussions present with a diverse range of symptoms and are associated with previous concussion history Background With the heightened awareness of concussions in all sports , the development and implementation of effective prevention strategies are necessary . Education has been advocated as an effective injury prevention intervention . Purpose To examine the effectiveness of the ‘ Smart Hockey : More Safety , More Fun ’ video on knowledge transfer among minor league hockey players . Study Design Cluster-r and omised controlled trial . Methods A total of 267 participants from two age divisions and competitive levels were assigned to either a video or no-video group . The video was shown ( or not shown ) to the entire team as a result of r and om assignment . To evaluate the effectiveness of the educational video , question naires specific to concussion knowledge and players ’ attitudes and behaviours were completed . Results There was a significant increase in the players ’ concussion knowledge scores immediately following exposure to the video ( F(1,103)=27.00 , p<0.001 ) . However , concussion knowledge at 2 months was not significantly different between the video and no-video groups , after controlling for prior knowledge level , age and competitive level ( F(1,115)=0.41 , p=0.523 ) . Similarly , players ’ attitudes and behaviour scores at 2 months did not differ between groups ( F(1,115)=0.41 , p=0.507 ) . Conclusions We were able to show that a single viewing of an educational video in hockey could immediately improve knowledge about concussion but that this effect was transient and lost at 2-month follow-up . Future prevention endeavours in hockey and other sports should attempt to incorporate strategies and modalities to enhance knowledge retention Objective : Following the Second International Conference on Concussion in Sport in 2005 , a summary agreement statement was published that introduced new terminology for sport-related concussions . This new classification system is binary ( ie , “ simple ” versus “ complex ” concussions ) . Athletes who are slow to recover ( ie , > 10 days ) are classified as having complex concussions . The purpose of this study was to determine if high school football players , retrospectively classified as having a simple or a complex concussion , could be differentiated in the first 48 after injury on the basis of symptom reporting or neuropsychological testing . Design : Case-control study . Setting : Pennsylvania high school football programs . Participants : The total sample consisted of 114 concussed high school football players who were identified through a 3 year prospect i ve cohort study . Interventions : All completed a computerized neuropsychological screening evaluation within 72 hours of injury . They were followed clinical ly until they recovered and were cleared to return to play . They were classified retrospectively as having a simple ( n = 55 ) or complex ( n = 59 ) concussion based on their recovery times . Main Outcome Measurements : Neurocognitive test performance and symptom ratings . Results : Within 72 hours after injury , athletes with complex concussions performed more poorly on neuropsychological testing and reported more symptoms than those with simple concussions . Athletes with complex concussions who were slow to recover were 18 times more likely to have 3 unusually low neuropsychological test scores than those with simple concussions ( 95 % CI = 2.3 - 144.9 ) . Athletes with previous concussions did not recover more slowly . Conclusions : This study provides evidence that supports and refutes the clinical usefulness of the new simple-complex concussion classification system OBJECTIVE To review 4 years of National Collegiate Athletic Association ( NCAA ) injury surveillance data for women 's ice hockey and to identify potential areas for injury prevention initiatives . BACKGROUND The NCAA ISS prospect ively collects data on injuries sustained during collegiate participation . Women 's NCAA ice hockey began participation in the ISS during the 2000 - 2001 season . On average , over the 4 years , 15.6 % of the eligible schools elected to send their injury data . MAIN RESULTS Over the 4 years of study , the rate of injury in games was more than 5 times higher than the injury rate in practice s ( 12.6 versus 2.5 injuries per 1000 athlete-exposures , rate ratio = 5.0 , 95 % confidence interval = 4.2 , 6.1 , P < .01 ) . Preseason practice injury rates were almost twice as high as in-season practice rates ( 4.2 versus 2.3 injuries per 1000 athlete-exposures , rate ratio = 1.8 , 95 % confidence interval = 1.7 , 2.0 , P < .01 ) . Concussions were the most common injury in both games ( 21.6 % ) and practice s ( 13.2 % ) . The rate of concussions in games appeared to be trending upward over the study period . The greatest number of game injuries ( approximately 50 % ) result ed from player contact , whereas practice injuries were from either contact with another object or noncontact mechanisms . RECOMMENDATIONS Women 's ice hockey is an evolving NCAA sport . Only 4 years of ISS data are available and , therefore , data should be interpreted with caution . Women 's ice hockey does not allow for formal body checking ; however , approximately 50 % of all game injuries were reported to result from contact with another player . Future research ers need to evaluate the effectiveness of the no-checking rule . Additional years of data collection will be required to allow the data to become more stable , and to increase attention to mechanism-of-injury issues . We anticipate that the hypothesized inconsistencies in skill level across and within the various women 's teams also will be reduced as more consistently skilled players develop , allowing for more stability in the injury scenario OBJECT Mild traumatic brain injury ( MTBI ) , often referred to as concussion when it occurs in sports , produces persistent cognitive problems in at least 15 % of patients . Unfortunately , conventional neuropsychological tests usually yield results within normal limits in this population . The main objective of this event-related potential ( ERP ) study was to underst and brain functioning during the performance of a working memory ( WM ) task in patients who have sustained an MTBI , mostly due to motor vehicle accident or sports concussion . This study also aim ed for a better underst and ing of the association between brain functioning as measured with ERP , behavioral performance on the WM task , postconcussion symptoms , type of injury ( that is , sports concussion vs other types ) , and time since the injury . METHODS Forty-four patients with MTBI ( 7.6 ± 8.4 months postinjury ) were tested on a visual WM task with simultaneous recording of ERP , and were compared with 40 control volunteers who were their equivalent for age and sex . Amplitude and latency of frontal ( N200 and N350 ) and parietal ( P200 and P300 ) ERP waves were measured and were compared between groups . Correlation analyses were also performed between ERP characteristics , clinical variables , and behavioral performance . RESULTS A significant group difference was found for behavioral performance on the WM task , in which the MTBI group had a lower percentage of correct answers than the control group ( p < 0.05 ) . The patients with MTBI also had smaller amplitudes of both frontal N350 and parietal P300 ERP components when compared with control volunteers ( p < 0.05 ) . No changes were found for latency of ERP components . Smaller ERP amplitudes were associated with slower reaction times and worse accuracy on the WM task among patients with MTBI ( p < 0.05 ) . Types of injury ( that is , sports concussion vs other mechanisms ) were not associated with different ERP characteristics . CONCLUSIONS Abnormal ERP results are observed in patients after MTBI or sports concussion , even for those in the nonacute stage after their injury . Current st and ard clinical evaluations most often fail to detect cerebral dysfunction after MTBI , even when patients or athletes report symptoms . Clinicians should be aware that patients with MTBI , including sports concussion , probably have underlying mild but persistent cerebral dysfunctions that require further investigation The purpose of this study was to investigate the sensitivity of  orientation and recent memory questions  in the diagnosis of concussion . In a prospect i ve study over 7 consecutive years ( 1985 - 1991 ) , all players at a professional Australian Rules Football club who sustained a concussive injury ( n = 28 ) were administered a set of questions evaluating orientation and recent memory .  Concussion was diagnosed independently on the basis of loss or disturbance of consciousness and clinical symptoms . A control group of age-matched nonconcussed players was administered the same set of questions . The results showed that items evaluating recently acquired information were more sensitive in the assessment of concussion than st and ard orientation items . The relative sensitivity of orientation questions must be considered when they are used in the clinical diagnosis of concussion in sport BACKGROUND Concussion is a serious problem in many contact sports , including rugby union football . The study 's primary aim was to measure the efficacy of padded headgear in reducing the rates of head injury or concussion . METHODS A cluster r and omized controlled trial with three arms was conducted with rugby union football teams as the unit of r and omization . Teams consisted of males participating in under 13- , 15- , 18- , and 20-yr age group competitions . The interventions were " st and ard " and " modified " padded headgear .  Headgear wearing and injury were measured for each study team at each game over two seasons . RESULTS Eighty-two teams participated in year 1 and 87 in year 2 . A total of 1493 participants ( 10,040 player hours ) were in the control group , 1128 participants ( 8170 player hours ) were assigned to the st and ard headgear group , and 1474 participants ( 10,650 player hours ) were assigned to the modified headgear group .  The compliance rates were low in all groups , but 46 % of participants wore st and ard headgear . An intention-to-treat analysis showed no differences in the rates of head injury or concussion between controls and headgear arms . Incidence rate ratios for st and ard headgear wearers referenced to controls were 0.95 and 1.02 for game and missed game injuries . Analyses of injury rates based on observed wearing patterns also showed no significant differences . Incidence rate ratios for st and ard headgear wearers referenced to nonwearers were 1.11 and 1.10 for game and missed game injuries . CONCLUSIONS Padded headgear does not reduce the rate of head injury or concussion . The low compliance rates are a limitation . Although individuals may choose to wear padded headgear , the routine or m and atory use of protective headgear can not be recommended Objective To investigate the clinical utility and sensitivity of a portable , automatic , frontal quantitative electroencephalographic ( QEEG ) acquisition device currently in development in detecting abnormal brain electrical activity after sport-related concussion . Design This was a prospect i ve , non-r and omized study of 396 high school and college football players , including cohorts of 28 athletes with concussion and 28 matched controls . All subjects underwent preseason baseline testing on measures of postconcussive symptoms , postural stability , and cognitive functioning , as well as QEEG . Clinical testing and QEEG were repeated on day of injury and days 8 and 45 postinjury for the concussion and control groups . Main Outcomes and Results The injured group reported more significant postconcussive symptoms during the first 3 days postinjury , which resolved by days 5 and 8 . Injured subjects also performed poorer than controls on neurocognitive testing on the day of injury , but no differences were evident on day 8 or day 45 . QEEG studies revealed significant abnormalities in electrical brain activity in the injured group on day of injury and day 8 postinjury , but not on day 45 . Conclusions Results from the current study on clinical recovery after sport-related concussion are consistent with early reports indicating a typical course of full recovery in symptoms and cognitive dysfunction within the first week of injury . QEEG results , however , suggest that the duration of physiological recovery after concussion may extend longer than observed clinical recovery . Further study is required to replicate and extend these findings in a larger clinical sample , and further demonstrate the utility of QEEG as a marker of recovery after sport-related concussion Objectives : In review ing the literature on sports injuries , few studies could be found in which exposure related incidences of injury in different types of sport were compared . These studies indicated that ice hockey , h and ball , basketball , soccer , and rugby are popular team sports with a relatively high risk of injury . The aim of the study was to compare the characteristics and incidence of injuries in male youth amateur soccer and rugby players . Methods : This prospect i ve cohort study comprised an initial baseline examination to ascertain the characteristics of the players and their level of performance , and a one season observation period during which a physician visited the team weekly and documented all occurring injuries . Twelve soccer and 10 rugby school teams with male amateur players aged 14–18 years were selected for the study . 145 soccer and 123 rugby players could be followed up over one season . Results : Comparison of the incidence of soccer and rugby injuries indicated that rugby union football was associated with a significantly higher rate of injury than soccer . The differences were pronounced for contact injuries , injuries of the head , neck , shoulder , and upper extremity , as well as for concussion , fractures , dislocations , and strains . Rugby players incurred 1.5 times more overuse and training injuries in relation to exposure time , and 2.7 times more match injuries than soccer players . Three rugby players but no soccer players had to stop their participation in sport because of severe injury . Conclusion : The incidence of injury in New Zeal and school teams playing soccer or rugby union is high , probably in part because of the low ratio of hours spent in training relative to hours spent playing matches . The development and implementation of preventive interventions to reduce the rate and severity of injury is recommended OBJECTIVE To prospect ively measure the immediate neurocognitive effects and early course of recovery from concussion and to examine the effects of loss of consciousness ( LOC ) and posttraumatic amnesia ( PTA ) on the severity of neurocognitive impairment immediately after concussion . METHODS A sports-related concussion research model was used to allow prospect i ve immediate evaluation of concussion . A total of 2385 high school and college football players were studied . Ninety-one players ( 3.8 % ) sustained concussions during the study . A brief neurocognitive and neurological screening measure , the St and ardized Assessment of Concussion  , was used to assess cognitive functioning before the football season , immediately after injury , and 15 minutes , 48 hours , and 90 days after injury . RESULTS St and ardized Assessment of Concussion scores immediately after concussion were significantly lower than the preseason baseline score and the noninjured population baseline mean , even for injured subjects without LOC or PTA . Subjects with LOC were most severely impaired immediately after injury , whereas those without LOC or PTA were least impaired . Significant impairment was also detected 15 minutes after injury , but all three groups returned to baseline levels of cognitive functioning within 48 hours . CONCLUSION These findings are the first to demonstrate not only that a gradient of increasing concussion severity is represented by PTA and LOC but also that measurable neurocognitive abnormalities are evident immediately after injury without PTA or LOC The diagnosis of sports-related concussion is mainly based on subjective clinical symptoms and neuropsychological tests . Therefore , reliable brain injury biomarkers to assess when it is safe to return to play are highly desirable . The overall objective of this study was to evaluate the utility of two newly described tau fragments for diagnosis and prognosis of sports-related concussions . This multi-center prospect i ve cohort study involved all 12 teams of the top professional ice hockey league in Sweden . A total of 288 players consented to participate in the study . Thirty-five players sustained concussions , of whom 28 underwent repeated blood samplings at 1 , 12 , 36 , and 144 h after the trauma , or when the player returned to play ( 7 to > 90 days ) . There was no significant increase in the levels of Tau-A in post-concussion sample s compared with preseason values . However , serum levels of Tau-C were significantly higher in post-concussion sample s compared with preseason . Further , levels of Tau-A correlated with the duration of post-concussive symptoms . Tau-A in serum , which is newly discovered biomarker , could be used to predict when it is safe to return to play after a sports-related concussion Background Neurocognitive testing has been endorsed as a “ cornerstone ’ of concussion management by recent Vienna and Prague meetings of the Concussion in Sport Group . Neurocognitive testing is important given the potential unreliability of athlete self-report after injury . Relying only on athletes'ormalities after injury . Study Design Case control study ; Level of evidence , 3 . Methods High school and college athletes with a diagnosed concussion were tested 2 days after injury . Postinjury neurocognitive performance ( Immediate Postconcussion Assessment and Cognitive Testing ) and symptom ( postconcussion symptom ) scores were compared with preinjury ( baseline ) scores and with those of an agex and education-matched noninjured athlete control group . “ Abnormal ” test performance was determined statistically with Reliable Change Index scores . Results Sixty-four percent of concussed athletes reported a significant increase in symptoms , as judged by postconcussion symptom scores , compared with preinjury baseline at 2 days after injury . Eighty-three percent of the concussed sample demonstrated significantly poorer neurocognitive test results relative to their own baseline performance . The addition of neurocognitive testing result ed in a net increase in sensitivity of 19 % . Ninety-three percent of the sample had either abnormal neurocognitive test results or a significant increase in symptoms , relative to their own baseline ; 30 % of a control group demonstrated either abnormalities in neurocognitive testing or elevated symptoms , as judged by postconcussion symptom scores . For the concussed group , use of symptom and neurocognitive test results result ed in an increased yield of 29 % overreliance on symptoms alone . In contrast , 0 % of the control group had both symptoms and abnormal neurocognitive testing . Conclusion Reliance on patients ’ self-reported symptoms after concussion is likely to result in underdiagnosis of concussion and may result in premature return to play . Neurocognitive testing increases diagnostic accuracy when used in conjunction with self-reported symptoms OBJECT The objective of this study was to measure the incidence of concussion ( scaled relative to number of athlete exposures ) and recurrent concussion within 2 teams of fourth-tier junior ice hockey players ( 16 - 21 years old ) during 1 regular season . METHODS A prospect i ve cohort study called the Hockey Concussion Education Project was conducted during 1 junior ice hockey regular season ( 2009 - 2010 ) involving 67 male fourth-tier ice hockey players ( mean age 18.2 ± 1.2 years , range 16 - 21 years ) from 2 teams . Prior to the start of the season , every player underwent baseline assessment s using the Sideline Concussion Assessment Tool 2 ( SCAT2 ) and the Immediate Post-Concussion Assessment and Cognitive Test ( ImPACT ) . The study protocol also required players who entered the study during the season to complete baseline SCAT2 and ImPACT testing . If the protocol was not followed , the postinjury test results of a player without true baseline test results would be compared against previously established age and gender group normative levels . Each regular season game was observed by a qualified physician and at least 1 other neutral nonphysician observer . Players who suffered a suspected concussion were evaluated at the game . If a concussion diagnosis was made , the player was subsequently examined in the physician 's office for a full clinical evaluation and the SCAT2 and ImPACT were repeated . Based on these evaluations , players were counseled on the decision of when to return to play . Athlete exposure was defined as 1 game played by 1 athlete . RESULTS Twenty-one concussions occurred during the 52 physician-observed games ( incidence 21.5 concussions per 1000 athlete exposures ) . Five players experienced repeat concussions . No concussions were reported during practice sessions . A concussion was diagnosed by the physician in 19 ( 36.5 % ) of the 52 observed games . One of the 5 individuals who suffered a repeat concussion sustained his initial concussion in a regular season game that was not observed by a physician , and as a result this single case was not included in the total of 21 total concussions . This initial concussion of the player was identified during baseline testing 2 days after the injury and was subsequently medically diagnosed and treated . CONCLUSIONS The incidence of game-related concussions ( per 100 [ corrected ] athlete exposures ) in these fourth-tier junior [ corrected ] ice hockey players was 7 [ corrected ] times higher than [ corrected ] previously reported in the literature . This difference may be the result of the use of st and ardized direct physician observation , diagnosis , and subsequent treatment . The results of this study demonstrate the need for follow-up studies involving larger and more diverse sample groups to reflect generalizability of the findings . These follow-up studies should involve other contact sports ( for example football and rugby ) and also include the full spectrum of gender , age , and skill levels CONTEXT The known detrimental effects of sport concussions on motor system function include balance problems , slowed motor execution , and abnormal motor cortex excitability . OBJECTIVE To assess whether these concussion-related alterations of motor system function are still evident in collegiate football players who sustained concussions but returned to competition more than 9 months before testing . DESIGN Case-control study . SETTING University laboratory . PATIENTS OR OTHER PARTICIPANTS A group of 21 active , university-level football players who had experienced concussions was compared with 15 university football players who had not sustained concussions . INTERVENTION(S ) A force platform was used to assess center-of-pressure ( COP ) displacement and COP oscillation regularity ( approximate entropy ) as measures of postural stability in the upright position . A rapid alternating-movement task was also used to assess motor execution speed . Transcranial magnetic stimulation over the motor cortex was used to measure long-interval intracortical inhibition and the cortical silent period , presumably reflecting y-aminobutyric acid subtype B receptor-mediated intracortical inhibition . MAIN OUTCOME MEASURE(S ) COP displacement and oscillation regularity , motor execution speed , long-interval intracortical inhibition , cortical silent period . RESULTS Relative to controls , previously concussed athletes showed persistently lower COP oscillation r and omness , normal performance on a rapid alternating-movement task , and more M1 intracortical inhibition that was related to the number of previous concussions . CONCLUSIONS Sport concussions were associated with pervasive changes in postural control and more M1 intracortical inhibition , providing neurophysiologic and behavioral evidence of lasting , sub clinical changes in motor system integrity in concussed athletes AIM To use the King-Devick ( KD ) test and Sports Concussion Assessment Tool 2 ( SCAT2 ) in amateur rugby union players to identify witnessed and unrecognised episodes of concussion that occurred from match participation . METHODS A prospect i ve observational cohort study was conducted on a premier club level amateur rugby union team during the 2012 competition in New Zeal and . Every player completed a pre-competition question naire on concussion history , a baseline PCSS and two trials of the KD before they participated in any match activities . RESULTS For players reporting a concussion in the previous three years there was an average of 4.0±2.8 concussions per player . There were 22 concussive incidents recorded over the duration of the competition ( 46 per 1000 match hours ) . Five concussive incidents were witnessed ( 11 per 1000 match hours ) and 17 unrecognised concussive incidents were identified with the KD ( 37 per 1000 match hours ) . Witnessed concussions recorded , on average , a longer KD on the day of injury ( 5.5±2.4s ) than unrecognised concussions ( 4.4±0.9s ) when compared with their baseline KD . DISCUSSION The KD was able to identify players that had not shown , or reported , any signs or symptoms of a concussion but who had meaningful head injury . The current rate of concussion reported was a ten-fold increase in previously reported concussion injury rates . This makes the KD suitable for rapid assessment in a limited time frame on the sideline such as a five-minute window to assess and review suspected concussed players in rugby union IMPORTANCE Animal models suggest that reduced cerebral blood flow ( CBF ) is one of the most enduring physiological deficits following concussion . Despite this , longitudinal studies documenting serial changes in regional CBF following human concussion have yet to be performed . OBJECTIVE To longitudinally assess the recovery of CBF in a carefully selected sample of collegiate athletes and compare time course of CBF recovery with that of cognitive and behavioral symptoms . DESIGN , SETTING , AND PARTICIPANTS A cohort of collegiate football athletes ( N = 44 ) participated in this mixed longitudinal and cross-sectional study at a private research institute specializing in neuroimaging between March 2012 and December 2013 .  Serial imaging occurred approximately 1 day , 1 week , and 1 month postconcussion for a subset of participants ( n = 17 ) . All athletes reported no premorbid mood disorders , anxiety disorders , substance abuse , or alcohol abuse . MAIN OUTCOMES AND MEASURES  Arterial spin labeling magnetic resonance imaging  was used to collect voxelwise relative CBF at each visit . Neuropsychiatric evaluations and a brief cognitive screen  were also performed at all 3 points . Clinicians trained in sports medicine provided an independent measure of real-world concussion outcome ( ie , number of days withheld from competition ) . RESULTS The results indicated both cognitive ( simple reaction time ) and neuropsychiatric symptoms at 1 day postinjury that resolved at either 1 week ( cognitive ; P < .005 ) or 1 month ( neuropsychiatric ; P < .005 ) postinjury . Imaging data suggested both cross-sectional ( ie , healthy vs concussed athletes ; P < .05 ) and longitudinal ( 1 day and 1 week vs 1 month postinjury ; P < .001 ) evidence of CBF recovery in the right insular and superior temporal cortex . Importantly , CBF in the dorsal midinsular cortex was both decreased at 1 month postconcussion in slower-to-recover athletes ( t11 = 3.45 ; P = .005 ) and was inversely related to the magnitude of initial psychiatric symptoms ( Hamilton Depression Scale : r = -0.64 , P = .02 ; Hamilton Anxiety Scale : r = -0.56 , P = .046 ) , suggesting a potential prognostic indication for CBF as a biomarker . CONCLUSIONS AND RELEVANCE To our knowledge , these results provide the first prospect i ve evidence of reduced CBF in human concussion and subsequent recovery . The resolution of CBF abnormalities closely mirrors previous reports from the animal literature and show real-world validity for predicting outcome following concussion OBJECT Pediatric sports-related concussions are a growing public health concern . The factors that determine injury severity and time to recovery following these concussions are poorly understood . Previous studies suggest that initial symptom severity and diagnosis of attention deficit hyperactivity disorder ( ADHD ) are predictors of prolonged recovery ( > 28 days ) after pediatric sports-related concussions . Further analysis of baseline patient characteristics may allow for a more accurate prediction of which patients are at risk for delayed recovery after a sports-related concussion . METHODS The authors performed a single-center retrospective case-control study involving patients cared for at the multidisciplinary Concussion Clinic at Children 's of Alabama between August 2011 and January 2013 . Patient demographic data , medical history , sport concussion assessment tool 2 ( SCAT2 ) and symptom severity scores , injury characteristics , and patient balance assessment s were analyzed for each outcome group . The control group consisted of patients whose symptoms resolved within 28 days . The case group included patients whose symptoms persisted for more than 28 days . The presence or absence of the SCAT2 assessment had a modifying effect on the risk for delayed recovery ; therefore , stratum-specific analyses were conducted for patients with recorded SCAT2 scores and for patients without SCAT2 scores . Unadjusted ORs and adjusted ORs ( aORs ) for an association of delayed recovery outcome with specific risk factors were calculated with logistic regression analysis . RESULTS A total of 294 patients met the inclusion criteria of the study . The case and control groups did not statistically significantly differ in age ( p = 0.7 ) . For the patients who had received SCAT2 assessment s , a previous history of concussion ( aOR 3.67 , 95 % CI 1.51 - 8.95 ) , presenting SCAT2 score < 80 ( aOR 5.58 , 95 % CI 2.61 - 11.93 ) , and female sex ( aOR 3.48 , 95 % CI 1.43 - 8.49 ) were all associated with a higher risk for postconcussive symptoms lasting more than 28 days . For patients without SCAT2 scores , female sex and reporting a history of ADHD significantly increased the odds of prolonged recovery ( aOR 4.41 , 95 % CI 1.93 - 10.07 and aOR 3.87 , 95 % CI 1.13 - 13.24 , respectively ) . Concussions result ing from playing a nonhelmet sport were also associated with a higher risk for prolonged symptoms in patients with and without SCAT2 scores ( OR 2.59 , 95 % CI 1.28 - 5.26 and OR 2.17 , 95 % CI 0.99 - 7.73 , respectively ) . Amnesia , balance abnormalities , and a history of migraines were not associated with symptoms lasting longer than 28 days . CONCLUSIONS This case-control study suggests c and i date risk factors for predicting prolonged recovery following sports-related concussion . Large prospect i ve cohort studies of youth athletes examined and treated with st and ardized protocol s will be needed to definitively establish these associations and confirm which children are at highest risk for delayed recovery Background Concussion is one of the most commonly occurring injuries in sport today . The Sport Concussion Assessment Tool ( SCAT ) is a commonly used paper neurocognitive tool . To date , little is known about SCAT baseline normative values in youth athletes . Objective The purpose of this study was to determine normative values on the SCAT for male and female youth hockey players . Methods This is a secondary data analysis of pooled data from three prospect i ve cohort studies examining the risk of injury in paediatric ice hockey players aged 9–17 years . A preseason baseline demographic and injury history question naire was completed by each player . Results A total of 4193 players completed SCATs at baseline and were included in the analysis . 781 players ( 18.6 % ) reported a previous history of concussion . Fatigue and low energy followed by headache were the most commonly reported symptoms in all players . The majority of youth players could recite all five words immediately but only three words when delayed . A smaller proportion of the males were able to report the months of the year in reverse order compared with females of a similar age . The median number of digits recited in reverse order was 4 . Conclusions Youth ratings varied between age groups , gender and from previously reported ratings of varsity athletes , possibly reflecting developmental and gender differences . An underst and ing of these differences in youth athletes is important to ensure appropriate performance expectations on the SCAT and when making clinical decisions following a concussion
Conditional recommendations are made supporting preventive interventions concussion education and rules prohibiting high-risk activity for both pediatric and adult amateur athletes and neck strengthening exercise in adult amateur athletes .
Strong recommendations are supported for head protective equipment in both pediatric and adult amateur athletes .
Strong recommendations regarding newer football helmet technology in adult amateur athletes and rules governing the implementation of body-checking in youth ice hockey are supported .
Background Awareness of the magnitude of contact sports-related concussions has risen exponentially in recent years .
Our objective is to conduct a prospect ively registered systematic review of the scientific evidence regarding interventions to prevent contact sports-related concussions .