bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pre-injury variables and risk of sport concussion
Authors: Mylabathula Sandhya , Mainwaring Lynda , Hutchison Michael , Richards Doug , Comper Paul 
Published: November 2017

ObjectiveThe study examined whether cognitive functioning, history of concussion (HOC), and sex predicted risk of sport concussion.DesignRetrospective study design. Predictive models were used to determine the predictive ability of each variable.SettingCanadian University.Participants708 data observations from 701 varsity athletes (41.2% female), representing 14 sports.Assessment of risk factorsTwo measures of cognitive functioning (mean reaction time and throughput [speed and accuracy]) were assessed using the Automated Neuropsychological Assessment Metrics testing battery. Categorical and continuous measures of HOC, and sex, were examined.Outcome measuresOccurrence of concussion after baseline testing.Main resultsHOC was a significant predictor for both sexes. For every previous concussion, the odds of sustaining another concussion increased by 1.5 (95% Confidence Interval [CI]: 1.1, 2.1 [females]; 1.2, 1.9 [males]). Females with a HOC had twice the odds of sustaining another concussion than those without a HOC (CI: 1.1, 4.0). For males, the odds were three times (CI: 1.7, 5.6). Cognitive functioning and sex were not meaningful predictors.ConclusionsThis study supports previous findings that HOC is a risk factor and suggests that pre-injury cognitive functioning is not a risk factor for sport concussion. Assessing HOC in all athletes prior to their competitive season provides information regarding their risk of future sport concussion. Thus, it is important for clinicians to record HOC, and to encourage athletes to report concussions to ensure an accurate HOC record. Pre-injury cognitive screening of athletes is not recommended for assessing risk of future concussion.Competing interestsSandhya Mylabathula, Lynda Mainwaring, and Michael Hutchison None.Doug Richards is the Medical Director at the MacIntosh Sports Medicine Clinic at the University of TorontoPaul Comper is a clinical neuropsychologist consultant with the NHLPA and a member of the Concussion Working Group, but neither were related to the current research
The effect of a national body checking policy change on concussion risk in youth ice hockey players
Authors: Black Amanda , Palacios-Derflingher Luz , Schneider Kathryn J , Hagel Brent E , Emery Carolyn A 
Published: November 2017

ObjectiveTo determine if the risk of game-related concussion differs for Pee Wee (11–12 years) ice hockey players in the season following a national policy change disallowing body checking (2013/2014) when compared to a season (2011/2012) when body checking was allowed.DesignHistorical cohort study.SettingCommunity ice hockey rinks.ParticipantsPee Wee players were recruited from 59 teams in all divisions of play in Alberta (n=883) in 2011/12 prior to the rule change and from 73 teams in 2013/14 following the rule change (n=617).Assessment of risk factorsPee Wee ice hockey players before and after a national body checking policy change.Outcome measuresSuspected concussions were identified by a team therapist/safety designate and referred to a sport medicine physician. Concussions were included if they met the Zurich 2013 Consensus definition of concussion.Main resultsThere were 104 game-related concussions (IR=2.79/1000 game-hours) in Alberta prior to the rule change and 24 concussions (IR=1.08/1000 game-hours) after. Based on a multivariable Poisson regression model adjusting for player size, age, body checking attitudes, previous injury, level of play, and position, accounting for clustering by team, the rate of concussion declined following the policy change [IRR=0.34 (95% CI; 0.21 – 0.56)]. Overall, a physician diagnosed 67.3% and 79.1% of suspected game concussions in 2011/2012 and 2013/2014, respectively.ConclusionsIntroduction of the national policy change disallowing body checking in Pee Wee resulted in a 66% reduction in the Alberta Pee Wee ice hockey concussion rate. These findings have important implications for youth ice hockey policy.Competing interestsNone.
Ability of scat3 and childscat3 to discriminate children with concussion from children with upper limb injuries and uninjured children in the emergency department
Authors: Babl Franz E , Dionisio Diana V , Davenport Lucy , Baylis Amy , Hearps Stephen , Bressan Silvia , Anderson Vicki , Oakley Ed , Davis Gavin A 
Published: November 2017

ObjectiveTo evaluate the ability of SCAT3 and ChildSCAT3 to discriminate children with concussion from children with upper limb injuries and uninjured children in the emergency departmentDesignProspective observational study.SettingTertiary children’s hospital emergency department.Participants264 children presenting to ED with concussion (CONC, n=90) and two control groups (i) upper limb injury (ULI, n=90) and (ii) well children (WELL, n=84) with equal sized subgroups in three age bands of 5–8, 9–12, and 13–16 years.Assessment and outcomeChild-SCAT3 was used in 5-12 years, SCAT3 in 13–16 years, administered by trained research assistants. Differences between study groups were analysed using ANOVA. Effect sizes were also assessed.ResultsThe number and severity of child and parent reported symptom scores for SCAT3 and the child-SCAT3 were significantly higher in CONC than either control group (p<0.001). Mean double and tandem stance errors were also significantly higher (p<0.001), and immediate memory and concentration were significantly lower for the CONC group (p<0.01). No group differences were found for orientation and digit backwards.Among SCAT3 symptoms, headache and pressure in head had the highest effect size (0.51 and 0.44 respectively, p<0.001). Among Child SCAT3 symptoms, I have headaches and I feel dizzy had the highest effect size (0.31 and 0.23 respectively, p<0.001). There were no significant differences between ULI and WELL control groups.ConclusionsOverall, SCAT3 and child-SCAT3 can differentiate concussed from non-concussed patients, in particular for number and symptom severity. However, some neuropsychological subtests do not differentiate concussed patients and controls.Competing interestsGAD is an honorary member of the Australian Football League Concussion Working Group, and has attended meetings organised by sporting organisations including the National Football League (USA), National Rugby League (Australia) and FIFA (Switzerland); however has not received any payment, research funding, or other monies from these groups other than for travel costs. GAD is a member of the International Concussion in Sport group that developed the SCAT3 and ChildSCAT3
Defining the elite: normative values for scat major components in healthy elite athletes
Authors: Moreau William J , Walden Taylor , Nabhan Dustin 
Published: November 2017

ObjectiveDescribe normative baseline SCAT 2 and 3 (SCAT) performance in elite athletes.DesignRetrospective cohort.SettingUnited States Olympic Committee Sports Medicine Clinics.ParticipantsSix hundred and forty-one SCAT baseline evaluations were performed on a population of 565 elite athletes (291 women and 350 men, mean age 24.9±5.2 years) representing 23 Summer and Winter Olympic sports as part of a multimodal concussion management program.InterventionNo intervention was applied. The SCAT evaluations were administered as a component of baseline testing on healthy athletes.Main Outcome MeasurementsBaseline SCAT performance on major components is described. T-tests were used to compare differences in baseline performance by sex.ResultsDuring baseline evaluation elite athletes reported a mean of 2.1 (1.8–2.4) symptoms with average symptom severity scores of 3.4 (3.0–3.9). Mean scores on SCAT 3 components in this population were; orientation 4.9 (4.8–4.9), immediate memory 14.5 (14.4–14.5), concentration 3.9 (3.8–4.0), tandem gait 11.7 (11.4–12.0), delayed recall 3.7 (3.6–3.8), balance 2.83 (2.2–3.4), SAC total 26.9 (26.8–27.1). This population reported historys of 1.19 (1.0–1.4) previous concussions. Females reported significantly more symptoms (3.9 vs 3.0, P=0.04), and scored significantly higher on the orientation (4.9 vs. 4.8, P=0.004), immediate memory (14.6 vs. 14.4, P=0.003), concentration (4.1 vs 3.8, P=0.0013) SAC total score (27.3 vs. 26.6, P<0.01)ConclusionsPopulation specific normative values for baseline SCAT performance in a population of elite athletes are presented in this case series.Clinical relevanceClinicians are encouraged to reference population specific normative values when interpreting SCAT performance.AcknowledgementsNone.Competing interestsNone.
Reliability of the scat2/3 in college athletes
Authors: Mrazik Martin , Lenchyshyn Jessica , Borza Carley , Naidu Dhiren , Lebrun Constance M 
Published: November 2017

ObjectiveTo evaluate psychometric properties of the Sport Concussion Assessment Tool (SCAT).DesignRetrospective clinical study in which athletes completed the SCAT over 2 consecutive seasons. Athletic therapists administered the SCAT and a pre-season medical questionnaire.SettingUniversity setting.Participants165 college athletes who were enrolled at a university in Western Canada who played collision sports.Interventionthe SCAT2 and subsequently the SCAT3 was administered to all participants at baseline.Main outcome measuresIntraclass coefficients (ICC’s) and paired sample t-tests.Main resultsThe intraclass reliability coefficients for demographic variables ranged from moderate to good (0.66 to 0.94). The reliability of the cognitive test results and balance error scoring system (BESS) was rated as good (0.83 and 0.88 respectively). Total symptom report and symptom severity report was moderate, with significant differences noted between males and females. History of concussion did not significantly impact reliability coefficients. Among the 22 athletes who suffered concussions during a competitive season, the reliability of the core components of the SCAT remained high.ConclusionsThe reliability of the SCAT2/3 is classified as good although symptom report is more variableCompeting interestsNone.Keywords: concussion, sport concussion assessment tool, psychometric properties
To document false-positive scores on the sport concussion assessment tool (scat3) in high school athletes
Authors: Covassin Tracey , Elbin RJ , Schatz Philip , Beidler Erica , Wallace Jessica 
Published: November 2017

ObjectiveTo document false-positive scores on the Sport Concussion Assessment Tool(SCAT3) in high school athletes.DesignPre-Test Only.SettingSix high schools in the Mid-West and Central Region of the USA.ParticipantsThe sample was composed of a total of 489 high school athletes who completedall components of the SCAT3: 157 female (Mean age=15.6, SD=1.8 years) and 322 male(Mean age=15.9, SD=1.5 years) adolescent athletes.InterventionThe SCAT3 was administered to all athletes.Outcome measuresCases were identified as “false-positive” by surpassing cutoff scores using 95% confidence intervals from the sample on SCAT3 components: Standardised Assessment ofConcussion (SAC: Mean 26.06±2.34, Cutoff<21), total severity of symptoms (Males: Mean:3.24±5.93, Cutoff>15; Females: Mean: 4.16±6.96, cutoff>18), tandem gait (Mean:15.55±4.52, Cutoff>25 sec), and total errors on the modified Balance Error Scoring System(mBESS: Mean: 3.42±2.67, Cutoff>9 errors).Main resultsOverall, 16% of athletes (n=78) obtained scores falling beyond false-positivecutoffs on at least one sub-component of the SCAT, and only 2% (N=10) obtained two or morescores beyond cutoffs. False-positive rates on individual components were as follows: SAC:5.7% (n=28), mBESS: 5.5% (n=27), tandem gait: 3.9% (n=19), total symptom severity: 4.9% (n=24).ConclusionsWhile rates of false positives fell generally within 95% CIs for individual components of the SCAT, the overall SCAT3 false-positive rate was 16%. Comparisons between post-concussion and baseline SCAT3 data should be based on 2 or more components falling outside 95% CIs.Competing interestsDr. Schatz serves on the ImPACT Scientific Advisory Board
The effects of age and learning disabilities in the king-devick test in adolescent ice-hockey players
Authors: Hokkanen Laura , Peltonen Kati , Vartiainen Matti , Laitala-Leinonen Tiina 
Published: November 2017

ObjectiveKing-Devick (K-D) is becoming a popular screening test for sport concussion. Rapid number naming may be impaired in developmental dyslexia and other learning disabilities (LD). The aim was to study the interaction of age and LD in K-D in adolescence. The hypothesis was that those with LD perform more poorly on the test regardless of age.DesignA case-control, cross-sectional nation-wide study.SettingPre-season 2015–16 baseline tests in all junior teams in the Finnish ice hockey League.ParticipantsA total of 805 male adolescents aged 12–21 (divided in 7 age groups), 75 of them reported LD.Outcome measuresThe K-D performance was measured twice. Time in the three subtests was combined to produce a sum score. Sum scores, and their difference, were used as outcome measures.Main ResultsIn the youngest age group the mean of the K-D second trial was 49.7 (48.3–51.0, 95% confidence intervals) and in the oldest age group 44.7 (42.9–46.5). In a two-way ANOVA those with LD performed poorer (p=0.014, ηp²=0.008) but there was no interaction between age and LD. Similarly, a repeated analysis of covariance yielded a significant main effect for the trial (p<0.001, ηp²=0.042) and for LD (p<0.001, ηp²=0.026) but not for their interaction when the effect of age was controlled.ConclusionsAdolescent players improve their performance in K-D with age, but those with learning disabilities remain slower despite maturation. If K-D is used as a single test for screening, and no baseline data is available, this needs to be recognised.Competing interestsNone.
A systematic review and meta-analysis on the role of exercise or rest in patients with concussion and mild traumatic brain injury
Authors: Lal Avtar , Kolakowsky-Hayner Stephanie , Ghajar Jamshid , Vazquez Oscar , Balamane Maya 
Published: November 2017

ObjectiveTo conduct a systematic review and meta-analysis evaluating the role of exercise or rest in patients with concussion or mild traumatic brain injury.DesignSystematic review and meta-analysis.Data sourcesMedline, PsychInfo, Scopus, Cochrane Controlled Trials Registers and Sport Discus, till March 2016 and hand search of some articles.Study selectionRandomised controlled trials (RCTS) and observational studies (OBS) comparing the effect of exercise or rest in patients with concussion, on different outcomes.ParticipantsChildren and adults with concussion or mild traumatic brain injury.InterventionExercise or Rest.OutcomesPost concussive symptoms (PCCS), balance error scoring system (BESS), immediate post concussion assessment and cognitive testing (ImPACT).Main resultsOur search generated 921 studies. Of these, 5 RCTs and 12 OBS met our inclusion criteria. Methodological quality of most of the studies was poor. Meta-analysis of 6 studies involving more than 556 patients showed statistical significant decrease in PCCS with exercise compared to control, Mean Difference (MD) [95% Confidence Interval (CI)], −14.6 [−17.8, −11.3], p<0.001. There was some clinical, but no statistical heterogeneity among the studies (I2=32%). Exercise did not affect BESS, neuropsychological scale and ImPACT score.There was not effect of rest on total symptoms in patients with concussion and number of patients with symptoms.ConclusionOur systematic review and meta-analysis showed clear benefits of exercise in PCCS. However, the evidence was based on poor quality studies that vary in duration, frequency and intensity of exercise. A good quality RCT needs to be conducted to evaluate a clear effect of exercise and rest in patients with concussion.Competing interestsNone.
Pilot survey regarding “the green folder” – an educator-designed secondary school return to learn protocol after a sport-related concussion
Authors: Carson James D , Safwan Aliya , Kraft Sari A , Kuwahara Nariko , Moser Stefanie E , Rabinovitch Sarah T , Mansoora Qurat-ul-Ain , Jegatheesan Vijitha , Moineddin Rahim , Fremont Pierre 
Published: November 2017

ObjectiveTo demonstrate whether a user-centred (teacher accepted and student focused) return to learn (RTL) protocol after a sport-related concussion (SRC)has an efficacious role.DesignProspective pilot survey.SettingFour sport medicine clinics in Ontario, Canada.ParticipantsTwenty-eight collegiate athletes (21 males and 7 females: age=20.2 ± 1.7 years, height=182.2 ± 11.9 cm, mass=90.3 ± 24.2 kg) without history of: headaches or migraines, substances/alcohol abuse, and/or psychiatric conditions.InterventionNineSRC students from one (index) school who used the new protocol and a control group (11 SRC students) from other schools, who did not use the new protocol,completed a web-based survey.Outcome measuresPrimary outcome measures include student perception of school support during their SRC RTL.Main resultsTwenty surveys were completed from an eligible 52 students (38.5%).Among students who received the Green Folder at the index school, 71.4% either strongly or mostly agreed thatsuch an RTL protocol could shorten the duration of SRC symptoms. At that school, 100% strongly or mostly agreed (versus 14.3% from the other schools) that the school was very helpful advising about the RTL steps and when they should return to school. 85.7% of students at the index school versus 28.6% from other schools, strongly or mostly agree that the school staff fully understands RTL strategies after SRC.ConclusionsThe “Green Folder” incorporating RTL steps and a daily class-by-class accommodation sign off by a guidance counsellor, appears to have perceived efficacy for SRC students. Further research will determine whether such a user-centred RTL protocol results in a more efficacious implementation of expert recommendations about concussion management, worthy of widespread dissemination.Competing interestsNone.
Survey of educators regarding the return to learn after a sport-related concussion
Authors: Carson James D , Garel Alisha , Rendely Alexandra , Meaney Christopher , Moser Stefanie E , Rabinovitch Sarah T , Kraft Sari A , Fremont Pierre 
Published: November 2017

ObjectiveTo evaluate the impact of an educational intervention upon educators’ knowledge of sport-related concussion (SRC) management strategies and their understanding of academic accommodations as part of the return to learn (RTL) strategy after an SRC.DesignA pre- and post-intervention study.SettingA sport-focused Ontario (Canada) secondary school.Participants94 educational staff, including teachers, administrators and school psychologists.InterventionsThree ten-minute didactic lectures were followed by ninety minute facilitated focus groups during an educators’ professional development workshop. Participants learned about the nature and management of SRC with an emphasis upon RTL. Participants also had to reflect on their own experiences with some of the 63 students who had RTL at that school, after an SRC during the prior 3.5 years.Outcome measuresParticipants answered pre and post intervention surveys directed toward knowledge of SRC management principles and acknowledgement of accommodations.Main results81 of the 94 participants submitted two matched pre and post surveys. Educators indicated significantly increased understanding of SRC management and showed a significantly increased support of accommodations after the intervention (p<0.05).ConclusionsEducators’ understanding of SRC management strategies is essential to facilitate a successful RTL. This study suggests that a brief educational intervention can improve the support of educators for academic accommodations as part of the RTL phase of SRC management.Competing interestsNone.
Utilisation of an electronic incident report to document injury-related demographics and medical triage in youth, high school and college athletes
Authors: Alberts Jay L , Linder Susan M , Russman Andrew , Figler Rick , Cruickshank Jason , Grey Bob , Lally Maureen , Day Tanujit 
Published: November 2017

ObjectiveTo develop and utilise a custom mobile application to provide a portable yet systematic method to characterise injury demographics, post-injury disposition, and immediate medical care of sport-related concussion in youth, high school and college settings.DesignRetrospective observational study.SettingAcademic medical centre.ParticipantsAthletes under the care of Cleveland Clinic Concussion Centre clinicians from August 5, 2014-March 1, 2016. The sample included youth (n=110), high school (n=1175) and college (n=309) athletes; approximately 35% of the sample were female.InterventionElectronic incident reports were completed on all student-athletes with suspected concussion to triage injury severity, document injury-related demographics along with immediate medical management. Total time to complete the incident report was less than three minutes.Outcome measuresSport, mechanism of injury, red flags, immediate symptoms, and post-injury disposition were recorded for all participants.Main resultsFootball and soccer represented the greatest frequency of injury across males and females respectively. Despite significantly fewer red flags in youth, they weresent to the emergency department four times more frequently (22%) than high school or college athletes (5%).ConclusionsThe systematic characterisation of injury profiles indicates athletes across the continuum of age share general characteristics in terms of incidence as a function of sport and setting (practice vs. competition). The disproportional disposition to emergency departments, despite the absence of red flags, indicates a more conservative approach to youth concussion triage compared to high school and college athletes.Competing interestsNone.
Does concussion education have an impact in behaviours amongst school-age rugby players?
Authors: Bosshardt Chris , England Mike , Medici Akbar de , Kipps Courtney 
Published: November 2017

BackgroundConcussion is a common injury in school-boy rugby, if managed incorrectly it can have serious consequences such as further injury, prolonged symptoms, and second impact syndrome. Adolescent players show poor knowledge levels and symptoms-reporting behaviour.ObjectiveInvestigate the effects of an educational presentation on the knowledge and behaviour of school age rugby players regarding concussion.DesignQuestionnaire based study.Setting120 male rugby players, aged 16–18.ParticipantsThree large rugby union playing schools in England.InterventionsIndependent Variable – Educational presentation aimed at school-age rugby players to improve their education and behaviours related to the condition.Players completed a questionnaire testing for likely behavioural responses from a selection of common concussion scenarios. Additional questions assessed knowledge of concussion symptoms, diagnosis and management. The questionnaires were completed pre-season and repeated 2–3 months after the presentation.OutcomeDependent variable: Questionnaire scores.ResultsThe students had significantly improved their responses giving 53.9% appropriate responses after the presentation (Md=55, n=34) compared to 46.1% before (Md=33.5,n=34) (U=400,Z=-2.18,p=0.029) with a moderate effect size (r?=?0.37).The knowledge of students increased from 37.85% correct responses before (Md=28,n=35) and 44.07% on follow up?(Md=28,n=35) but with no significant difference (U?=?575.5,Z?=?-?0.88,p=0.378 with a small effect size (r?=?0.15)).Completed surveys showed increased awareness of guidelines from 19.4% to 73.2% (p=0.00 McNemars Test).ConclusionsThe students had showed improved concussion behaviour in response to concussion scenarios at 2–3 month follow up in contrast to previous studies on educational interventions. There was no increase in players knowledge of concussion. The literature shows increases in short-term knowledge with other forms of concussion education but this effect is often lost at long term follow up. There was increased awareness of guidelines. Future concussion education should be modeled on the educational presentation to improve behavioural outcomes.