Purpose: This study evaluated the consistency between athletes’ self-reported cognitive symptoms ... more Purpose: This study evaluated the consistency between athletes’ self-reported cognitive symptoms and cognitive test performance. Methods: The sample included 784 Canadian Football League athletes who underwent standardized cognitive testing with cognitive testing (ImPACT) and the Brief Symptom Inventory (BSI-18) at baseline. Over 2 consecutive seasons, 46 players were diagnosed with concussions following assessment with team physicians within 48 hours; 10 were eliminated due to missing data. Five cognitive symptoms (feeling slowed down, feeling in a fog, not feeling right, difficulties concentration, difficulties with memory) were used to create a composite score (Cog). The Cog index, the depression, anxiety, total index scores from the BSI, and the 5 ImPACT cognitive domains were correlated at baseline and post-injury. History of learning disabilities, ADHD, psychiatric diagnosis, and history of concussion were co-variates. Results: There were no significant correlations between Co...
Purpose: The purpose of this study was to examine baseline and post-concussion injury characteris... more Purpose: The purpose of this study was to examine baseline and post-concussion injury characteristics of ocular eye movements using the Sync Think visual eye tracking apparatus in professional football players in the Canadian Football League (CFL). Methods: The visual tracking testing protocol uses an integrated stimulus presentation-eye tracking apparatus (EyeLink CL; SR Research, Ontario, Canada) with which eye movements were recorded at 500 Hz using infrared video-oculography. The standard deviation of radial errors (SDRE) and tangential errors (SDTE) were used to determine poor visual tracking. Participants were (n = 748) rostered players in the Canadian Football League. All participants completed assessments at baseline. Sixteen players completed post-concussion assessments and 98 players completed post-exertional assessments during the 2021 season to evaluate the impact of physical exertion on ocular movement metrics. Results: Participants with diagnosed concussions (n = 16+) ...
Purpose: Current research suggests that athletes with Attention Deficit Hyperactivity Disorder (A... more Purpose: Current research suggests that athletes with Attention Deficit Hyperactivity Disorder (ADHD) are at risk for poorer outcomes arising from sport related concussions (SRC). There is limited research related evaluating mental health outcomes in athletes diagnosed with ADHD. The purpose of the study is to evaluate mental health outcomes among Canadian Football League (CFL) athletes with (ADHD) and to measure outcomes based upon a history of concussion. Methods: Professional football players from the CFL (n = 784) were administered a baseline mental health measure, the Health-Related Quality of Life (HRQL), as a component of pre-season evaluations as part of a larger cohort study (Active Rehabilitation). Diagnosis of ADHD was the independent variable and HRQL index scores measuring physical functioning, depression, cognitive functioning, were dependent variables. A second analysis compared ADHD athletes with no history of concussion to those with a history of concussion on the H...
Objective Investigation of anxiety and depression symptoms at baseline and following sport relate... more Objective Investigation of anxiety and depression symptoms at baseline and following sport related concussion in a population of professional and collegiate football players. Method A quasi-experimental prospective longitudinal design was implemented. Participants included 198 Canadian Football League and University of Alberta varsity football players at baseline. Additionally, this study tracked 13 concussed athletes, 12 orthopaedic control athletes, and 15 healthy control athletes over approximately a 2 month period. Statistical analysis included an ANOVA and repeated measures ANOVA to identify differences in mental health at baseline as well as after injury at 3 time points (24-48 hours post injury, asymptomatic, and 1 month post return to play). Results At baseline, players who had a history of 1 or more concussions reported a greater number of anxiety and depression symptoms in comparison to players who did not have a history of concussion (F(2, 197) = 66.75, (p =.000)). At the...
CI, 1.3-2.3) symptoms of a maximum 22 with a severity of 3.0 (95% CI, 1.9-4.1) (maximum possible ... more CI, 1.3-2.3) symptoms of a maximum 22 with a severity of 3.0 (95% CI, 1.9-4.1) (maximum possible 132). The most commonly reported symptoms were trouble falling asleep (n¼34, 21%), fatigue (n¼29, 18%), neck pain (n¼28, 17%), and nervousness/anxiety (n¼28, 17%). The mean immediate memory score was 14.6 (95% CI, 14.5-14.7) of a maximum 15 and the mean delayed recall score was 4.0 (95% CI, 3.9-4.2) of a maximum 5. The concentration examinations, repetition of digits backwards and months in reverse order, were completed with 74% and 91% accuracy, respectively. Participants averaged maximum orientation and coordination scores. Conclusions: This study provides normative baseline values for the SCAT3 among collegiate and professional American football players. Our findings suggest the presence of few reported symptoms at baseline and high proficiency on the orientation, memory, concentration, and coordination components of the SCAT3. These data may be used to guide clinicians when making return-to-play decisions for injured athletes in the absence of individual baseline tests.
Introduction: Patients with concussion often present to the emergency department (ED). Current gu... more Introduction: Patients with concussion often present to the emergency department (ED). Current guidelines recommend graded return to work and physical activity (i.e., sport, recreation and exercise activities); however, whether emergency physicians target this advice based on patient-reported activities is unknown. This study aimed to assess mismatches between physicians’ rest and return-to-activity advice and self-reported pre-injury work and physical activity of adult concussion patients. Methods: Adults (>17 years) presenting with a concussion from April 2013 to April 2015 to a study ED with Glasgow coma scale score ≥13 were recruited by on-site research assistants. Data on patient characteristics (i.e., age, sex, employment, and physical activity level) and activity leading to injury were collected from structured patient interviews. A structured questionnaire collected data from the treating physician about discharge advice provided. “Working” was defined as employed or enro...
Introduction: Patients with concussion often present to the emergency department (ED). Although s... more Introduction: Patients with concussion often present to the emergency department (ED). Although sports and recreation (SR) activities account for less than half of all adult concussions, guidelines developed for management of SR-related concussions (SRC) are widely used for all concussion patients. This study aimed to identify whether there are clinically relevant differences in patient and injury characteristics between SRC and those occurring outside of SR activities. Methods: Adults ( >17 years) presenting from April 2013 to April 2015 with a concussion to one of three EDs with Glasgow coma scale score ≥13 were recruited by on-site research assistants. Data on patient characteristics (i.e., age, sex, employment, lifestyle, relevant medical history), ED presentation (i.e., EMS arrival, hours since injury, CTAS, Glasgow Coma Scale score) and injury characteristics (i.e., activity leading to injury, loss of consciousness [LOC], signs and symptoms [scored using the Rivermead Post-...
Introduction: Patients with mild traumatic brain injury (mTBI) frequently present to the emergenc... more Introduction: Patients with mild traumatic brain injury (mTBI) frequently present to the emergency department (ED); however, wide variation in diagnosis and management has been demonstrated in this setting. Sub-optimal mTBI management can contribute to post-concussion syndrome (PCS), affecting vocational outcomes like return to work. This study documented the work-related events, ED management, discharge advice, and outcomes for employed patients presenting to the ED with mTBI. Methods: Adult (>17 years) patients presenting to one of three urban EDs in Edmonton, Alberta with Glasgow coma scale score ≥13 within 72 hours of a concussive event were recruited by on-site research assistants. Follow-up calls ascertained outcomes, including symptoms and their severity, advice received in the ED, and adherence to discharge instructions, at 30 and 90 days after ED discharge. Dichotomous variables were analyzed using chi-square testing; continuous variables were compared using t-tests or M...
Purpose: Assessment of emotional functioning is essential in sports-related concussion (SRC) mana... more Purpose: Assessment of emotional functioning is essential in sports-related concussion (SRC) management. This study investigated the prediction of mental health outcomes from the SCAT-3 Symptom Scale. Methods: Canadian university athletes who compete in contact sports participated in a large-scale study (Active Rehabilitation). A total of 235 participants (males = 67%) completed the Brief Symptom Inventory (BSI), Quality of Life Scale (QOLS), and Sideline Concussion Assessment Tool, 3rd edition (SCAT). Step-wise regression analysis using demographic variables (gender, age, history of Learning Disability, history of ADHD, diagnosis of psychiatric condition) and psychological symptoms from the SCAT were used as predictors for the BSI (Depression and Anxiety) and QOLS (Depression and Anxiety). Results: Regression analysis revealed female gender, previous psychiatric diagnosis and Nervousness (SCAT) significantly predicted higher scores on the Depression subscales of BSI (R2 = 0.21, F1,...
The aims were to (1) examine the rates and mechanisms of concussion and head impact in youth foot... more The aims were to (1) examine the rates and mechanisms of concussion and head impact in youth football (high school level or younger); (2) identify modifiable risk factors for concussion and head impact; and (3) evaluate the effectiveness of prevention strategies in tackle football at any level. Nine databases (CINAHL Plus with Full Text; Cochrane Central Register of Controlled Trials; EMBASE; ERIC; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily; ProQuest Dissertations & Theses Global Database; PsycINFO; Scopus; and SPORTDiscus with Full Text) were searched using the search strategy focusing on four main concepts: concussion/head impact, tackle football, modifiable risk factors, and primary prevention. Two reviewers completed title, abstract, and full-text screening as well as risk of bias assessment (using the Downs and Black checklist), with a third author available to resolve any disagreements. After removing duplicates, 1911 articles were returned. Fifty-eight articles were included in the review and 20 in the meta-analysis. The overall combined rates of concussion (including game and practice-related concussion) based on the meta-analysis were 0.78 concussions/1000 athlete exposures [95% confidence interval (CI) 0.67–0.89] for high school football (ages 13–19) and 1.15 concussions/1000 athlete exposures (95% CI 0.89–1.41) for minor football players (ages 5–15). There is evidence that contact training and practice contact restrictions have reduced the rate of head impacts and concussion. Heads Up Football (an intervention focused on coach education and contact training) has been shown to reduce the rate of concussion by 32% and head impacts by 38% amongst high school football players. Limiting contact practices in high schools to 2 days per week reduced practice head impacts per player-season by 42%, and limiting full contact in practice to 75 min per week in the second week of the season and 60 min in week 3 and beyond resulted in a 54% decrease in the practice-related concussion rate (p = 0.003). This review identified a critical need for interventions to address the high rates of concussion and head impact in youth football. To date, contact training and contact restrictions have the strongest evidence supporting their effectiveness at reducing these rates. Future research should use consistent concussion definitions and validated injury surveillance systems, and ensure complete reporting of participant characteristics and sampling details. Prospero ID CRD42020193775.
Purpose The assessment of concussed athletes uses standardized tools like the Sport Concussion As... more Purpose The assessment of concussed athletes uses standardized tools like the Sport Concussion Assessment Tool (SCAT). The purpose of this study was to evaluate whether concussed athletes accurately recalled baseline functioning. Methods A retrospective cohort analysis of University football student-athletes from 2014-16 seasons was conducted. Forty-six student-athletes (M=19.7, SD=1.8) who suffered a concussion during the competitive season underwent a post-concussion assessment with a sports medicine physician within 24 hours of injury. Assessments included use of the symptom report from The SCAT3. Athletes were asked to recall their pre-injury baseline functioning. Results Of the 46 athletes who underwent assessments, 22 reported having at least 1 symptom (M=1.4, SD=2.0) at baseline evaluations. Yet at the initial medical evaluation, only 10 of these athletes correctly recalled having symptoms prior to injury, and none of them accurately reported their total symptom report. Paire...
Introduction: Patients with mild traumatic brain injury (mTBI) often present to the emergency dep... more Introduction: Patients with mild traumatic brain injury (mTBI) often present to the emergency department (ED). Incorrect diagnosis may delay appropriate treatment and recommendations for these patients, prolonging recovery. Notable proportions of missed mTBI diagnosis have been documented in children and athletes, while diagnosis of mTBI has not been examined in the general adult population. Methods: A prospective cohort study was conducted in one academic (site 1) and two non-academic (sites 2 and 3) EDs in Edmonton, Canada. On-site research assistants enrolled adult (>17 years) patients presenting within 72 hours of the injury event with clinical signs of mTBI and Glasgow comma scale score ≥13. Patient demographics, injury characteristics, and ED flow information were collected by chart review. Physician-administered questionnaires and patient interviews documented the recommendations given by emergency physicians at discharge. Bi-variable comparisons are reported using Pearson...
Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, Jan 17, 2015
To measure neurocognitive functioning in college and professional football players after game par... more To measure neurocognitive functioning in college and professional football players after game participation. Retrospective, cross-sectional cohort design. Ninety-four male university and professional football players. All participants completed Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) testing at baseline, and either at postconcussion (group 1) or postgame (group 2) participation. Results from the 5 ImPACT composite scores (Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time and Impulse Control) and Total Symptom Score. Repeated-measures analysis of variance demonstrated a significant main effect for time (improvements) in 3 of 5 domains for the postconcussion group, but no improvements in the postgame group. The postconcussion group presented with significantly improved results on 4 of 5 ImPACT domains compared with the postgame group at the follow-up time interval. Participation in a football game with potential cumulative head contacts did not...
Educating athletes, coaches, parents and healthcare providers about concussion management is a pu... more Educating athletes, coaches, parents and healthcare providers about concussion management is a public health priority. There is an abundance of information on sports concussions supported by position statements from governing sport and medical organisations. Yet surveys of athletes, parents, coaches and healthcare providers continue to identify multiple barriers to the successful management of sports concussion. To date, efforts to provide education using empirically sound methodologies are lacking. To provide a comprehensive review of scientific research on concussion education efforts and make recommendations for enhancing these efforts. Qualitative literature review of sports concussion education. Databases including PubMed, Sport Discus and MEDLINE were searched using standardised terms, alone and in combination, including 'concussion', 'sport', 'knowledge', 'education' and 'outcome'. Studies measuring the success of education intervention...
ABSTRACT It is critical that physicians understand concussion management. Identify practice patte... more ABSTRACT It is critical that physicians understand concussion management. Identify practice patterns/knowledge base in two physician populations. On-line survey. Ontario, Canada. Physicians from Sections: Sport and Exercise Medicine (SEM), General and Family Practice (SGFP). Emailed survey, 2 reminders. Practice patterns/knowledge base, learning methods: current/preferred. Participants: SEM 92/594 (15.5%), SGFP 270/12,168 (2.2%); urban practice (90.2% SEM, 71.5% SFGP; P<.001). In preceding 3 months, 84.8% of SEM and 65.6% of SFGP had managed patients with concussion. More SEM than SGFP physicians saw >5 children under 18 with concussions per month (40.2% SEM, 9.5% SGFP; P<001). Tools: Clinical examination (92.4% SEM, 93.7% SFGP); Sport Concussion Assessment Tool (SCAT/SCAT2) (68.4% SEM, 34.1% SFGP; P<.001); balance testing (56.5% SEM, 37.4% SFGP; P=.001); computerized neurocognitive testing (23.9% SEM, 1.9% SFGP; P<.001); concussion grading scales (9.8% SEM, 14.1% SFGP; P<.001). Management: Complete physical rest (65.2% SEM, 68.5% SFGP); absolute cognitive rest (46.7% SEM, 51.9% SFGP); modified school/work until symptom resolution (50.0% SEM, 38.5% SFGP; P=.026); no cognitive rest (3.2% SEM, 9.6% SGFP; P=.026). Return-to-play: Clinical examination (87.0% SEM, 82.6% SFGP); SCAT/SCAT2 (60.8% SEM, 29.6% SFGP; P<.001); balance testing (56.5% SEM, 37.4% SFGP; P<.001); computerized neurocognitive testing (35.9% SEM, 2.2% SFGP; P<.001); concussion grading scales (7.6% SEM, 9.6% SFGP). Current learning sources: colleagues (55.4% SEM, 27.8% SFGP; P<.001); specialists (33.7% SEM, 23.7% SFGP; P=.030); continuing medical education (CME) courses/conferences (67.4% SEM, 54.7% SFGP; P=.017); journals/publications (48.9% SEM, 25.2% SFGP; P<.001); websites (35.8% SEM, 32.2% SFGP); medical school/residency training (19.6% SEM, 17.4% SFGP). Preferred learning sources: CME courses/conferences (85.9% SEM, 73.9% SFGP; P=.006); websites (35.9% SEM, 47.8%, SFGP; P=.024); medical school/residency training (37.0% SEM, 47.8% SFGP). Gaps exist between consensus-based recommendations regarding concussions and current clinical practice patterns. Enhanced training in medical school/residency and additional CME initiatives are recommended.
Purpose: This study evaluated the consistency between athletes’ self-reported cognitive symptoms ... more Purpose: This study evaluated the consistency between athletes’ self-reported cognitive symptoms and cognitive test performance. Methods: The sample included 784 Canadian Football League athletes who underwent standardized cognitive testing with cognitive testing (ImPACT) and the Brief Symptom Inventory (BSI-18) at baseline. Over 2 consecutive seasons, 46 players were diagnosed with concussions following assessment with team physicians within 48 hours; 10 were eliminated due to missing data. Five cognitive symptoms (feeling slowed down, feeling in a fog, not feeling right, difficulties concentration, difficulties with memory) were used to create a composite score (Cog). The Cog index, the depression, anxiety, total index scores from the BSI, and the 5 ImPACT cognitive domains were correlated at baseline and post-injury. History of learning disabilities, ADHD, psychiatric diagnosis, and history of concussion were co-variates. Results: There were no significant correlations between Co...
Purpose: The purpose of this study was to examine baseline and post-concussion injury characteris... more Purpose: The purpose of this study was to examine baseline and post-concussion injury characteristics of ocular eye movements using the Sync Think visual eye tracking apparatus in professional football players in the Canadian Football League (CFL). Methods: The visual tracking testing protocol uses an integrated stimulus presentation-eye tracking apparatus (EyeLink CL; SR Research, Ontario, Canada) with which eye movements were recorded at 500 Hz using infrared video-oculography. The standard deviation of radial errors (SDRE) and tangential errors (SDTE) were used to determine poor visual tracking. Participants were (n = 748) rostered players in the Canadian Football League. All participants completed assessments at baseline. Sixteen players completed post-concussion assessments and 98 players completed post-exertional assessments during the 2021 season to evaluate the impact of physical exertion on ocular movement metrics. Results: Participants with diagnosed concussions (n = 16+) ...
Purpose: Current research suggests that athletes with Attention Deficit Hyperactivity Disorder (A... more Purpose: Current research suggests that athletes with Attention Deficit Hyperactivity Disorder (ADHD) are at risk for poorer outcomes arising from sport related concussions (SRC). There is limited research related evaluating mental health outcomes in athletes diagnosed with ADHD. The purpose of the study is to evaluate mental health outcomes among Canadian Football League (CFL) athletes with (ADHD) and to measure outcomes based upon a history of concussion. Methods: Professional football players from the CFL (n = 784) were administered a baseline mental health measure, the Health-Related Quality of Life (HRQL), as a component of pre-season evaluations as part of a larger cohort study (Active Rehabilitation). Diagnosis of ADHD was the independent variable and HRQL index scores measuring physical functioning, depression, cognitive functioning, were dependent variables. A second analysis compared ADHD athletes with no history of concussion to those with a history of concussion on the H...
Objective Investigation of anxiety and depression symptoms at baseline and following sport relate... more Objective Investigation of anxiety and depression symptoms at baseline and following sport related concussion in a population of professional and collegiate football players. Method A quasi-experimental prospective longitudinal design was implemented. Participants included 198 Canadian Football League and University of Alberta varsity football players at baseline. Additionally, this study tracked 13 concussed athletes, 12 orthopaedic control athletes, and 15 healthy control athletes over approximately a 2 month period. Statistical analysis included an ANOVA and repeated measures ANOVA to identify differences in mental health at baseline as well as after injury at 3 time points (24-48 hours post injury, asymptomatic, and 1 month post return to play). Results At baseline, players who had a history of 1 or more concussions reported a greater number of anxiety and depression symptoms in comparison to players who did not have a history of concussion (F(2, 197) = 66.75, (p =.000)). At the...
CI, 1.3-2.3) symptoms of a maximum 22 with a severity of 3.0 (95% CI, 1.9-4.1) (maximum possible ... more CI, 1.3-2.3) symptoms of a maximum 22 with a severity of 3.0 (95% CI, 1.9-4.1) (maximum possible 132). The most commonly reported symptoms were trouble falling asleep (n¼34, 21%), fatigue (n¼29, 18%), neck pain (n¼28, 17%), and nervousness/anxiety (n¼28, 17%). The mean immediate memory score was 14.6 (95% CI, 14.5-14.7) of a maximum 15 and the mean delayed recall score was 4.0 (95% CI, 3.9-4.2) of a maximum 5. The concentration examinations, repetition of digits backwards and months in reverse order, were completed with 74% and 91% accuracy, respectively. Participants averaged maximum orientation and coordination scores. Conclusions: This study provides normative baseline values for the SCAT3 among collegiate and professional American football players. Our findings suggest the presence of few reported symptoms at baseline and high proficiency on the orientation, memory, concentration, and coordination components of the SCAT3. These data may be used to guide clinicians when making return-to-play decisions for injured athletes in the absence of individual baseline tests.
Introduction: Patients with concussion often present to the emergency department (ED). Current gu... more Introduction: Patients with concussion often present to the emergency department (ED). Current guidelines recommend graded return to work and physical activity (i.e., sport, recreation and exercise activities); however, whether emergency physicians target this advice based on patient-reported activities is unknown. This study aimed to assess mismatches between physicians’ rest and return-to-activity advice and self-reported pre-injury work and physical activity of adult concussion patients. Methods: Adults (>17 years) presenting with a concussion from April 2013 to April 2015 to a study ED with Glasgow coma scale score ≥13 were recruited by on-site research assistants. Data on patient characteristics (i.e., age, sex, employment, and physical activity level) and activity leading to injury were collected from structured patient interviews. A structured questionnaire collected data from the treating physician about discharge advice provided. “Working” was defined as employed or enro...
Introduction: Patients with concussion often present to the emergency department (ED). Although s... more Introduction: Patients with concussion often present to the emergency department (ED). Although sports and recreation (SR) activities account for less than half of all adult concussions, guidelines developed for management of SR-related concussions (SRC) are widely used for all concussion patients. This study aimed to identify whether there are clinically relevant differences in patient and injury characteristics between SRC and those occurring outside of SR activities. Methods: Adults ( >17 years) presenting from April 2013 to April 2015 with a concussion to one of three EDs with Glasgow coma scale score ≥13 were recruited by on-site research assistants. Data on patient characteristics (i.e., age, sex, employment, lifestyle, relevant medical history), ED presentation (i.e., EMS arrival, hours since injury, CTAS, Glasgow Coma Scale score) and injury characteristics (i.e., activity leading to injury, loss of consciousness [LOC], signs and symptoms [scored using the Rivermead Post-...
Introduction: Patients with mild traumatic brain injury (mTBI) frequently present to the emergenc... more Introduction: Patients with mild traumatic brain injury (mTBI) frequently present to the emergency department (ED); however, wide variation in diagnosis and management has been demonstrated in this setting. Sub-optimal mTBI management can contribute to post-concussion syndrome (PCS), affecting vocational outcomes like return to work. This study documented the work-related events, ED management, discharge advice, and outcomes for employed patients presenting to the ED with mTBI. Methods: Adult (>17 years) patients presenting to one of three urban EDs in Edmonton, Alberta with Glasgow coma scale score ≥13 within 72 hours of a concussive event were recruited by on-site research assistants. Follow-up calls ascertained outcomes, including symptoms and their severity, advice received in the ED, and adherence to discharge instructions, at 30 and 90 days after ED discharge. Dichotomous variables were analyzed using chi-square testing; continuous variables were compared using t-tests or M...
Purpose: Assessment of emotional functioning is essential in sports-related concussion (SRC) mana... more Purpose: Assessment of emotional functioning is essential in sports-related concussion (SRC) management. This study investigated the prediction of mental health outcomes from the SCAT-3 Symptom Scale. Methods: Canadian university athletes who compete in contact sports participated in a large-scale study (Active Rehabilitation). A total of 235 participants (males = 67%) completed the Brief Symptom Inventory (BSI), Quality of Life Scale (QOLS), and Sideline Concussion Assessment Tool, 3rd edition (SCAT). Step-wise regression analysis using demographic variables (gender, age, history of Learning Disability, history of ADHD, diagnosis of psychiatric condition) and psychological symptoms from the SCAT were used as predictors for the BSI (Depression and Anxiety) and QOLS (Depression and Anxiety). Results: Regression analysis revealed female gender, previous psychiatric diagnosis and Nervousness (SCAT) significantly predicted higher scores on the Depression subscales of BSI (R2 = 0.21, F1,...
The aims were to (1) examine the rates and mechanisms of concussion and head impact in youth foot... more The aims were to (1) examine the rates and mechanisms of concussion and head impact in youth football (high school level or younger); (2) identify modifiable risk factors for concussion and head impact; and (3) evaluate the effectiveness of prevention strategies in tackle football at any level. Nine databases (CINAHL Plus with Full Text; Cochrane Central Register of Controlled Trials; EMBASE; ERIC; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily; ProQuest Dissertations & Theses Global Database; PsycINFO; Scopus; and SPORTDiscus with Full Text) were searched using the search strategy focusing on four main concepts: concussion/head impact, tackle football, modifiable risk factors, and primary prevention. Two reviewers completed title, abstract, and full-text screening as well as risk of bias assessment (using the Downs and Black checklist), with a third author available to resolve any disagreements. After removing duplicates, 1911 articles were returned. Fifty-eight articles were included in the review and 20 in the meta-analysis. The overall combined rates of concussion (including game and practice-related concussion) based on the meta-analysis were 0.78 concussions/1000 athlete exposures [95% confidence interval (CI) 0.67–0.89] for high school football (ages 13–19) and 1.15 concussions/1000 athlete exposures (95% CI 0.89–1.41) for minor football players (ages 5–15). There is evidence that contact training and practice contact restrictions have reduced the rate of head impacts and concussion. Heads Up Football (an intervention focused on coach education and contact training) has been shown to reduce the rate of concussion by 32% and head impacts by 38% amongst high school football players. Limiting contact practices in high schools to 2 days per week reduced practice head impacts per player-season by 42%, and limiting full contact in practice to 75 min per week in the second week of the season and 60 min in week 3 and beyond resulted in a 54% decrease in the practice-related concussion rate (p = 0.003). This review identified a critical need for interventions to address the high rates of concussion and head impact in youth football. To date, contact training and contact restrictions have the strongest evidence supporting their effectiveness at reducing these rates. Future research should use consistent concussion definitions and validated injury surveillance systems, and ensure complete reporting of participant characteristics and sampling details. Prospero ID CRD42020193775.
Purpose The assessment of concussed athletes uses standardized tools like the Sport Concussion As... more Purpose The assessment of concussed athletes uses standardized tools like the Sport Concussion Assessment Tool (SCAT). The purpose of this study was to evaluate whether concussed athletes accurately recalled baseline functioning. Methods A retrospective cohort analysis of University football student-athletes from 2014-16 seasons was conducted. Forty-six student-athletes (M=19.7, SD=1.8) who suffered a concussion during the competitive season underwent a post-concussion assessment with a sports medicine physician within 24 hours of injury. Assessments included use of the symptom report from The SCAT3. Athletes were asked to recall their pre-injury baseline functioning. Results Of the 46 athletes who underwent assessments, 22 reported having at least 1 symptom (M=1.4, SD=2.0) at baseline evaluations. Yet at the initial medical evaluation, only 10 of these athletes correctly recalled having symptoms prior to injury, and none of them accurately reported their total symptom report. Paire...
Introduction: Patients with mild traumatic brain injury (mTBI) often present to the emergency dep... more Introduction: Patients with mild traumatic brain injury (mTBI) often present to the emergency department (ED). Incorrect diagnosis may delay appropriate treatment and recommendations for these patients, prolonging recovery. Notable proportions of missed mTBI diagnosis have been documented in children and athletes, while diagnosis of mTBI has not been examined in the general adult population. Methods: A prospective cohort study was conducted in one academic (site 1) and two non-academic (sites 2 and 3) EDs in Edmonton, Canada. On-site research assistants enrolled adult (>17 years) patients presenting within 72 hours of the injury event with clinical signs of mTBI and Glasgow comma scale score ≥13. Patient demographics, injury characteristics, and ED flow information were collected by chart review. Physician-administered questionnaires and patient interviews documented the recommendations given by emergency physicians at discharge. Bi-variable comparisons are reported using Pearson...
Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, Jan 17, 2015
To measure neurocognitive functioning in college and professional football players after game par... more To measure neurocognitive functioning in college and professional football players after game participation. Retrospective, cross-sectional cohort design. Ninety-four male university and professional football players. All participants completed Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) testing at baseline, and either at postconcussion (group 1) or postgame (group 2) participation. Results from the 5 ImPACT composite scores (Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time and Impulse Control) and Total Symptom Score. Repeated-measures analysis of variance demonstrated a significant main effect for time (improvements) in 3 of 5 domains for the postconcussion group, but no improvements in the postgame group. The postconcussion group presented with significantly improved results on 4 of 5 ImPACT domains compared with the postgame group at the follow-up time interval. Participation in a football game with potential cumulative head contacts did not...
Educating athletes, coaches, parents and healthcare providers about concussion management is a pu... more Educating athletes, coaches, parents and healthcare providers about concussion management is a public health priority. There is an abundance of information on sports concussions supported by position statements from governing sport and medical organisations. Yet surveys of athletes, parents, coaches and healthcare providers continue to identify multiple barriers to the successful management of sports concussion. To date, efforts to provide education using empirically sound methodologies are lacking. To provide a comprehensive review of scientific research on concussion education efforts and make recommendations for enhancing these efforts. Qualitative literature review of sports concussion education. Databases including PubMed, Sport Discus and MEDLINE were searched using standardised terms, alone and in combination, including 'concussion', 'sport', 'knowledge', 'education' and 'outcome'. Studies measuring the success of education intervention...
ABSTRACT It is critical that physicians understand concussion management. Identify practice patte... more ABSTRACT It is critical that physicians understand concussion management. Identify practice patterns/knowledge base in two physician populations. On-line survey. Ontario, Canada. Physicians from Sections: Sport and Exercise Medicine (SEM), General and Family Practice (SGFP). Emailed survey, 2 reminders. Practice patterns/knowledge base, learning methods: current/preferred. Participants: SEM 92/594 (15.5%), SGFP 270/12,168 (2.2%); urban practice (90.2% SEM, 71.5% SFGP; P<.001). In preceding 3 months, 84.8% of SEM and 65.6% of SFGP had managed patients with concussion. More SEM than SGFP physicians saw >5 children under 18 with concussions per month (40.2% SEM, 9.5% SGFP; P<001). Tools: Clinical examination (92.4% SEM, 93.7% SFGP); Sport Concussion Assessment Tool (SCAT/SCAT2) (68.4% SEM, 34.1% SFGP; P<.001); balance testing (56.5% SEM, 37.4% SFGP; P=.001); computerized neurocognitive testing (23.9% SEM, 1.9% SFGP; P<.001); concussion grading scales (9.8% SEM, 14.1% SFGP; P<.001). Management: Complete physical rest (65.2% SEM, 68.5% SFGP); absolute cognitive rest (46.7% SEM, 51.9% SFGP); modified school/work until symptom resolution (50.0% SEM, 38.5% SFGP; P=.026); no cognitive rest (3.2% SEM, 9.6% SGFP; P=.026). Return-to-play: Clinical examination (87.0% SEM, 82.6% SFGP); SCAT/SCAT2 (60.8% SEM, 29.6% SFGP; P<.001); balance testing (56.5% SEM, 37.4% SFGP; P<.001); computerized neurocognitive testing (35.9% SEM, 2.2% SFGP; P<.001); concussion grading scales (7.6% SEM, 9.6% SFGP). Current learning sources: colleagues (55.4% SEM, 27.8% SFGP; P<.001); specialists (33.7% SEM, 23.7% SFGP; P=.030); continuing medical education (CME) courses/conferences (67.4% SEM, 54.7% SFGP; P=.017); journals/publications (48.9% SEM, 25.2% SFGP; P<.001); websites (35.8% SEM, 32.2% SFGP); medical school/residency training (19.6% SEM, 17.4% SFGP). Preferred learning sources: CME courses/conferences (85.9% SEM, 73.9% SFGP; P=.006); websites (35.9% SEM, 47.8%, SFGP; P=.024); medical school/residency training (37.0% SEM, 47.8% SFGP). Gaps exist between consensus-based recommendations regarding concussions and current clinical practice patterns. Enhanced training in medical school/residency and additional CME initiatives are recommended.
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