Time-to-Event Analyses: Return to Unrestricted Participation Following Sport-Related Concussion in a Cohort of High School Athletes

2020 ◽  
Author(s):  
Tracey Covassin ◽  
Abigail C. Bretzin ◽  
Erica Beidler ◽  
Jessica Wallace
Keyword(s):  
High School ◽  
High School Student ◽  
Student Athletes ◽  
Event Analysis ◽  
Time To Event ◽  
Injury Surveillance System ◽  
Kaplan Meier ◽  
Injury Reporting ◽  
Recovery Trajectory ◽  
High School Athletic

Abstract Context: Understanding time-loss resulting from sport-related concussion (SRC) within individual sports allows high school athletic trainers to provide accurate and clinically evidence-based information. Currently there is a lack of research regarding patterns of clinical recovery outcomes in high school student-athletes across sports. Objective: To describe the time to authorized unrestricted RTP following SRC in a large cohort of high school student-athletes in variety of sports using a time-to-event analysis. Design: Descriptive Epidemiology Study. Setting: Aggregate injury and player exposure data from the STATE-XXX High School Athletic Association (XHSAA) Head Injury Reporting System (HIRS). Patients or Other Participants: High school student-athletes. Main Outcome Measure(s): Dates for SRC injury events and authorized unrestricted RTP were entered into the HIRS for each case, and were used to calculate time to unrestricted RTP. Survival analysis determined time to authorized RTP for males and females in weekly increments across sports and academic years. Separate Kaplan-Meier analyses adjusted for SRC cases with a history of concussion also identified the proportions of student-athletes that obtained authorized medical clearance in weekly increments. Results: There was a total of 15,821 SRC cases, 10,375 (65.6%) male and 5,446 (34.4%) female, reported during the 2015–16 through 2018–19 academic years. The median time to authorized unrestricted RTP was 11 days for all cases. Approximately, 30% of concussed student-athletes were not cleared for unrestricted RTP by 14 days following their SRC diagnosis, with 13% taking longer than 21 days to unrestricted RTP after SRC. Conclusions: The results from this multi-site, State-based injury surveillance system indicate that it is not abnormal for high school student-athletes to take longer than 14 days to fully recovery from a SRC. This information may be useful for educating high school student-athletes and sport stakeholders, normalizing SRC recovery trajectory perceptions, and establishing realistic RTP timeline expectations.

scholarly journals Time-to-Event Analyses: Return to Unrestricted Participation After Sport-Related Concussion in a Cohort of High School Athletes

2021 ◽  
Author(s):  
Tracey Covassin ◽  
Abigail C. Bretzin ◽  
Erica Beidler ◽  
Jessica Wallace
Keyword(s):  
High School ◽  
Head Injury ◽  
High School Student ◽  
Student Athletes ◽  
Reporting System ◽  
Event Analysis ◽  
Time To Event ◽  
Injury Surveillance System ◽  
Injury Reporting ◽  
High School Athletic

Context Understanding time loss resulting from sport-related concussion (SRC) within individual sports allows high school athletic trainers to provide accurate and evidence-based clinical information. Currently, research regarding patterns of clinical recovery outcomes in high school student-athletes across sports is lacking. Objective To describe the time to authorized unrestricted return to participation (RTP) after SRC in a large cohort of high school student-athletes in a variety of sports using a time-to-event analysis. Design Descriptive epidemiology study. Setting Aggregate injury and player exposure data from the Michigan High School Athletic Association Head Injury Reporting System. Patients or Other Participants High school student-athletes. Main Outcome Measure(s) Dates for SRC injury events and authorized unrestricted RTP were entered into the Head Injury Reporting System for each case and were used to calculate time to unrestricted RTP. Survival analysis indicated the time to authorized RTP for males and females in weekly increments across sports and academic years. Separate Kaplan-Meier analyses adjusted for SRC cases with a history of concussion also identified the proportions of student-athletes who obtained authorized medical clearance in weekly increments. Results A total of 15 821 SRCs, 10 375 (65.6%) in males and 5446 (34.4%) in females, were reported during the 2015–2016 through 2018–2019 academic years. The median time to authorized unrestricted RTP was 11 days for all patients. Approximately 30% of concussed student-athletes were not cleared for unrestricted RTP by 14 days after their SRC diagnosis, with 13% taking longer than 21 days to return to unrestricted RTP after SRC. Conclusions The results from this multisite, state-based injury surveillance system indicated that it is not abnormal for high school student-athletes to take longer than 14 days to fully recover from an SRC. This information may be useful for educating high school student-athletes and sport stakeholders, normalizing SRC recovery trajectory perceptions, and establishing realistic RTP timeline expectations.

scholarly journals A-09 Time to Unrestricted Participation Following Sport-Related Concussion in High School Athletes

2020 ◽  
Vol 35 (5) ◽  
pp. 605-605
Author(s):  
T Covassin ◽  
A Bretzin ◽  
E Beidler ◽  
J Wallace
Keyword(s):  
High School ◽  
Event Analysis ◽  
High School Athletes ◽  
High School Sports ◽  
School Sports ◽  
Time Estimates ◽  
Kaplan Meier ◽  
Medical Clearance ◽  
Injury Reporting ◽  
High School Athletic

Abstract Objective To measure time-to-unrestricted participation in high school athletes following a sport-related concussion (SRC) diagnosis. Method This was a descriptive epidemiological study using the Michigan High School Athletic Association (MHSAA) online Head Injury Reporting System (HIRS). This study included 10,411 (65.9%) male and 5,412 (34.1%) female SRC cases that occurred in 20 sports with greater than 30 SRC cases during the 2015–2016 to 2018–2019 academic years. The HIRS includes dates for SRC injury events and medical clearance for unrestricted return-to-participation for each case; dates were used to calculate recovery time. Kaplan-Meier time-to-event analysis identified crude proportions of athletes that had not obtained medical clearance in weekly increments (e.g., 7 days, 14 days, 21 days, 28 days, 35 days) across sports. Results The median time-to-unrestricted participation was 11 days. Overall, 71.8% of SRC cases took longer than 7 days to return, 29.6% of SRC cases took longer than 14 days, 13.1% of cases took longer than 21 days to return, and 6.5% took longer than 28 days to return to their respective sports. Results by sport show that over 25% of gymnasts took longer than 28 days to return-to-unrestricted participation, followed by competitive cheerleaders (15.5%), wrestlers (12.1%), and male divers (12.0%). Conclusions Almost one in three high school athletes with SRC took longer than 14 days to return-to-unrestricted participation. These results serve as proportional time estimates for return-to-unrestricted participation across a sample of 20 high school sports; and provide rationale to further evaluate recovery patterns in individual sport groups.

Examining the role of high school athletic directors in promoting leadership development in high school student-athletes

2020 ◽  
Vol 14 (1) ◽  
pp. 58-81 ◽  
Author(s):  
Alexander J. Sturges ◽  
Zenzi Huysmans ◽  
William Way ◽  
Aaron Goodson
Keyword(s):  
High School ◽  
Leadership Development ◽  
High School Student ◽  
Student Athletes ◽  
Athletic Directors ◽  
High School Athletic

Removal From Activity After Sports- Related Concussion in Sex-Comparable Sports From the Michigan High School Athletic Association

2021 ◽  
pp. 036354652110200
Author(s):  
Aaron J. Zynda ◽  
Kyle M. Petit ◽  
Morgan Anderson ◽  
Christopher P. Tomczyk ◽  
Tracey Covassin
Keyword(s):  
High School ◽  
Student Athletes ◽  
Female Athletes ◽  
Student Athlete ◽  
Male Athletes ◽  
Certified Athletic Trainers ◽  
Reporting Behaviors ◽  
Injury Event ◽  
Injury Reporting ◽  
High School Athletic

Background: Research has demonstrated that female athletes are more likely to report their sports-related concussion (SRC) symptoms compared with male athletes; however, it is unknown if these reporting behaviors correspond to immediate removal from activity in sex-comparable sports. Purpose: To compare the incidence of high school student-athletes removed and not removed from activity after SRC in sex-comparable sports in Michigan. Study Design: Descriptive epidemiology study. Methods: Participants included student-athletes diagnosed with SRC participating in Michigan High School Athletic Association–sponsored athletic activities (22 sex-comparable sports) between 2016 and 2019. All SRCs were recorded in the association’s Head Injury Reporting System (HIRS) by certified athletic trainers, administrators, or coaches. Removal from activity indicated that the student-athlete was removed from play at the time of an injury event. If the student-athlete reported that his or her suspected injury event occurred earlier during activity or if symptom onset was delayed, “not removed from activity” was entered into the HIRS. Incidence proportions were calculated by dividing SRCs not removed by total SRCs in each sport. Risk ratios were calculated by dividing the incidence proportions of girls not removed by boys not removed in each sport. Results: A total of 4418 (2773 female, 1645 male) SRCs were reported, with the most occurring in female soccer players (n = 1023). Overall, 515 girls and 243 boys were not removed from activity, resulting in incidences of 0.19 (95% CI, 0.17-0.20) and 0.15 (95% CI, 0.13-0.17), respectively. Across all sports, girls were 1.26 (95% CI, 1.09-1.45) times as likely to not be removed from activity compared with boys. Of the sports with the most SRCs—soccer, basketball, baseball/softball, and lacrosse—girls had 1.37 (95% CI, 1.09-1.72), 1.15 (95% CI, 0.89-1.47), 1.19 (95% CI, 0.77-1.84), and 1.35 (95% CI, 0.94-1.95) times the risk of not being removed, respectively. Conclusion: Girls were at greater risk of not being removed from activity compared with boys in sex-comparable sports. Results from this study should be incorporated into SRC education in Michigan and potentially elsewhere to inform affiliated personnel of potential sex differences and protect female student-athletes from further harm.

Sports-Related Concussion Occurrence at Various Time Points During High School Athletic Events: Part 2

2018 ◽  
Vol 46 (9) ◽  
pp. 2270-2276 ◽  
Author(s):  
Tracey Covassin ◽  
Kyle M. Petit ◽  
Jennifer L. Savage ◽  
Abigail C. Bretzin ◽  
Meghan E. Fox ◽  
...  
Keyword(s):  
High School ◽  
Student Athletes ◽  
Female Athletes ◽  
Medical Professional ◽  
Medical Attention ◽  
Certified Athletic Trainers ◽  
Common Time ◽  
Injury Reporting ◽  
High School Athletic ◽  
Time Point

Background: Sports-related concussion (SRC) injury rates, and identifying those athletes at the highest risk, have been a primary research focus. However, no studies have evaluated at which time point during an athletic event athletes are most susceptible to SRCs. Purpose: To determine the clinical incidence of SRCs during the start, middle, and end of practice and competition among high school male and female athletes in the state of Michigan. Study Design: Descriptive epidemiological study. Methods: There were 110,774 male and 71,945 female student-athletes in grades 9 through 12 (mean time in high school, 2.32 ± 1.1 years) who participated in sponsored athletic activities (13 sports) during the 2015-2016 academic year. An SRC was diagnosed and managed by a medical professional (ie, MD, DO, PA, NP). SRC injuries were reported by certified athletic trainers, athletic administrators, and coaches using the Michigan High School Athletic Association Head Injury Reporting System. Time of SRC was defined as the beginning, middle, or end of practice/competition. Clinical incidence was calculated by dividing the number of SRCs in a time point (eg, beginning) by the total number of participants in a sport per 100 student-athletes (95% CI). Risk ratios were calculated by dividing one time point by another time point. Results: There were 4314 SRCs reported, with the highest in football, women’s basketball, and women’s soccer. The total clinical incidence for all sports was 2.36 (95% CI, 2.29-2.43) per 100 student-athletes. The most common time for SRCs was the middle, followed by the end of all events. Athletes had a 4.90 (95% CI, 4.44-5.41) and 1.50 (95% CI, 1.40-1.60) times greater risk during the middle of all events when compared with the beginning and end, respectively. There was a 3.28 (95% CI, 2.96-3.63) times greater risk at the end of all events when compared with the beginning. Conclusion: Athletes were at the greatest risk for SRCs at the middle of practice and competition when compared with the beginning and end. Clinical Relevance: The current study suggests that medical attention is particularly important during the middle of all athletic events. Intervention measures to limit SRCs may be most beneficial during the middle of athletic events.

Sex Differences in the Clinical Incidence of Concussions, Missed School Days, and Time Loss in High School Student-Athletes: Part 1

2018 ◽  
Vol 46 (9) ◽  
pp. 2263-2269 ◽  
Author(s):  
Abigail C. Bretzin ◽  
Tracey Covassin ◽  
Meghan E. Fox ◽  
Kyle M. Petit ◽  
Jennifer L. Savage ◽  
...  
Keyword(s):  
High School ◽  
Sex Differences ◽  
High School Student ◽  
Student Athletes ◽  
Female Student ◽  
National Collegiate Athletic Association ◽  
Female Athletes ◽  
Male Student ◽  
Time Loss ◽  
Injury Surveillance System

Background: Sports-related concussion (SRC) injury rates are well established in collegiate athletics through epidemiological studies using the National Collegiate Athletic Association Injury Surveillance System. However, few studies have examined sex differences, time loss, and missed school days in high school athletes, especially at the state level. Purpose: To identify sex differences in the clinical incidence of SRCs, missed school days, and time loss in high school student-athletes. Study Design: Descriptive epidemiological study. Methods: A total of 193,757 (116,434 male and 77,323 female) student-athletes (10th grade ± 1.1) participating in Michigan High School Athletic Association (MHSAA)–sponsored athletic activities were recorded in the Head Injury Reporting System. Certified athletic trainers, school athletic administrators, and coaches from MHSAA high schools reported SRC data and overall participation for the 2015-2016 academic year. Total concussive injuries, as well as missed school days and time loss for each concussive injury, were reported. The clinical incidence was calculated by dividing the number of SRCs in a particular category by the number of participants in that category and presented with 95% CIs. Relative risk ratios (RRs) were determined for sex-comparable sports. Results: The overall clinical incidence for all sports was 1.7 per 100 player-seasons (95% CI, 1.6-1.8) and 1.9 (95% CI, 1.8-2.0) for male sports and 1.5 (95% CI, 1.4-1.6) for female sports. Female athletes were at a 1.9 (95% CI, 1.8-2.2) times greater risk for enduring SRCs than male athletes in sex-comparable sports, with a greater risk in baseball/softball (RR, 2.7 [95% CI, 1.9-3.8]), basketball (RR, 2.5 [95% CI, 2.1-2.9]), and soccer (RR, 1.6 [95% CI, 1.4-1.9]). Female student-athletes had significantly longer time loss than male student-athletes ( P < .001). The mean number of missed school days did not differ between sexes ( P = .70). Conclusion: High school female student-athletes have a higher risk for an SRC in all sex-comparable sports except lacrosse. This may be because of biomechanical differences of the head-neck segment, hormonal differences, and the fact that female athletes are more likely to report symptoms after a suspected SRC. Clinical Relevance: Despite sex differences in the clinical incidence of SRCs and time loss from participation in high school sports, the numbers of missed school days are relatively similar between sexes.

The Practical Process of Making Student-athletes Study by High School Athletic Club Director

2012 ◽  
Vol 25 (3) ◽  
pp. 115-135 ◽  
Author(s):  
임성철 ◽  
Young Shin Won
Keyword(s):  
High School ◽  
Student Athletes ◽  
High School Athletic ◽  
Athletic Club

scholarly journals Review of Outcomes after Diagnosis of Malignancy in Kidney Transplant Patients: UNOS Database

2021 ◽  
Vol 2 (3) ◽  
pp. 253-263
Author(s):  
Het Patel ◽  
Nikhil Agrawal ◽  
Voravech Nissaisorakarn ◽  
Ridhi Gupta ◽  
Francesca Cardarelli
Keyword(s):  
Kidney Transplant ◽  
Graft Failure ◽  
Event Analysis ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Time To Event ◽  
Transplant Patients ◽  
Kaplan Meier ◽  
Lung Malignancy ◽  
Kidney Transplant Patients

Malignancy is the third major cause of death among transplant recipients. Patient and kidney transplant outcomes after the diagnosis of malignancy are not well described. We reviewed incidences and outcomes of colorectal, lung, PTLD, and renal malignancy after transplant among patients who received a transplant from January 2000 to December 2018 using the UNOS/OPTN database. Incidence of each malignancy was measured at 5 years and 10 years of transplant. The Kaplan–Meier curve was used for time-to-event analysis (graft and patient outcomes). Additionally, we sought to identify the causes of graft failure among these recipients. We found that 12,764 (5.5%) patients suffered malignancy, excluding squamous and basal cell skin carcinoma after transplant. During the first 5 years of transplant, incidence of colorectal, lung, PTLD, and renal malignancies was 2.99, 9.21, 15.61, and 8.55 per 10,000 person-years, respectively. Rates of graft failure were 10.3%, 7.6%, 19.9%, and 18.8%, respectively, among these patients at 5 years. Mortality rate was highest among patients who suffered lung malignancy (84%), followed by colorectal (61.5%), PTLD (49.1%), and renal (35.5%) at 5 years after diagnosis of malignancy. In conclusion, kidney transplant recipients diagnosed with lung malignancy have the lowest graft survival, compared to PTLD, colorectal, and renal malignancy. PTLD has the highest incidence rate in the first 5 years of transplant.

6. Sport, Gender-Equitable Attitudes and Abuse Perpetration Among a Sample of High School Student-Athletes

2013 ◽  
Vol 52 (2) ◽  
pp. S15
Author(s):  
Heather L. McCauley ◽  
Daniel Tancredi ◽  
Jay Silverman ◽  
Michele Decker ◽  
Maria Catrina Virata ◽  
...  
Keyword(s):  
High School ◽  
High School Student ◽  
Student Athletes
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