Acute and Subacute Clinical Markers After Sport-Related Concussion

ObjectiveThis study aimed to determine the association of a range of off-field symptoms reported by athletes retrospectively with on-field concussion signs and in-office symptoms among rugby union players.BackgroundPlayers with sports concussion experience multiple symptoms. Understanding the association between these symptoms and clinical markers of concussion would facilitate a targeted approach to symptom assessment and treatment.Design/MethodsCross-sectional study. We consecutively enrolled 92 adult rugby union players, within the first 72 hours after sport concussion. Ten symptoms assessed using a retrospective symptoms interview were examined for their association with observed concussion signs and post-concussion symptoms using the Post-Concussion Symptoms Scale (PCSS).ResultsOdds ratios revealed that athletes who was overtly symptomatic based on retrospective concussion interview at the time of the concussion were over 2.6 times more likely (p = 0.047) to have exhibited post-traumatic amnesia when compared with athletes who was asymptomatic. There were no differences between groups in terms of on-field loss of consciousness or confusion. Off-field symptoms reported by athlete were associated with symptoms reporting on the Beck Depression Inventory (OR 2.8; 95% CI 1.14–6.88), headache (OR 4.9; 95% CI 1.92–12.79), memory concerns (OR 3.15; 95% CI 1.06–9.34), pressure in head (OR 2.8; 95% CI 1.03–8.08), and visual disturbances (OR 3.9; 95% CI 1.05–14.50) within the first 72 hours after concussion.ConclusionsSymptomatic concussed rugby athletes have increased odds for sustaining on-field concussion signs that can be observed by others and persistent symptoms within the first 72 hours after concussion. Information from the on-field and off-field assessment is essential in understanding the severity of sports concussion.

Can Sport Concussion Assessment Tool (SCAT) Symptom Scores Be Converted to Rivermead Post-concussion Symptoms Questionnaire (RPQ) Scores and Vice Versa? Findings From the Toronto Concussion Study

Background: The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and the Sports Concussion Assessment Tool (SCAT) are widely used self-report tools assessing the type, number, and severity of concussion symptoms. There are overlapping symptoms and domains, though they are scored differently. The SCAT consists of 22 questions with a 7-point Likert scale for a total possible score 132. The RPQ has 16 questions and a 5-point Likert scale for a total of 80 possible points. Being able to convert between the two scores would facilitate comparison of results in the concussion literature.Objectives: To develop equations to convert scores on the SCAT to the RPQ and vice versa.Methods: Adults (17–85 years) diagnosed with a concussion at a referring emergency department were seen in the Hull-Ellis Concussion and Research Clinic, a rapid access concussion clinic at Toronto Rehab–University Health Network (UHN) Toronto Canada, within 7 days of injury. The RPQ and SCAT symptom checklists as well as demographic questionnaires were administered to all participants at Weeks 1, 2, 3, 4, 5, 6, 7, 8, 12, 16.Results: 215 participants had 1,168 matched RPQ and SCAT assessments. Total scores of the RPQ and the SCAT had a rho = 0.91 (p < 0.001); correlations were lower for sub-scores of specific symptom domains (range 0.74–0.87, p < 0.001 for all domain comparisons). An equation was derived to calculate SCAT scores using the number and severity of symptoms on the RPQ. Estimated scores were within 3 points of the observed total score on the SCAT. A second equation was derived to calculate the RPQ from the proportion weighted total score of the SCAT. This equation estimated corresponding scores within 3 points of the observed score on the RPQ.Conclusions: The RPQ and SCAT symptom checklists total scores are highly correlated and can be used to estimate the total score on the corresponding assessment. The symptom subdomains are also strongly correlated between the 2 scales however not as strongly correlated as the total score. The equations will enable researchers and clinicians to quickly convert between the scales and to directly compare concussion research findings.

An Evaluation of Post-Concussion Return to School Guidelines: A Survey of Massachusetts School Nurses

Although all states have legislation pertaining to youth sports concussion, most of these laws focus on return-to-play procedures; only a few address return-to-learn (RTL) accommodations for students who have experienced a concussion. To address this gap in the legislation, some states and nongovernmental organizations have developed RTL guidelines to advise school personnel, parents, and health care providers on best practices for accommodating students' postconcussion reintegration into academic activity. In 2018, the Massachusetts Department of Public Health (MDPH) developed RTL guidelines which were disseminated to school nurses (SNs) at all public and nonpublic middle and high schools in the state. In 2020, the MDPH engaged the Injury Prevention Center at Boston Medical Center to survey Massachusetts SNs to assess the usefulness of the guidelines. The response rate was 63%; 92% found the booklet extremely useful or moderately useful; and 70% endorsed that the booklet fostered collaboration among stakeholders.

Education, Political Party, and Football Viewership Predict Americans' Attention to News About Concussions in Sports

News outlets, sports coverage, and even Hollywood movies have highlighted the growing body of research documenting the long-term negative consequences of traumatic injury in athletics, particularly, (sports-related) concussions. Despite so much media coverage, little is known about how much attention members of the American public pay to sports concussion news. Disparities in attention to concussion news among sociodemographic groups may contribute to further inequalities in rates of concussions that stem from participation in collision sports. In this study, using a 2017 nationally representative survey of US residents (n = 964), we examine the social, political, and demographic correlates of individuals' attention to news about concussions in sports. Regression results indicate that older, more educated, Democratic-leaning respondents reported that they pay more attention to news about concussions. Additionally, respondents with a greater past competitive athletic participation and those who regularly watch baseball and football reported higher levels of attention to concussion news. These findings are consistent with previous research showing higher levels of news consumption and trust in science among the highly educated and Democrats. The increased levels among football viewers may be in response to the inclusion of concussion news in game coverage.

Deep Neural Network Approach For Sentiment Analysis Of Tweets Related To Sports Concussion

Concussion and Traumatic brain injuries (TBI) are serious injuries that impair the normal functionality of a person’s brain. Symptoms can include confusion, disorientation, loss of consciousness, memory lost, and in more sever situations fatality. It is reported that 39% of children (ages 10-18 years old) who visit the hospital due to a sports-related head injury were diagnosed with concussion and 24% with the possible concussion [1]. In order to bring awareness about the seriousness of the TBI to the attention of the policy makers, a neural network based sentiment analysis ensemble system that automates the process of gathering the opinion of the general public is designed. A preprocessing pipeline is proposed that embeds various word-level features into a single concatenated vector. Input vectors are processed by varying Convolutional Neural Network (CNN) and Long Short-Term Memory (LSTM) Networks. The proposed ensemble system achieves an evaluation score of 62.71% based on its precision and recall, and compares well with other state-of-the art systems.

Deep Neural Network Approach For Sentiment Analysis Of Tweets Related To Sports Concussion

Concussion and Traumatic brain injuries (TBI) are serious injuries that impair the normal functionality of a person’s brain. Symptoms can include confusion, disorientation, loss of consciousness, memory lost, and in more sever situations fatality. It is reported that 39% of children (ages 10-18 years old) who visit the hospital due to a sports-related head injury were diagnosed with concussion and 24% with the possible concussion [1]. In order to bring awareness about the seriousness of the TBI to the attention of the policy makers, a neural network based sentiment analysis ensemble system that automates the process of gathering the opinion of the general public is designed. A preprocessing pipeline is proposed that embeds various word-level features into a single concatenated vector. Input vectors are processed by varying Convolutional Neural Network (CNN) and Long Short-Term Memory (LSTM) Networks. The proposed ensemble system achieves an evaluation score of 62.71% based on its precision and recall, and compares well with other state-of-the art systems.

A - 27 The Clinical Utilization of SWAY and mBESS for Post-Trauma and Follow-up Concussion Evaluations

Objective SWAY is a mobile software system using an accelerometer designed to measure postural sway and reaction time in the context of concussion. This study examined the efficacy of SWAY in detecting changes in balance and reaction time before and after concussion. Methods College athletes (N = 30, 10 females) underwent baseline, post-trauma, and follow-up evaluations following a concussion including SWAY, mBESS, Sports Concussion Assessment Tool 5th Edition (SCAT-5), and Immediate Post Concussion Assessment and Cognitive Testing (ImPACT). Results Paired-samples t-tests revealed a decline in SWAY balance from baseline (M = 82.65, SD = 14.48) to post-trauma (M = 74.61, SD = 17.41), t(29) = 2.99, p = 0.006, but no significant difference was observed in reaction time (M = 5.07, SD = 13.61), t(29) = 2.04, p = 0.050. Meanwhile, balance improved at follow-up (M = 78.93, SD = 15.32), and was no longer discrepant from baseline (M = 81.97, SD = 14.51), t(21) = 1.03, p = 0.316. Similarly, there was a significant decline in mBESS scores from baseline (M = 2.88, SD = 3.62) to post-trauma (M = 5.68, SD = 5.32), t(24) = −3.51, p = 0.002, followed by a return to baseline at follow up (M = 4.22, SD = 4.95), t(22) = −1.60, p = 0.124. Conclusions Although challenges were apparent in obtaining an optimal baseline, current results appear to support the clinical utility of SWAY for assessing balance in the context of concussion evaluations. Further research appears warranted to support SWAY as a method of diagnosing concussion and monitoring return to baseline.

A - 26 AMPAR as a Sports Concussion Biomarker and Its Relationship to Neurocognitive Functioning in Collegiate Athletes

Objective This prospective controlled observational cohort pilot study investigated a potential blood-based biomarker [α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR)] and relationship to neurocognitive testing in collegiate athletes. Methods A multisport sample of 60 collegiate athletes (53% female; 44 contact, 16 non-contact controls) completed ImPACT testing and provided blood samples at a pre-season baseline and within 4 weeks post-season. Plasma and serum samples were processed for AMPAR peptides and antibodies. Twelve athletes did not complete all procedures and were excluded from the final analysis (final n = 48; 36 contact; 12 controls). Results Contact athletes demonstrated greater increases in serum AMPAR antibodies compared to controls (t(46) = 3.24;p < 0.01). On neurocognitive testing, controls had a faster reaction time than contact athletes at baseline (p < 0.05); however, this increased post season (p < 0.01), with the mean change in reaction time (contact: M = 0.06, SD = 0.19; control: M = 0.00, SD = 0.04) approaching significance (t(37.23) = 1.54; p < 0.15). Additionally, ImPACT reaction time was correlated (r = 0.37;p < 0.05) with serum AMPAR antibodies, with slowed reaction time related to increased AMPAR in contact athletes only and only post-season. Conclusions Serum AMPAR antibody levels significantly increased in the contact group and were correlated with reaction time on contact athlete neurocognitive testing at post-season only, with contact athletes showing both slower reaction time and increased levels of AMPAR antibodies compared to controls. No findings were identified in plasma AMPAR peptides, possibly related to sample processing which could not be done immediately in this pilot study. Future research and replication is needed; however, AMPAR may represent a blood-based concussion biomarker, with potential for clinical utility in athletes.