OBJECTIVE This prospective observational cohort study of high-school football athletes was performed to determine if high-acceleration head impacts (HHIs) that do not result in clinically diagnosed concussion still lead to increases in serum levels of biomarkers indicating traumatic brain injury (TBI) in asymptomatic athletes and to determine the longitudinal profile of these biomarkers over the course of the football season. METHODS Sixteen varsity high-school football athletes underwent baseline neurocognitive testing and blood sampling for the biomarkers tau, ubiquitin C-terminal hydrolase L1 (UCH-L1), neurofilament light protein (NF-L), glial fibrillary acidic protein (GFAP), and spectrin breakdown products (SBDPs). All athletes wore helmet-based accelerometers to measure and record head impact data during all practices and games. At various time points during the season, 6 of these athletes met the criteria for HHI (linear acceleration > 95 g and rotational acceleration > 3760 rad/sec ); in these athletes a second blood sample was drawn at the end of the athletic event during which the HHI occurred. Five athletes who did not meet the criteria for HHI underwent repeat blood sampling following the final game of the season. In a separate analysis, all athletes who did not receive a diagnosis of concussion during the season (n = 12) underwent repeat neurocognitive testing and blood sampling after the end of the season. RESULTS Total tau levels increased 492.6% ± 109.8% from baseline to postsession values in athletes who received an HHI, compared with 164% ± 35% in athletes who did not receive an HHI (p = 0.03). Similarly, UCH-L1 levels increased 738.2% ± 163.3% in athletes following an HHI, compared with 237.7% ± 71.9% in athletes in whom there was no HHI (p = 0.03). At the end of the season, researchers found that tau levels had increased 0.6 ± 0.2 pg/ml (p = 0.003) and UCH-L1 levels had increased 144.3 ± 56 pg/ml (p = 0.002). No significant elevations in serum NF-L, GFAP, or SBDPs were seen between baseline and end-of-athletic event or end-of-season sampling (for all, p> 0.05). CONCLUSIONS In this pilot study on asymptomatic football athletes, an HHI was associated with increased markers of neuronal (UCH-L1) and axonal (tau) injury when compared with values in control athletes. These same markers were also increased in nonconcussed athletes following the football season.
INTRODUCTION While recent guidelines have hoped to form consensus regarding management of concussion, it is unclear if they have been effective in conveying this information to the public. Many parents and athletes obtain medical recommendations via the internet. This study aims to evaluate consistency between online resources and guideline statements in post-concussion return to play (RTP) decisions. METHODS Five websites were selected through a Google search for return to play after concussion. These websites represented a federal government institution (Centers for Disease Control, CDC); a national high school association website (National Federation of State High School Associations, NFHS); a popular nationally-recognized medical website for patients (WebMD); a University hospital (University of Michigan, UM); a popular parent-driven website for sports parents (MomsTeam, MT); as well as a website for a private concussion clinic (Sports Concussion Institute, SCI). The Zurich Sport Concussion Consensus Statement was used as the gold standard for RTP recommendations, and eight specific items identified. Three independent reviewers graded each website for each of the eight recommendations (A = states guideline recommendations appropriately; B = mentions guideline recommendation; C = does not mention guideline recommendation; F = inappropriate recommendation made). RESULTS >A grade of A was assigned for 45.8% of recommendations, B for 25.0%, C for 25.0%, and F for 4.2%. All websites were assigned grade A for recommendation of no return to play on the day of injury. Only 1 website (WebMD) commented on medication usage in conjunction with the Zurich Statement, and only 2 websites (SCI, UM) commented on management of persistent symptoms. No website correctly commented on all eight guideline recommendations. CONCLUSION Online resources are inconsistent in relaying guideline recommendations for RTP. This is a potential source of confusion in management of concussion for athletes and their parents which may result in inappropriate RTP.
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