A Systematic Review and Meta-Analysis Investigating Head Trauma in Boxing

Abstract

Objectives: Although physical trauma has been reported in boxing since its inception, boxing still appeals to athletes and spectators. This systematic review and meta-analysis assess both acute and chronic neurological and neuropsychological effects that boxing has on the brain. Further assessments in terms of comparisons of the concussion ratio in boxing to other combat sports, as well as the efficiency of wearing headguards, are also performed. Data Sources: This systematic review and meta-analysis used the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The outcomes incorporated included physical chronic abnormalities of the brain, neuropsychiatric, and neurological disorders sustained in amateur or professional boxing, in addition to the safety benefits of boxing headguards. Odds ratios, descriptive statistics, and inferential statistics are also reported. Main Results: From the 84 articles reviewed, the 35 included articles suggested that boxers have a significantly elevated risk of sustaining a concussion compared with other combat sports (risk ratio [RR]: 0.253 vs RR: 0.065, P < 0.001). From the 631 amateur and professional boxers analyzed, 147 (23.30%) had cavum septum pellucidum, whereas 125 of 411 amateur and professional boxers (30.41%) presented with some form of brain atrophy. Dementia or amnesia was observed in 46 of 71 boxers (61.79%), 36 of 70 (51.43%) had various forms and severities of cognitive disorders, and 57 of 109 (52.29%) displayed abnormal computed tomography or electroencephalogram scan results. Utilization of headguards significantly increased the risk for stoppages in amateur bouts, compared with boxers not wearing a headguard (OR: 1.75 vs 0.53, P < 0.050). Conclusions: Boxing is a hazardous sport that has the potential to have fatal and negative life-changing results. Because of the limited reliable data regarding the efficiency of boxing headguards, future research should focus on the overall significance that headguards may have for reducing head trauma.

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“…Through the psychological scale survey of boxers, it shows that detailed results have been obtained in anxiety level, self-confidence, team identity and opponent attitude, which provides practical data support for boxers' psychological training and psychological support, helps to formulate more personalized and effective training plans and improve athletes' psychological quality in the competition. This is consistent with Bozdarov et al 47 and Donnelly et al 48 .…”

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The spectrum of acute and chronic consequences of neurotrauma in professional and amateur boxing – A call to action is advocated to better understand and prevent this phenomenon

“…Concussions are the most common form of mild TBI in contact sports ( Koh and Cassidy, 2004 ). According to a recent systematic review published by Donnelly et al boxers have a significantly elevated risk of sustaining a concussion compared with other combat sports ( Donnelly et al, 2023 ). What distinguishes concussions from mild TBI is that the first are defined as a functional injury without structural damages seen in conventional neuroimaging, whereas the latter may present with both structural and functional injury ( Karlin, 2011 ).…”

“…However, boxing-related neurotrauma presents as a vast spectrum, including acute, subacute, and chronic neurological and neuropsychological complications, as well as death. Despite changes in regulations, as well as improved medical and safety precautions, fatalities in the ring and long-term consequences of repeated traumatic brain injuries (TBI) are still occurring and reported in the literature ( Donnelly et al, 2023 ; Alevras et al, 2022 ; Teramoto et al, 2018 ; Baird et al, 2010a ). Over the years, the chronic effects of repeated TBI have become evident with the recognition of conditions such as chronic traumatic encephalopathy (CTE) or post-concussive syndrome (PCS), which dramatically impact quality of life ( McKee et al, 2023 ; Iverson et al, 2023 ; Morales et al, 2022 ; Wallace et al, 2018 ).…”