Short-Term Outcomes of Concussions in Major League Baseball: A Historical Cohort Study of Return to Play, Performance, Longevity, and Financial Impact

Abstract

Background:The short-term outcomes of concussions within Major League Baseball (MLB) warrant further consideration beyond a medical standpoint given that performance, career, and financial data remain unknown. The perception of this injury directly affects decision making from the perspective of both player and franchise.Purpose:To evaluate the effect of concussion on MLB players by (1) establishing return-to-play (RTP) time after concussion; (2) comparing the career length and performance of players with concussion versus those who took nonmedical leave; and (3) analyzing player financial impact after concussion.Study Design:Cohort study; Level of evidence, 3.Methods:Contracts, transactions, injury reports, and performance statistics from 2005 to 2017 were analyzed by comparing matched players who sustained a concussion versus those who took nonmedical leave. Of the 4186 eligible MLB players, 145 sustained concussions resulting in the activation of concussion protocol and 538 took nonmedical leave. RTP time was recorded. Career length was analyzed in reference to an experience-based stratification of full seasons remaining after the concussion. Changes in player performance and salary before and after concussion were compared with the same parameters for players who took nonmedical leave.Results:The mean RTP time was 26 days (95% CI, 20-32 days) for athletes with concussion and 8 days (95% CI, 6-10 days) for those who took nonmedical leave. Athletes with concussion had a mean of 2.8 full seasons remaining, whereas athletes who took nonmedical leave had 3.1 seasons remaining (P = .493). The probability of playing in the MLB after concussion compared with the nonmedical leave pool was not significantly lower (P = .534, log-rank test; hazard ratio, 1.108). Postconcussion performance decreased significantly in position players, including a lower batting average and decreased on-base percentage in the players with concussion compared with those returning from nonmedical leave. Players who sustained a concussion lost a mean of US$654,990 annually compared with players who took nonmedical leave.Conclusion:This study of the short-term outcomes after concussion in limited-contact MLB athletes demonstrates that concussions may not decrease career spans but may result in decreased performance in addition to financial loss when compared with matched controls who took nonmedical leave. In sports such as baseball that are not subject to repetitive head trauma, career spans may not decrease after a single concussive event. However, sentinel concussions have deleterious short-term effects on performance and compensation among MLB players.

Concussion Incidence and Impact on Player Performance in Major League Baseball Players Before and After a Standardized Concussion Protocol

“…In another study examining the effects of concussion among professional baseball players, Ramkumar et al 36 found that batters had a significant decrease in BA and OBP postconcussion, both before and after 2011. These findings are in keeping with the current study, which also demonstrated a significant drop in sabermetric performance measures such as wOBA, wRC+, and WAR.…”

“…Finally, although there was no control group of players with alternate injuries or returning from nonmedical leave to compare performance measures, the current study used each player's preconcussion performance as an internal control to evaluate the impact of concussion. 9,36 Future research needs to be done with access to medical charts to identify players with concussions and specify mechanism of injury. Comparisons should be made with a control group of players with alternate injuries or returning from nonmedical leave to better determine the effects of concussion on performance both in the short and long term.…”

“…18 MLB responded to this growing concern regarding concussions and the impact on player performance by implementing a standard concussion protocol at the start of the 2011-2012 season. 21,28,36,39 The protocol requires preseason neurocognitive baseline testing in the form of the SCAT5, use of the SCAT5 as a standardized concussion screening tool during play, the addition of a 7-day DL exclusively for concussed players, neurological evaluation demonstrating a return to baseline before returning to play, and prohibition of same-day return to play. The MLB concussion management protocol also states that concussion diagnosis is made by a certified athletic trainer with the use of SCAT5 and best clinical judgment.…”

Concussions in the National Basketball Association: Analysis of Incidence, Return to Play, and Performance From 1999 to 2018

“…Numerous investigations in recent years have examined concussive injuries in the NFL, 6,9,22,37 NHL, 11,26,27 and MLB. 5,48,50,53 In each of these professional leagues, authors have reported that the institution of league-wide, formalized concussion policies resulted in increases in concussion incidence. 26,37,50 However, in one of the relatively few investigations that has studied concussions in NBA players, Padaki et al 45 found that incidence was not statistically different following the institution of the NBACP but that RTP time had increased.…”

Epidemiology and Impact of Prior Musculoskeletal Injury and Orthopaedic Surgery on Draft Rank, Availability, and Short-term Performance in Major League Baseball: A Summary Analysis and Matched Cohort of 1890 Predraft Players

“…In baseball, where increased research into pitching biomechanics, quantitative performance analytics, and pitch counts highlights the growing concern for injury awareness and proclivity, there exists little evidence on the epidemiology and effects of predraft injuries in MLB. 8,20 In a recent comprehensive review of major and minor league baseball injury epidemiology, Camp et al 3 described the limitations of unofficial, publicly available data as follows: low fidelity with absent medical specialist oversight, low granularity of diagnoses and pathoanatomy, and misinterpretation commonly attributed to the reliance on roster management tools such as the disabled list (DL).…”