The Role of Concussion History and Gender in Recovery from Soccer-Related Concussion

Colvin, Alicia; Mullen, Jimmy; Lovell, Mark R.; West, Robin V.; Collins, Michael James; Groh, Megan

doi:10.1177/0363546509332497

Cited by 283 publications

(104 citation statements)

References 33 publications

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“…11,38,39 Even though previous studies have shown fewer than three prior concussions to not predispose patients to prolonged symptoms, 40 recent data have begun to indicate poorer performance on neurocognitive testing in patients with only one prior injury. 41 Our data show patients with at least two prior concussions may be predisposed to poorer outcomes.…”

Section: Discussionmentioning

confidence: 60%

Characteristics of Prolonged Concussion Recovery in a Pediatric Subspecialty Referral Population

Corwin

Zonfrillo

Master

et al. 2014

The Journal of Pediatrics

204

205

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Objective To identify pre-existing characteristics associated with prolonged recovery from concussion in a sample of patients referred to a pediatric sports medicine clinic. Study design This was a retrospective, exploratory cohort study of 247 patients age 5-18 years old with concussion referred to a tertiary pediatric hospital-affiliated sports medicine clinic from July 1, 2010, through December 31, 2011. A random sample of all eligible patient visits (3740) was chosen for further review and abstraction. Statistical comparisons between subsets of patients were conducted using exact chi-square tests, logistic regression, quantile regression, and Kaplan Meier survival curves. Results The median time until returning to school part-time was 12 days (interquartile range (IQR) 6-21); until returning to school full-time without accommodations was 35 days (IQR 11-105); until becoming symptom-free was 64 days (IQR 18-119); and until being fully cleared to return to sports was 75 days (IQR 30-153). 73% of all patients were symptomatic for >4 weeks, 73% were prescribed some form of school accommodation, and 61% reported a decline in grades. Characteristics associated with a prolonged recovery included a history of depression or anxiety; an initial complaint of dizziness; abnormal convergence or symptom provocation following oculomotor examination on physical examination; and history of prior concussion. Conclusion Pediatric and adolescent patients with concussion may experience cognitive and emotional morbidity that can last for several months following injury. Clinicians should consider specific pre-existing characteristics and presenting symptoms that may be associated with a more complicated recovery for concussion patients.

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Section: Discussionmentioning

confidence: 60%

Characteristics of Prolonged Concussion Recovery in a Pediatric Subspecialty Referral Population

Corwin

Zonfrillo

Master

et al. 2014

The Journal of Pediatrics

204

205

View full text Add to dashboard Cite

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“…This gender bias in sampling likely results from the higher prevalence of mTBI among males ; however, when matched by sport, females present a higher rate of mTBI than the opposite gender (Gessel et al, 2007), which presents the importance of expanding mTBI research across more representative samples. Although not exhaustive, individual studies have presented disparate results in relation to cognitive outcomes of mTBI (e.g., minor female advantages, Moore, Ashman, Cantor, Krinick, & Spielman, 2010; minor male advantages, Colvin et al, 2009; no long-term differences, Tsushima, Lum, & Geling, 2009). One meta-analysis assessed gender as a moderator (Dougan et al, 2013); however, their review involved effect sizes on neuropsychological outcomes at only 1-10 days post-mTBI.…”

Section: Unexplored Moderating Variablesmentioning

confidence: 99%

The neuropsychological outcomes of concussion: A systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury.

2014

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Mild Traumatic Brain Injury (mTBI), also known as concussion, has become a growing public health concern, prevalent in both athletic and military settings. Many researchers have examined post-mTBI neuropsychological outcomes, leading to multiple meta-analyses amalgamating individual study results. Objective: Considering the plethora of meta-analytic findings, the next logical step stands as a systematic review of meta-analyses, effectively reporting key moderators that predict post-mTBI neuropsychological outcomes. Method: A systematic review of reviews yielded 11 meta-analyses meeting inclusion criteria (i.e., English-language systematic reviews/meta-analyses covering post-mTBI observational cognitive research on late adolescents/adults), with their findings qualitatively synthesized based on moderator variables (i.e., cognitive domain, time since injury, past head injury, participant characteristics, comparison group, assessment technique, and persistent symptoms). Results: The overall effect sizes ranged for both general (range: .07-.61) and sports-related mTBI (range: .40 -.81) and differed both between and within cognitive domains, with executive functions appearing most sensitive to multiple mTBI. Cognitive domains varied in recovery rates, but overall recovery occurred by 90 days postinjury for most individuals and by 7 days postinjury for athletes. Greater age/education and male gender produced smaller effects sizes, and high school athletes suffered the largest deficits post-mTBI. Controlgroup comparisons yielded larger effects than within-person designs, and assessment techniques had limited moderating effects. Conclusions: Overall, meta-analytic review quality remained low with few studies assessing publication or study quality bias. Meta-analyses consistently identified adverse acute mTBI-related effects and fairly rapid symptom resolution. Future meta-analyses should better operationally define cognitive constructs to produce more consistent effect estimates across domains. Keywords: mTBI, concussion, mild traumatic brain injury, cognition, neuropsychologySupplemental materials: http://dx.doi.org/10.1037/neu0000037.supp Mild Traumatic Brain Injury (mTBI), also known as concussion, stands as a prevalent neurotrauma within the general population , increasingly common in both athletic (Coronado, McGuire, Faul, Sugerman, & Pearson, 2012) and military settings (Iverson, Langlois, McCrea, & Kelly, 2009). The rates and consequences of mTBI have become progressively more publicized, both in sports (Moser, 2007) and in modern conflicts (Hayward, 2008). Highly prevalent in American football (Gessel, Fields, Collins, Dick, & Comstock, 2007), mTBI now represents a signature injury of the sport. Although its seriousness has been historically underestimated, repeated mTBIs among young athletes have been linked to significant neurodegeneration long after retiring from play (Gavett, Stern, & McKee, 2011;Guskiewicz et al., 2005;McKee et al., 2009). In 2011, Dave Duerson, a former American football safety, took his o...

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“…Female athletes have greater concussion rates, report greater increases in symptoms after concussion, and have greater impairment on neuropsychological testing after concussion compared with male athletes. It is unclear if these differences are biomechanical, hormonal and/or are due to reporting bias [63–66]. In CTE, the vast majority of patients studied have been men because brain donation has largely occurred among professional athletes in contact sports.…”

Section: Epidemiologymentioning

confidence: 99%

Chronic Traumatic Encephalopathy: Where Are We and Where Are We Going?

Mez

Stern

McKee

2013

Curr Neurol Neurosci Rep

110

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Chronic traumatic encephalopathy (CTE, previously called punch drunk and dementia pugilistica) has a rich history in the medical literature in association with boxing, but has only recently been recognized with other contact sports, such as football and ice hockey, as well as with military blast injuries. CTE is thought to be a neurodegenerative disease associated with repeated concussive and subconcussive blows to the head. There is characteristic gross and microscopic pathology found in the brain, including frontal and temporal atrophy, axonal degeneration, and hyperphosphorylated tau and TAR DNA-binding protein 43 pathology. Clinically, there are characteristic progressive deficits in cognition (memory, executive dysfunction), behavior (explosivity, aggression), mood (depression, suicidality), and motor function (parkinsonism), which correlate with the anatomic distribution of brain pathology. While CTE shares clinical and neuropathological traits with other neurodegenerative diseases, the clinical syndrome and the neuropathology as a whole are distinct from other neurodegenerative diseases. Here we review the CTE literature to date. We also draw on the literature from mild traumatic brain injury and other neurodegenerative dementias, particularly when these studies provide guidance for future CTE research. We conclude by suggesting seven essential areas for future CTE research.

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The Role of Concussion History and Gender in Recovery from Soccer-Related Concussion

Cited by 283 publications

References 33 publications

Characteristics of Prolonged Concussion Recovery in a Pediatric Subspecialty Referral Population

Characteristics of Prolonged Concussion Recovery in a Pediatric Subspecialty Referral Population

The neuropsychological outcomes of concussion: A systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury.

Chronic Traumatic Encephalopathy: Where Are We and Where Are We Going?

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