Database: Ovid MEDLINE(R) 1966 to January Week 3 2004
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Database: Ovid MEDLINE(R) <1966 to January Week 3 2004> Search Strategy: ------1 exp Brain Concussion/ (2841) 2 exp sports/ or exp athletic injuries/ (54981) 3 1 and 2 (295) 4 limit 3 to (human and english language) (265) 5 exp *Brain Concussion/ and 4 (186) 6 limit 5 to yr=1996-2004 (149) 7 limit 6 to review articles (45) 8 limit 7 to yr=1999-2004 (39) 9 limit 6 to yr=2003-2004 (36) 10 8 or 9 (68) 11 from 10 keep 1,3,5,7,9,11,13-14,17-18,20,28-29,37,43-46,48,50,56,62-64 (24) 12 10 not 11 (44) 13 from 12 keep 1 (1) 14 12 not 13 (43) 15 from 14 keep 1-43 (43) 16 from 15 keep 1-43 (43)
*************************** <1> Unique Identifier 10498114 Authors Harmon KG. Institution Sports Medicine Clinic, Hall Health Primary Care Center, University of Washington, Seattle 98195, USA. Title Assessment and management of concussion in sports.[see comment]. [Review] [17 refs] Comments Comment in: Am Fam Physician. 1999 Sep 1;60(3):738, 741-2; PMID: 10498102 Source American Family Physician. 60(3):887-92, 894, 1999 Sep 1. Abstract The most common head injury in sports is concussion. Athletes who sustain a prolonged loss of consciousness should be transported immediately to a hospital for further evaluation. Assessment of less severe injuries should include a thorough neurologic examination. The duration of symptoms and the presence or absence of post-traumatic amnesia and loss of consciousness should be noted. To avoid premature return to play, a good understanding of the possible hazards is important. Potential hazards of premature return to play include the possibility of death from second-impact syndrome, permanent neurologic impairment from cumulative trauma, and the postconcussion syndrome. [References: 17]
<2> Unique Identifier 11578022 Authors Kushner DS. Institution Department of Neurology, University of Miami School of Medicine, Florida 33101, USA. Title Concussion in sports: minimizing the risk for complications.[see comment]. [Review] [25 refs] Comments Comment in: Am Fam Physician. 2001 Sep 15;64(6):938, 940; PMID: 11578033, Comment in: Am Fam Physician. 2002 Jun 15;65(12):2435-6; PMID: 12086235 Source American Family Physician. 64(6):1007-14, 2001 Sep 15. Abstract Mild traumatic brain injury, or concussion, is a common consequence of collisions, falls and other forms of contact in sports. Concussion may be defined as an acute trauma-induced alteration of mental function lasting fewer than 24 hours, with or without preceding loss of consciousness. The physician's responsibilities in assessing an athlete with concussion include determining the need for emergency intervention and offering guidance about the athlete's ability to return to play. Concussion may be complicated by cerebral edema related to the second impact syndrome, cumulative neuropsychologic deficits, intracranial bleeding or the postconcussion syndrome. The risk of complications is increased in athletes who prematurely return to play and in those with prolonged loss of consciousness or post-traumatic amnesia. An athlete with prolonged loss of consciousness or signs and symptoms that worsen or persist after a concussion should be evaluated in the emergency department. An athlete should not be allowed to resume sports participation until all symptoms of a concussion have resolved. [References: 25]
<3> Unique Identifier 10496590 Authors Wojtys EM. Hovda D. Landry G. Boland A. Lovell M. McCrea M. Minkoff J. Title Current concepts. Concussion in sports. [Review] [73 refs] Source American Journal of Sports Medicine. 27(5):676-87, 1999 Sep-Oct.
<4> Unique Identifier 12642248 Authors Collins MW. Field M. Lovell MR. Iverson G. Johnston KM. Maroon J. Fu FH. Institution Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15203, USA. Title Relationship between postconcussion headache and neuropsychological test performance in high school athletes. Source American Journal of Sports Medicine. 31(2):168-73, 2003 Mar-Apr. Abstract BACKGROUND: The relevance of headache to outcome after sports-related concussion is poorly understood. HYPOTHESES: High school athletes reporting headache approximately 1 week after injury will have significantly more other concussion symptoms and will perform more poorly on neuropsychological tests than athletes not experiencing headache. STUDY DESIGN: Prospective cohort study. METHODS: Study participants included 109 high school athletes who had sustained concussion and who were divided into two groups: those reporting headache 7 days after injury and those reporting no headaches. The two groups were compared regarding on-field markers of concussion severity at the time of injury and symptoms and neurocognitive test results collected via ImPACT, a computerized neuropsychological test battery and postconcussion symptom scale, at a mean of 6.8 days after injury. RESULTS: Athletes reporting posttraumatic headache demonstrated significantly worse performance on reaction time and memory ImPACT neurocognitive composite scores. These athletes also reported significantly more symptoms other than headache and were more likely to have demonstrated on-field anterograde amnesia. CONCLUSIONS: Findings suggest that any degree of postconcussion headache in high school athletes 7 days after injury is likely associated with an incomplete recovery after concussion. Copyright 2003 American Orthopaedic Society for Sports Medicine
<5> Unique Identifier 12734070 Authors McKeever CK. Schatz P. Institution Department of Psychology, Drexel University, Philadelphia, PA, USA. Title Current issues in the identification, assessment, and management of concussions in sports-related injuries. [Review] [38 refs] Source Applied Neuropsychology. 10(1):4-11, 2003. Abstract The recent literature has focused on the need for appropriate identification, assessment, and management of sports-related concussion. This article addresses current issues in the prevalence and assessment of sports-related concussion. Despite a paucity of research on female athletes and youth athletes, there is evidence that female athletes are at higher risk for injury than males and that concussions may affect children and young adolescents differently than older adolescents and adults. Sideline, baseline, and postconcussion assessments have become prevalent in documenting preinjury and postinjury performance, tracking recovery rates, and assisting return-to-play decisions. New computerized assessment procedures are growing in popularity and use. Future directions in the assessment and management of sports-related concussion include increased research on prevalence rates and effects of concussions for females and youth athletes, educating parents of youth athletes as well as family physicians on the importance of baseline and postconcussion cognitive assessments, and further validation of computerized assessment measures. [References: 38]
<6> Unique Identifier 12734071 Authors Covassin T. Swanik CB. Sachs ML. Institution Department of Kinesiology, Temple University, Philadelphia, PA 19122, USA. Title Epidemiological considerations of concussions among intercollegiate athletes. Source Applied Neuropsychology. 10(1):12-22, 2003. Abstract The purpose of this study was to examine epidemiological trends of concussions among 15 different intercollegiate sports during the 1997-1998, 1998-1999, and 1999-2000 seasons. Data were collected using the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS). For the 15 sports studied during the 3 academic years, the NCAA ISS documented 3,535 team-seasons, 40,547 reportable injuries, 5,566,924 practice athlete exposures (AEs), and 1,090,298 game AEs. Concussions accounted for 6.2% of all reported injuries during this 3- year study. Of all the reported injuries, women lacrosse players (13.9%) reported the highest percentage of suffering a concussion during a game followed by women's soccer (11.4%), men's ice hockey (10.3%), men's lacrosse (10.1%), football (8.8%), women's basketball, (8.5%), field hockey (7.2%), men's soccer (7.0%), wrestling (6.6%), men's basketball (5.0%), baseball (4.2%), and women's volleyball (4.1%). Female athletes from all 7 sports were found to be at a lower risk for suffering concussions during practice sessions than the 8 male sports. However, female athletes were found to be at a greater risk for suffering concussions during games compared to male athletes. Injury trends over the 3- year period indicate concussions continue to be on the rise for athletes participating in collegiate football, men's soccer, and women's and men's basketball.
<7> Unique Identifier 14591481 Authors Barr WB. Institution NYU Comprehensive Epilepsy Center, New York University School of Medicine, Rivergate 4th Floor, 560 First Avenue, New York, NY 10016, USA. [email protected] Title Neuropsychological testing of high school athletes. Preliminary norms and test-retest indices. Source Archives of Clinical Neuropsychology. 18(1):91-101, 2003 Jan. Abstract This study provides preliminary norms and test-retest indices on a brief battery of neuropsychological tests administered to a sample of 60 male and 40 female high school athletes. Forty-eight subjects completed retesting 8 weeks later. Analyses of baseline scores indicate that girls outperform boys on selected measures of processing speed and executive functions [Wechsler Adult Intelligence Scale-III (WAIS-III) Digit Symbol, Trails B, and Controlled Oral Word Association Test (COWAT)]. Test-retest reliability was low and varied widely among the tests. There were no gender differences in test-retest reliability. Reliable Change Indices (RCIs) were computed on the test-retest data for use in clinical interpretation. These preliminary results indicate that caution should be used in interpreting neuropsychological test data from high school athletes. The current findings indicate that separate norms for boys and girls are warranted. Caution should be used in interpreting discrepancies from baseline scores as a result of what may turn out to be poor test-retest reliability in this population.
<8> Unique Identifier 14615355 Authors Naunheim RS. Standeven J. Bayly P. Title Cumulative effects of soccer heading are not fully known.[comment]. Comments Comment on: BMJ. 2003 Aug 16;327(7411):351-2; PMID: 12919964 Source BMJ. 327(7424):1168, 2003 Nov 15.
<9> Unique Identifier 10522628 Authors McCrory PR. Institution Department of Medicine (Neurology), University of Melbourne, Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia. Title You can run but you can't hide: the role of concussion severity scales in sport. [Review] [14 refs] Source British Journal of Sports Medicine. 33(5):297-8, 1999 Oct.
<10> Unique Identifier 12547735 Authors Collie A. Maruff P. Institution CogState Ltd, Melbourne, Victoria, Australia. [email protected] Title Computerised neuropsychological testing. Source British Journal of Sports Medicine. 37(1):2-3, 2003 Feb.
<11> Unique Identifier 12945942 Authors Wennberg RA. Tator CH. Institution Division of Neurology, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada. Title National Hockey League reported concussions, 1986-87 to 2001-02.[see comment]. Comments Comment in: Can J Neurol Sci. 2003 Aug;30(3):183; PMID: 12945938 Source Canadian Journal of Neurological Sciences. 30(3):206-9, 2003 Aug. Abstract OBJECTIVES: To examine the longitudinal media reported rate of concussions in the National Hockey League (NHL) over the period 1986-87 to 2001-02. METHODS: All injury reports published in the weekly sports newspaper The Hockey News for the 16 seasons 1986-87 through 2001-02 were reviewed for reported concussions. The Hockey News reports are based on weekly injury reports released by the NHL, which derive from reports submitted to the league by individual team offices. RESULTS: Adjusted for changes in the number of teams and games per season over the 16 year study period, and expressed as: number of concussions per 1000 games, results by season (starting with 1986-87) were 4, 8, 7, 7, 5, 5, 7, 7, 6, 8, 13, 20, 30, 27, 30, 25. Comparing each season with the prior season, significant increases were reported in 1997-98 and 1998-99 (p < 0.05 and 0.025, respectively), with no change since 1998-99. CONCLUSIONS: The reported concussion rate in the NHL during the last five years is more than triple that of the previous decade. Bigger, faster players, new equipment and harder boards and glass have all theoretically increased the risk of concussion in the NHL in recent years. However, the abrupt increase and subsequent plateau in concussion rate since 1997 suggests that increased recognition and reporting may be primarily responsible for the apparent increase in incidence.
<12> Unique Identifier 12945938 Authors Johnston KM. Title Hockey concussion reporting improved.[comment]. Comments Comment on: Can J Neurol Sci. 2003 Aug;30(3):206-9; PMID: 12945942 Source Canadian Journal of Neurological Sciences. 30(3):183, 2003 Aug.
<13> Unique Identifier 11495324 Authors McCrory P. Institution Centre for Sports Medicine Research & Education, and Brain Research Institute, University of Melbourne, Australia. [email protected] Title New treatments for concussion: the next millennium beckons. [Review] [36 refs] Source Clinical Journal of Sport Medicine. 11(3):190-3, 2001 Jul. Abstract As increased understanding of the pathophysiology of mild traumatic brain injury and concussion develops, so the scientific rationale for interventional pharmacological therapy becomes paramount. A number of agents have been postulated or have been the subject of anecdotal noncontrolled trials. This paper reviews the published evidence in this regard. To date no effective pharmacological therapy exists that satisfies Class I evidence-based medicine criteria. [References: 36]
<14> Unique Identifier 12629426 Authors Booher MA. Wisniewski J. Smith BW. Sigurdsson A. Institution Division of Sports Medicine, University of North Carolina, Chapel Hill 27599, USA. [email protected] Title Comparison of reporting systems to determine concussion incidence in NCAA Division I collegiate football. Source Clinical Journal of Sport Medicine. 13(2):93-5, 2003 Mar. Abstract OBJECTIVE: To determine the incidence of concussion during the 2001 Division I-A college football season through utilization of the Internet. DESIGN: Prospective Internet survey. SETTING: Internet Web site. PARTICIPANTS: Head athletic trainers from Division I-A collegiate football programs. MAIN OUTCOME MEASURES: During the 2001-2002 football season, head athletic trainers from 87 Division I-A football programs agreed to use an Internet Web site to submit weekly data on the number of athlete exposures and concussions. RESULTS: A total of 373 concussions were reported over the course of a season in both practices and games combined. Of these concussions, 256 (68.6%) occurred during games, and 117 (31.4%) occurred during practice. The injury rate per 1,000 athletic exposures was 5.56 in games and 0.25 in practices. There were 230 grade 1 (61.7%), 134 grade 2 (35.9%), and 9 grade 3 (2.4%) concussions reported. There was a significant (p < 0.01) difference found between the total concussion injury rate and game concussion injury rate when comparing the Internet and the NCAA injury data collection methods. CONCLUSIONS: The results of this study suggest an underreporting of concussions using the NCAA Injury Surveillance System and demonstrate that the Internet is a simple and effective tool for data collection.
<15> Unique Identifier 12855924 Authors Collins MW. Iverson GL. Lovell MR. McKeag DB. Norwig J. Maroon J. Institution UPMC Sports Concussion Program, Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh Medical Center, 3200 South Water Street, Pittsburgh, PA 15203, U.S.A. [email protected] Title On-field predictors of neuropsychological and symptom deficit following sports-related concussion. Source Clinical Journal of Sport Medicine. 13(4):222-9, 2003 Jul. Abstract OBJECTIVE: Investigate the relationship between on-field markers of concussion severity and postinjury neuropsychological and symptom presentation in an athlete-specific population. DESIGN: Case control study. SETTING: Multicenter analysis of high school and college athletes. PARTICIPANTS: A total of 78 athletes sustaining sports-related concussion were selected from a larger sample of 139 concussed athletes. ASSESSMENT OF PREDICTOR VARIABLES: On-field presence of disorientation, posttraumatic amnesia, retrograde amnesia, and loss of consciousness. MAIN OUTCOME MEASURES: ImPACT, a computerized neuropsychological test battery, was administered pre-season and, on average, 2 days postinjury. Good postinjury presentation (n = 44) was defined as no measurable change, relative to baseline, in terms of both ImPACT memory and symptom composite scores. Poor presentation (n = 34) was defined as a 10-point increase in symptom reporting and 10-point decrease in memory functioning (exceeding the 80% confidence interval for measurement error on ImPACT). Athletes failing to meet good or poor selection criteria (n = 61) were not included in the analysis. RESULTS: Odds ratios revealed that athletes demonstrating poor presentation at 2 days postinjury were over 10 times more likely (P < 0.001) to have exhibited retrograde amnesia following concussive injury when compared with athletes exhibiting good presentation. Similarly, athletes with poor presentation were over 4 times more likely (P < 0.013) to have exhibited posttraumatic amnesia and at least 5 minutes of mental status change. There were no differences between good and poor presentation groups in terms of on-field loss of consciousness. CONCLUSIONS: The presence of amnesia, not loss of consciousness, appears predictive of symptom and neurocognitive deficits following concussion in athletes. Athletes presenting with on-field amnesia should undergo comprehensive and individualized assessment prior to returning to sport participation. Continued refinement of sports concussion grading scales is warranted in lieu of consistent findings that brief loss of consciousness is not predictive of concussion injury severity.
<16> Unique Identifier 11495322 Authors McCrea M. Institution Neuropsychology Service, Waukesha Memorial Hospital, Wisconsin 53188, USA. [email protected] Title Standardized mental status assessment of sports concussion. [Review] [46 refs] Source Clinical Journal of Sport Medicine. 11(3):176-81, 2001 Jul. Abstract Neurocognitive status is often considered the domain of neurologic functioning most sensitive to change following concussion, but the effects are often subtle and difficult to detect on routine clinical examination. Recent efforts have focused on the development of brief, standardized methods of mental status assessment for use by sports medicine clinicians to quantify the acute neurocognitive effects of concussion and objectively track postinjury recovery. Research has demonstrated the reliability, validity, and sensitivity of these measures in detecting concussion in athletes and providing empirical data for consideration in the context of other examination findings, neuropsychologic test data, and neuroimaging results. Standardized measures of mental status and other postconcussive symptoms are valuable tools to assist clinicians in the assessment and management of concussion, but should not be used as a replacement for medical evaluation or viewed as a stand-alone means for determining readiness to return to competition after injury. [References: 46]
<17> Unique Identifier 11495321 Authors Johnston KM. Ptito A. Chankowsky J. Chen JK. Institution Department of Neurosurgery, McGill University, Montreal, Quebec, Canada. Title New frontiers in diagnostic imaging in concussive head injury. [Review] [141 refs] Source Clinical Journal of Sport Medicine. 11(3):166-75, 2001 Jul. Abstract Concussed athletes may have documented incapacitating postconcussive symptoms, neuropsychological deficits, and consequent important changes in their lives and sport, yet the majority of neuroimaging attempts reveal few findings to account for these signs and symptoms. In this paper, we explore new techniques in the neuroimaging of concussion including diffusion-weighted magnetic resonance imaging and functional brain imaging technology. [References: 141]
<18> Unique Identifier 11495320 Authors McCrory P. Johnston KM. Mohtadi NG. Meeuwisse W. Institution Centre for Sports Medicine Research & Education, and Brain Research Institute, University of Melbourne, Victoria, Australia. [email protected] Title Evidence-based review of sport-related concussion: basic science. [Review] [84 refs] Source Clinical Journal of Sport Medicine. 11(3):160-5, 2001 Jul. Abstract The evidence base for sport-related concussive brain injury is reviewed in this paper. In the past, pathophysiological understanding of this common condition has been extrapolated from studies of severe brain trauma. More recent scientific study demonstrates that this approach is unsatisfactory, and the clinical features of concussion represent a predominantly functional brain injury rather than manifest by structural or neuropathological damage. Such understanding of this condition remains incomplete at this stage. [References: 84] <19> Unique Identifier 11495319 Authors Johnston KM. McCrory P. Mohtadi NG. Meeuwisse W. Institution Department of Neurosurgery, McGill University, Montreal, Quebec, Canada. Title Evidence-Based review of sport-related concussion: clinical science. [Review] [164 refs] Source Clinical Journal of Sport Medicine. 11(3):150-9, 2001 Jul. Abstract The clinical nature of sport-related concussion is discussed in this paper. Particularly highlighted are the difficulties with definition, injury severity grading, classification, and understanding of clinical symptoms. In addition, the well-recognized sequelae of concussion including the motor and convulsive manifestations are discussed in detail. Where possible, an evidence-based approach is adopted to assist the understanding of the literature in this complex area. [References: 164]
<20> Unique Identifier 11495317 Authors Grindel SH. Lovell MR. Collins MW. Institution Saint Vincent Sports Medicine Fellowship, Erie, Pennsylvania 16502, USA. [email protected] Title The assessment of sport-related concussion: the evidence behind neuropsychological testing and management. [Review] [75 refs] Source Clinical Journal of Sport Medicine. 11(3):134-43, 2001 Jul. Abstract Because of the lack of valid evidence to support the current recommendations for the management of mild traumatic brain injury (concussion), many physicians, athletic trainers, coaches, and athletes have called into question the way concussions are treated in athletics. This review article discusses the current evidence for the management of concussion in high school, college, and professional sports. A complete review of the epidemiologic and neuropsychological studies to date is presented and critically reviewed, as are other assessment and management tools in concussion. The appropriate use of neuropsychological testing, grading scales, and return-to-play recommendations are discussed in depth based on the current evidence. Additionally, areas requiring further research are identified and future trends are briefly discussed. [References: 75]
<21> Unique Identifier 12852688 Authors Cantu RC. Institution Neurosurgery Service, Emerson Hospital, 133 Ormac, Concord, MA 01742, USA. [email protected] Title Recurrent athletic head injury: risks and when to retire. [Review] [24 refs] Source Clinics in Sports Medicine. 22(3):593-603, x, 2003 Jul. Abstract This article focuses on the issues related to recurrent athletic head injuries; specifically, when cumulative exponential injury or the second impact syndrome may be anticipated. Case histories and research studies are used to illustrate the salient points. A signs-and-symptoms checklist for use in concussion evaluation and management is included. Finally, the topic of when to retire after repeated athletic head injuries is discussed and illustrated with a case study. [References: 24]
<22> Unique Identifier 12874161 Authors Marchie A. Cusimano MD. Institution Division of Neurosurgery and the Injury Prevention Research Centre, St. Michael's Hospital, University of Toronto, Toronto, ON. Title Bodychecking and concussions in ice hockey: Should our youth pay the price?. Source CMAJ Canadian Medical Association Journal. 169(2):124-8, 2003 Jul 22.
<23> Unique Identifier 9987591 Authors Leblanc KE. Institution Louisiana State University Medical Center, New Orleans, USA. Title Concussion in sport: diagnosis, management, return to competition. [Review] [16 refs] Source Comprehensive Therapy. 25(1):39-44; discussion 45, 1999 Jan. Abstract Concussions can occur in any sports activity. Although no standards for grading and managing concussions exist, many sets of guidelines have been proposed. Therefore, physicians should be familiar with at least one set to assist in diagnosing and managing concussions. [References: 16]
<24> Unique Identifier 12831642 Authors Collins MW. Hawn KL. Institution University of Pittsburgh Medical Center, Center for Sports Medicine, Sports Concussion Program, 3200 South Water Street, Pittsburgh, PA 15203, USA. [email protected] Title The clinical management of sports concussion. [Review] [53 refs] Source Current Sports Medicine Reports. 1(1):12-22, 2002 Feb. Abstract Concussion is among the hottest topics in sports medicine today. It is a highly individualized injury which oftentimes has a subtle presentation that is easily misdiagnosed, and therefore mishandled. When to return a concussed athlete to participation is a highly controversial topic that, to this point, has been primarily based on any one of 17 sets of guidelines. Neuropsychologic and cognitive testing has introduced a quantitative and sensitive measure that allows the clinician to verify an athlete's return to normal functioning levels. It is based on the firm belief that every concussion is a unique event, and must be handled as such. The realization that there is no one formula that can handle an injury this complex and multifaceted is perhaps the greatest breakthrough in mild traumatic brain injury research in the past decade. [References: 53]
<25> Unique Identifier 12831649 Authors Cantu RC. Institution National Center for Catastrophic Sports Injury Research, John Cuming Building, Suite 820, 131 ORNAC, Concord, MA 01742, USA. [email protected] Title Athletic head injury. Source Current Sports Medicine Reports. 2(3):117-9, 2003 Jun.
<26> Unique Identifier 12831672 Authors Grindel SH. Institution Primary Care Sports Medicine, Spectrum Health, Reed City Campus, 300 N. Patterson Road, Reed City, MI 49677-0075, USA. [email protected] Title Epidemiology and pathophysiology of minor traumatic brain injury. [Review] [62 refs] Source Current Sports Medicine Reports. 2(1):18-23, 2003 Feb. Abstract This review article presents evidence from the current literature on the epidemiology and pathophysiology of concussion. The recent epidemiologic data for a variety of sports are presented relevant to the general population, and professional, college, and high school athletics. The evidence for the pathophysiology of head injury is presented using a mixture of current animal and human studies. A brief discussion on the benefits and limitations of the evidence is offered for the both the epidemiology and pathophysiology of concussion, and how it relates to current treatment options. [References: 62]
<27> Unique Identifier 12831644 Authors McCrory P. Institution Centre for Sports Medicine Research and Education, University of Melbourne, Parkville, Victoria 3052, Australia. [email protected] Title Treatment of recurrent concussion. [Review] [41 refs] Source Current Sports Medicine Reports. 1(1):28-32, 2002 Feb. Abstract The management of an athlete with recurrent concussions, whether persistently symptomatic or not, remains anecdotal. Currently, there are no evidence-based guidelines upon which a team physician can advise the athlete. All doctors involved in athlete care need to be aware of the potential for medicolegal problems if athletes are inappropriately returned to sport prematurely or, in the case of professional athletes, held out of sport or retired on the basis of nonscientific recommendations. This paper discusses such issues. [References: 41]
<28> Unique Identifier 12831673 Authors Guskiewicz KM. Institution Sports Medicine Research Laboratory, 211 Fetzer, CB#8700, University of North Carolina, Chapel Hill, NC 27599-8700, USA. [email protected] Title Assessment of postural stability following sport-related concussion. [Review] [48 refs] Source Current Sports Medicine Reports. 2(1):24-30, 2003 Feb. Abstract Despite the increased amount of research being conducted in the area of sport- related concussion, there is still a limited understanding regarding its effect on the injured brain's ability to control motor functions and coordination. This review determines the efficacy of postural stability testing as an adjunct to concussion assessment of athletes. Multiple studies, using both sophisticated force plate technology, as well as those using less sophisticated clinical balance tests, have identified postural stability deficits lasting several days following sport-related concussion. It appears that postural stability testing provides a useful tool for objectively assessing the motor domain of neurologic functioning, and should be considered a reliable and valid adjunct to the assessment of athletes suffering from concussion. Although symptom severity, neurocognitive function, and postural stability are often affected initially following concussion, they are not necessarily related or even affected to the same degree. Each of these should be considered when attempting to make return- to-play decisions following concussion. [References: 48]
<29> Unique Identifier 12831643 Authors Gebke KB. Institution Indiana University School of Medicine, Department of Family Medicine/Sports Medicine, Long Hospital, 2nd Floor, 1110 W. Michigan Street, Indianapolis, IN 46220, USA. [email protected] Title Mild traumatic brain injury. [Review] [20 refs] Source Current Sports Medicine Reports. 1(1):23-7, 2002 Feb. Abstract Mild traumatic brain injury is frequently seen in an athletic population, especially in contact sports. Many underlying pathophysiologic mechanisms have been identified. Several injury classification schemes have been proposed, yet severity grading and management remain controversial. Although second-impact syndrome is the driving force behind conservative management by many clinicians, athletes suffer more commonly from postconcussive syndrome. Recent research has examined the diagnostic value of several available tests, including electroencephalogram, magnetic resonance imaging, and neuropsychologic testing, with variable results. Neuropsychologic testing has shown promise in evaluating cognitive function when baseline studies are obtained and compared with postinjury examinations. Treatment of postconcussive symptoms with selective serotonin reuptake inhibitors has also been tested, with favorable results. [References: 20]
<30> Unique Identifier 14625338 Authors McKeag DB. Title Understanding sports-related concussion: coming into focus but still fuzzy. [comment]. Comments Comment on: JAMA. 2003 Nov 19;290(19):2549-55; PMID: 14625331, Comment on: JAMA. 2003 Nov 19;290(19):2556-63; PMID: 14625332 Source JAMA. 290(19):2604-5, 2003 Nov 19.
<31> Unique Identifier 14625331 Authors Guskiewicz KM. McCrea M. Marshall SW. Cantu RC. Randolph C. Barr W. Onate JA. Kelly JP. Institution Departments of Exercise and Sport Science, University of North Carolina at Chapel Hill, 27599, USA. [email protected] Title Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study.[see comment]. Comments Comment in: JAMA. 2003 Nov 19;290(19):2604-5; PMID: 14625338 Source JAMA. 290(19):2549-55, 2003 Nov 19. Abstract CONTEXT: Approximately 300 000 sport-related concussions occur annually in the United States, and the likelihood of serious sequelae may increase with repeated head injury. OBJECTIVE: To estimate the incidence of concussion and time to recovery after concussion in collegiate football players. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of 2905 football players from 25 US colleges were tested at preseason baseline in 1999, 2000, and 2001 on a variety of measures and followed up prospectively to ascertain concussion occurrence. Players injured with a concussion were monitored until their concussion symptoms resolved and were followed up for repeat concussions until completion of their collegiate football career or until the end of the 2001 football season. MAIN OUTCOME MEASURES: Incidence of concussion and repeat concussion; type and duration of symptoms and course of recovery among players who were injured with a concussion during the seasons. RESULTS: During follow-up of 4251 player- seasons, 184 players (6.3%) had a concussion, and 12 (6.5%) of these players had a repeat concussion within the same season. There was an association between reported number of previous concussions and likelihood of incident concussion. Players reporting a history of 3 or more previous concussions were 3.0 (95% confidence interval, 1.6-5.6) times more likely to have an incident concussion than players with no concussion history. Headache was the most commonly reported symptom at the time of injury (85.2%), and mean overall symptom duration was 82 hours. Slowed recovery was associated with a history of multiple previous concussions (30.0% of those with > or =3 previous concussions had symptoms lasting >1 week compared with 14.6% of those with 1 previous concussion). Of the 12 incident within-season repeat concussions, 11 (91.7%) occurred within 10 days of the first injury, and 9 (75.0%) occurred within 7 days of the first injury. CONCLUSIONS: Our study suggests that players with a history of previous concussions are more likely to have future concussive injuries than those with no history; 1 in 15 players with a concussion may have additional concussions in the same playing season; and previous concussions may be associated with slower recovery of neurological function.
<32> Unique Identifier 12776088 Authors Bowen AP. Institution South Shore Hospital, South Weymouth, MA, USA. [email protected] Title Second impact syndrome: a rare, catastrophic, preventable complication of concussion in young athletes. Source Journal of Emergency Nursing. 29(3):287-9, 2003 Jun.
<33> Unique Identifier 12593614 Authors Lovell MR. Collins MW. Iverson GL. Field M. Maroon JC. Cantu R. Podell K. Powell JW. Belza M. Fu FH. Institution Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. [email protected] Title Recovery from mild concussion in high school athletes. Source Journal of Neurosurgery. 98(2):296-301, 2003 Feb. Abstract OBJECT: A computerized neuropsychological test battery was conducted to evaluate memory dysfunction and self-reporting of symptoms in a group of high school athletes who had suffered concussion. METHODS: Neuropsychological performance prior to and following concussion was compared with the test performance of an age-matched control group. Potentially important diagnostic markers of concussion severity are discussed and linked to recovery within the 1st week of injury. CONCLUSIONS: High school athletes who had suffered mild concussion demonstrated significant declines in memory processes relative to a noninjured control group. Statistically significant differences between preseason and postinjury memory test results were still evident in the concussion group at 4 and 7 days postinjury. Self-reported neurological symptoms such as headache, dizziness, and nausea resolved by Day 4. Duration of on-field mental status changes such as retrograde amnesia and posttraumatic confusion was related to the presence of memory impairment at 36 hours and 4 and 7 days postinjury and was also related to slower resolution of self-reported symptoms. The results of this study suggest that caution should be exercised in returning high school athletes to the playing field following concussion. On-field mental status changes appear to have prognostic utility and should be taken into account when making return-to-play decisions following concussion. Athletes who exhibit on-field mental status changes for more than 5 minutes have longer- lasting postconcussion symptoms and memory decline.
<34> Unique Identifier 12650417 Authors Erlanger D. Kaushik T. Cantu R. Barth JT. Broshek DK. Freeman JR. Webbe FM. Institution Department of Neuroscience and Education, Columbia University, New York, New York, USA. [email protected] Title Symptom-based assessment of the severity of a concussion. Source Journal of Neurosurgery. 98(3):477-84, 2003 Mar. Abstract OBJECT: Current grading systems of concussion and return-to-play guidelines have little empirical support. The authors therefore examined the relationships of the characteristics and symptoms of concussion and the history of concussion to three indicators of concussion severity-number of immediate symptoms, number of symptoms at the initial follow-up examination, and duration of symptoms--to establish an empirical basis for grading concussions. METHODS: Forty-seven athletes who sustained concussions were administered alternate forms of an Internet-based neurocognitive test until their performances were within normal limits relative to baseline levels. Assessments of observer-reported and self- reported symptoms at the sideline of the playing field on the day of injury, and at follow-up examinations were also obtained as part of a comprehensive concussion management protocol. Although loss of consciousness (LOC) was a useful indicator of the initial severity of the injury, it did not correlate with other indices of concussion severity, including duration of symptoms. Athletes reporting memory problems at follow-up examinations had significantly more symptoms in general, longer durations of those symptoms, and significant decreases in scores on neurocognitive tests administered approximately 48 hours postinjury. This decline of scores on neurocognitive testing was significantly associated with an increased duration of symptoms. A history of concussion was unrelated to the number and duration of symptoms. CONCLUSIONS: This paper represents the first documentation of empirically derived indicators of the clinical course of postconcussion symptom resolution. Self-reported memory problems apparent 24 hours postconcussion were robust indicators of the severity of sports-related concussion and should be a primary consideration in determining an athlete's readiness to return to competition. A decline on neurocognitive testing was the only objective measure significantly related to the duration of symptoms. Neither a brief LOC nor a history of concussion was a useful predictor of the duration of postconcussion symptoms.
<35> Unique Identifier 12756388 Authors Field M. Collins MW. Lovell MR. Maroon J. Institution Department of Neurological Surgery, University of Pittsburgh School of Medicine Center for Sports Medicine, Pennsylvania 15213, USA. [email protected] Title Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. Source Journal of Pediatrics. 142(5):546-53, 2003 May. Abstract OBJECTIVE: To evaluate symptoms and neurocognitive recovery patterns after sports-related concussion in high school and college athletes. STUDY DESIGN: College athletes (n = 371) and high school athletes (n = 183) underwent baseline neuropsychological evaluation between 1997 and 2000. Individuals who received a concussion during athletic competition (n = 54) underwent serial neuropsychologic evaluation after injury and were compared with a noninjured within-sample control group (n = 38). Main outcome measures included structured interview, four memory measures, and Concussion Symptom Scale ratings. Baseline to postinjury change scores and multiple analyses of variance were used to compare recovery curves within and between groups. RESULTS: High school athletes with concussion had prolonged memory dysfunction compared with college athletes with concussion. High school athletes performed significantly worse than age- matched control subjects at 7 days after injury (F = 2.90; P <.005). College athletes, despite having more severe in-season concussions, displayed commensurate performance with matched control subjects by day 3 after concussion. Self-report of postconcussion symptoms by student athletes was not predictive of poor performance on neuropsychologic testing. CONCLUSIONS: Caution and systematic evaluation should be undertaken before returning athletes with concussion to competition. Sole reliance on the self-report of the athlete may be inadequate. Preliminary data may suggest a more protracted recovery from concussion in high school athletes.
<36> Unique Identifier 12413034 Authors McCrory P. Institution Centre for Sports Medicine Research and Education, Brain Research Institute, University of Melbourne, Australia. Title 2002 Refshauge Lecture. When to retire after concussion?. [Review] [91 refs] Source Journal of Science & Medicine in Sport. 5(3):169-82, 2002 Sep. Abstract The management of an athlete with recurrent concussions, whether persistently symptomatic or not, remains anecdotal. There are no evidence-based guidelines upon which a team physician can advise the athlete. All doctors involved in athlete care need to be aware of the potential for medicolegal problems if athletes are inappropriately returned to sport prematurely or in the case of professional athletes held out of sport or retired on the basis of non- scientific recommendations. [References: 91]
<37> Unique Identifier 11294409 Authors Johnston KM. Lassonde M. Ptito A. Institution Department of Neurosurgery, McGill University Health Center and McGill Sport Medicine, Montreal, Quebec, Canada. Title A contemporary neurosurgical approach to sport-related head injury: the McGill concussion protocol. [Review] [62 refs] Source Journal of the American College of Surgeons. 192(4):515-24, 2001 Apr. <38> Unique Identifier 14560730 Authors Tagliabue P. Title Tackling concussions in sports.[comment]. Comments Comment on: Neurosurgery. 2003 Oct;53(4):799-812; discussion 812-4; PMID: 14519212 Source Neurosurgery. 53(4):796, 2003 Oct.
<39> Unique Identifier 10981754 Authors Maroon JC. Lovell MR. Norwig J. Podell K. Powell JW. Hartl R. Institution Department of Neurosurgery, University of Pittsburgh Medical Center, Pennsylvania 15213, USA. [email protected] Title Cerebral concussion in athletes: evaluation and neuropsychological testing. [Review] [50 refs] Source Neurosurgery. 47(3):659-69; discussion 669-72, 2000 Sep. Abstract OBJECTIVE: To conduct a topic review of studies related to cerebral concussion in athletes, as an aid to improving decision-making and outcomes. METHODS: We review the literature to provide an historical perspective on the incidence and definition of and the management guidelines for mild traumatic brain injury in sports. In addition, metabolic changes resulting from cerebral concussion and the second-impact syndrome are reviewed, to provide additional principles for decision-making. Neuropsychological testing, as it applies to athletes, is discussed in detail, to delineate baseline assessments, the characteristics of the neuropsychological evaluation, the neuropsychological tests used, and the methods for in-season identification of cerebral concussion. Future directions in the management of concussions are presented. RESULTS: The incidence of cerebral concussions has been reduced from approximately 19 per 100 participants in football per season to approximately 4 per 100, i.e., 40,000 to 50,000 concussions per year in football alone. The most commonly used definitions of concussion are those proposed by Cantu and the American Academy of Neurology. Each has associated management guidelines. Concussion or loss of consciousness occurs when the extracellular potassium concentration increases beyond the upper normal limit of approximately 4 to 5 mmol/L, to levels of 20 to 50 mmol/L, inhibiting the action potential and leading to loss of consciousness. This phenomenon helps to explain the delayed effects of symptoms after trauma. CONCLUSION: Neuropsychological testing seems to be an effective way to obtain useful data on the short-term and long-term effects of mild traumatic brain injury. Moreover, knowledge of the various definitions and management strategies, as well as the utility of neuropsychological testing, is essential for those involved in decision-making with athletes with mild traumatic brain injuries. [References: 50]
<40> Unique Identifier 12296529 Authors Landry GL. Institution Department of Pediatrics, University of Wisconsin-Madison, 53705, USA. [email protected] Title Central nervous system trauma management of concussions in athletes. [Review] [52 refs] Source Pediatric Clinics of North America. 49(4):723-41, 2002 Aug. Abstract The care of athletes with concussions is challenging because each patient has different symptoms. An athlete should never be returned to play until completely asymptomatic. Classification systems for concussions are not based on scientific evidence and represent some practitioners' best guess at what is safe for young athletes. Many experienced team physicians believe they can allow an athlete to play safely if there are no symptoms at rest and no symptoms with increasing intensity of exercise. Abbreviated neuropsychological testing and balance tests show promise for use in the field to increase the sensitivity of our neurological evaluation on injured athletes. Any neuropsychological or balance evaluation is more helpful if baseline data is collected on athletes before they are injured. [References: 52]
<41> Unique Identifier 10966352 Authors Poirier MP. Wadsworth MR. Institution Division of Emergency Medicine, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA. Title Sports-related concussions. [Review] [34 refs] Source Pediatric Emergency Care. 16(4):278-83; quiz 284-6, 2000 Aug. Abstract Concussion is the most common head injury occurring in sports participation. Concussions range from a brief period of neural dysfunction to a prolonged period of unconsciousness with retrograde amnesia. It is imperative that the pediatric emergency medicine specialist be familiar with the proper initial assessment of the child or adolescent athlete who has sustained a sports-related concussion, the latest grading scales of concussions, and the current recommendations for returning the athlete to competition. A systematic approach to the athlete who has suffered a concussion will minimize the risk of further injury or mortality. [References: 34]
<42> Unique Identifier 10946735 Authors Kelly JP. Institution Department of Neurology, Chicago Neurological Institute, Illinois, USA. Title Concussion in sports and recreation. [Review] [35 refs] Source Seminars in Neurology. 20(2):165-71, 2000. Abstract More than 800 sports-related concussions occur in the United States each day, sometimes involving high-profile athletes whose injuries reach public awareness through sports broadcasts and news media. Although nonphysicians are often present and relied upon for the detection of concussion in the sports setting, the proper diagnosis and management of this neurological problem require a physician's thoughtful attention to the athlete's signs and symptoms. This article offers a diagnostic protocol and treatment recommendations as well as a useful grading scale and management strategy for return to competition. [References: 35]
<43> Unique Identifier 11347686 Authors Kirkendall DT. Jordan SE. Garrett WE. Institution United States Soccer Federation, Chicago, Illinois, USA. Title Heading and head injuries in soccer. [Review] [62 refs] Source Sports Medicine. 31(5):369-86, 2001. Abstract In the world of sports, soccer is unique because of the purposeful use of the unprotected head for controlling and advancing the ball. This skill obviously places the player at risk of head injury and the game does carry some risk. Head injury can be a result of contact of the head with another head (or other body parts), ground, goal post, other unknown objects or even the ball. Such impacts can lead to contusions, fractures, eye injuries, concussions or even, in rare cases, death. Coaches, players, parents and physicians are rightly concerned about the risk of head injury in soccer. Current research shows that selected soccer players have some degree of cognitive dysfunction. It is important to determine the reasons behind such deficits. Purposeful heading has been blamed, but a closer look at the studies that focus on heading has revealed methodological concerns that question the validity of blaming purposeful heading of the ball. The player's history and age (did they play when the ball was leather and could absorb significant amounts of water), alcohol intake, drug intake, learning disabilities, concussion definition and control group use/composition are all factors that cloud the ability to blame purposeful heading. What does seem clear is that a player's history of concussive episodes is a more likely explanation for cognitive deficits. While it is likely that the subconcussive impact of purposeful heading is a doubtful factor in the noted deficits, it is unknown whether multiple subconcussive impacts might have some lingering effects. In addition, it is unknown whether the noted deficits have any affect on daily life. Proper instruction in the technique is critical because if the ball contacts an unprepared head (as in accidental head-ball contacts), the potential for serious injury is possible. To further our understanding of the relationship of heading, head injury and cognitive deficits, we need to: learn more about the actual impact of a ball on the head, verify the exposure to heading at all ages and competitive levels, determine stable estimates of concussive injury rates across the soccer spectrum, conduct prospective longitudinal studies on soccer players focusing on exposure, injury and cognition, and determine the minimum safe age to begin instruction on the skill of heading. Only then will we be able to speak with some authority on the issue of heading and head injuries in soccer. [References: 62]