Advertisement

Concussion Characteristics and Early Postinjury Outcomes Between College Students and Intercollegiate Athletes

Published:October 18, 2021DOI:https://doi.org/10.1016/j.apmr.2021.09.013

      Abstract

      Objective

      To describe concussion characteristics among general college students and compare postinjury outcomes to intercollegiate student athletes.

      Design

      Retrospective cohort.

      Setting

      Large university in the Southeast region of the United States.

      Participants

      A total of 179 (N=179) college students’ (female=120; 67.0%; 23.9±3.9 years) and 49 athletes’ (female=28, 57.1%;19.3±1.3 years) medical records were examined. Participants self-reported injury mechanism, health history information, and completed clinical assessments acutely (<7 days postinjury).

      Main Outcome Measures

      Descriptive statistics were calculated for each group. Concussion outcomes between students with and without certain health history diagnoses were assessed using separate t tests. We conducted univariate regression analyses to determine if sex, age, and time from concussion to first clinical assessment were significant predictors of clinical outcomes. Statistically significant variables were included as covariates in a series of 1-way analyses of covariance to identify differences in balance, symptom severity, total symptom presence, and neurocognitive domain performance between students and athletes. Fisher exact tests were used to compare health history information between groups (α<0.05).

      Results

      Among students, 24% reported sustaining a concussion while participating in recreational sports, and 27% of impacts occurred to the back of the head. Students had higher proportions of headache, migraine, anxiety, and depression (P<.05). Students reported greater total symptom presence (P=.006) and performed worse on the computerized neurocognitive test domain score for complex attention (P=.015) relative to athletes.

      Conclusions

      These findings highlight the need for better access to medical care for non– National Collegiate Athletic Association sanctioned athletes because of a large proportion of concussions in the student sample being sustained during sports participation. Identifying common injury mechanisms can provide clinicians with powerful information to improve evaluation and treatment models.

      Keywords

      List of abbreviations:

      ADHD (attention-deficit hyperactivity disorder), BESS (Balance Error Scoring System), CNT (neurocognitive testing), LD (learning disorder), RCI (reliable change index)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Daneshvar DH
        • Riley DO
        • Nowinski CJ
        • McKee AC
        • Stern RA
        • Cantu RC.
        Long-term consequences: effects on normal development profile after concussion.
        Phys Med Rehabil Clin N Am. 2011; 22: 683-700
        • Decq P
        • Gault N
        • Blandeau M
        • et al.
        Long-term consequences of recurrent sports concussion.
        Acta Neurochir (Wien). 2016; 158: 289-300
        • De Beaumont L
        • Lassonde M
        • Leclerc S
        • Théoret H.
        Long-term and cumulative effects of sports concussion on motor cortex inhibition.
        Neurosurgery. 2007; 61: 329-337
        • Stern RA
        • Riley DO
        • Daneshvar DH
        • Nowinski CJ
        • Cantu RC
        • McKee AC.
        Long-term consequences of repetitive brain trauma: chronic traumatic encephalopathy.
        PM R. 2011; 3: S460-S467
        • Bramley H
        • Heverley S
        • Lewis MM
        • Kong L
        • Rivera R
        • Silvis M.
        Demographics and treatment of adolescent posttraumatic headache in a regional concussion clinic.
        Pediatr Neurol. 2015; 52: 493-498
        • Knollman-Porter K
        • Brown J
        • Flynn M.
        A preliminary examination of concussion knowledge by collegiate athletes and non-athletes.
        Am J Speech Lang Pathol. 2018; 27: 778-795
        • Langlois JA
        • Rutland-Brown W
        • Wald MM.
        The epidemiology and impact of traumatic brain injury: a brief overview.
        J Head Trauma Rehabil. 2006; 21: 375-378
        • Macpherson A
        • Fridman L
        • Scolnik M
        • Corallo A
        • Guttmann A.
        A population-based study of paediatric emergency department and office visits for concussions from 2003 to 2010.
        Paediatr Child Health. 2014; 19: 543-546
        • Cancelliere C
        • Coronado V
        • Taylor C
        • Xu L.
        Epidemiology of isolated vs. non-isolated mild traumatic brain injury treated in emergency departments in the United States, 2006-2012: sociodemographic characteristics.
        J Head Trauma Rehabil. 2017; 32: E37-E46
        • Asken BM
        • McCrea MA
        • Clugston JR
        • Snyder AR
        • Houck ZM
        • Bauer RM.
        Playing through it”: delayed reporting and removal from athletic activity after concussion predicts prolonged recovery.
        J Athl Train. 2016; 51: 329-335
        • Elbin RJ
        • Sufrinko A
        • Schatz P
        • et al.
        Removal from play after concussion and recovery time.
        Pediatrics. 2016; 138e20160910
        • Lempke LB
        • Schmidt JD
        • Lynall RC.
        Athletic trainers’ concussion-assessment and concussion-management practices: an update.
        J Athl Train. 2020; 55: 17-26
        • Bailey CM
        • Echemendia RJ
        • Arnett PA.
        The impact of motivation on neuropsychological performance in sports-related mild traumatic brain injury.
        J Int Neuropsychol Soc. 2006; 12: 475-484
        • Bailey CM
        • Arnett PA.
        Motivation and the assessment of sports-related concussion.
        in: Slobounov S Sebastianelli W Foundations of sport-related brain injuries. Springer, US2006: 171-193
        • Rabinowitz AR
        • Merritt VC
        • Arnett PA.
        The return-to-play incentive and the effect of motivation on neuropsychological test-performance: implications for baseline concussion testing.
        Dev Neuropsychol. 2015; 40: 29-33
        • Rabinowitz AR
        • Merritt V
        • Arnett PA.
        A pilot investigation of the Motivation Behaviors Checklist (MBC): an observational rating scale of effort towards testing for baseline sports-concussion assessment.
        J Clin Exp Neuropsychol. 2016; 38: 599-610
        • Trinidad KJ
        • Schmidt JD
        • Register-Mihalik JK
        • Groff D
        • Goto S
        • Guskiewicz KM.
        Predicting clinical concussion measures at baseline based on motivation and academic profile.
        Clin J Sport Med. 2013; 23: 462-469
        • Davies SC
        • Bird BM.
        Motivations for underreporting suspected concussion in college athletics.
        J Clin Sport Psychol. 2015; 9: 101-115
        • Kerr ZY
        • Register-Mihalik JK
        • Kroshus E
        • Baugh CM
        • Marshall SW.
        Motivations associated with nondisclosure of self-reported concussions in former collegiate athletes.
        Am J Sports Med. 2016; 44: 220-225
        • Huffer KW.
        A convoluted concussion case.
        J Am Coll Health. 2020 Oct 21; ([Epub ahead of print])
        • Williams RM
        • Welch CE
        • Weber ML
        • Parsons JT
        • Valovich McLeod TC
        Athletic trainers’ management practices and referral patterns for adolescent athletes after sport-related concussion.
        Sports Health. 2014; 6: 434-439
        • Buckley TA
        • Burdette G
        • Kelly K.
        Concussion-management practice patterns of National Collegiate Athletic Association Division II and III athletic trainers: how the other half lives.
        J Athl Train. 2015; 50: 879-888
        • Collins MW
        • Kontos AP
        • Okonkwo DO
        • et al.
        Statements of agreement from the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion meeting held in Pittsburgh, October 15-16, 2015.
        Neurosurgery. 2016; 79: 912-929
        • Guskiewicz Teel E.
        Clinical management of sport-related concussion: developing a roadmap to a successful outcome.
        Kinesiol Rev. 2015; 4: 156-168
        • Houck Z
        • Asken B
        • Bauer R
        • Clugston J.
        Predictors of post-concussion symptom severity in a university-based concussion clinic.
        Brain Inj. 2019; 33: 480-489
        • Brown DA
        • Elsass JA
        • Miller AJ
        • Reed LE
        • Reneker JC.
        Differences in symptom reporting between males and females at baseline and after a sports-related concussion: a systematic review and meta-analysis.
        Sports Med. 2015; 45: 1027-1040
        • Sufrinko A
        • McAllister-Deitrick J
        • Elbin R
        • Collins MW
        • Kontos AP.
        Family history of migraine is associated with posttraumatic migraine symptoms following sport-related concussion.
        J Head Trauma Rehabil. 2018; 33: 7-14
        • Kontos AP
        • Elbin RJ
        • Lau B
        • et al.
        Posttraumatic migraine as a predictor of recovery and cognitive impairment after sport-related concussion.
        Am J Sports Med. 2013; 41: 1497-1504
        • Elbin RJ
        • Kontos AP
        • Kegel N
        • Johnson E
        • Burkhart S
        • Schatz P
        Individual and combined effects of LD and ADHD on computerized neurocognitive concussion test performance: evidence for separate norms.
        Arch Clin Neuropsychol. 2013; 28: 476-484
      1. Centers for Disease Control and Prevention. ADHD throughout the years. Available at: https://www.cdc.gov/ncbddd/adhd/timeline.html. Accessed March 11, 2021.

        • Lovell MR
        • Iverson GL
        • Collins MW
        • et al.
        Measurement of symptoms following sports-related concussion: reliability and normative data for the post-concussion scale.
        Appl Neuropsychol. 2006; 13: 166-174
        • Ponsford J
        • Cameron P
        • Fitzgerald M
        • Grant M
        • Mikocka-Walus A
        • Schönberger M.
        Predictors of postconcussive symptoms 3 months after mild traumatic brain injury.
        Neuropsychology. 2012; 26: 304-313
        • Broshek DK
        • Erlanger D.
        Sex differences in outcome following sports-related concussion.
        J Neurosurg. 2005; 102: 8
        • Broglio SP
        • McCrea M
        • McAllister T
        • et al.
        A national study on the effects of concussion in collegiate athletes and US military service academy members: the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium structure and methods.
        Sports Med. 2017; 47: 1437-1451
        • Bell DR
        • Guskiewicz KM
        • Clark MA
        • Padua DA.
        Systematic review of the Balance Error Scoring System.
        Sports Health. 2011; 3: 287-295
        • Hunt TN
        • Ferrara MS
        • Bornstein RA
        • Baumgartner TA.
        The reliability of the modified Balance Error Scoring System.
        Clin J Sport Med. 2009; 19: 471-475
        • Riemann BL
        • Guskiewicz KM.
        Effects of mild head injury on postural stability as measured through clinical balance testing.
        J Athl Train. 2000; 35: 19-25
        • Echemendia RJ
        • Meeuwisse W
        • McCrory P
        • et al.
        The Sport Concussion Assessment Tool 5th Edition (SCAT5).
        Br J Sports Med. 2017; 51: 848-850
        • Gualtieri C
        • Johnson L.
        Reliability and validity of a computerized neurocognitive test battery, CNS Vital Signs.
        Arch Clin Neuropsychol. 2006; 21: 623-643
        • Cohen J.
        Statistical power analysis.
        Curr Dir Psychol Sci. 1992; 1: 98-101
        • McElveen M
        • Rossow A.
        Relationship of intramural participation to GPA and retention in first-time-in-college students.
        Recreat Sports J. 2014; 38: 50-54
        • Vasold KL
        • Deere SJ
        • Pivarnik JM.
        Club and intramural sports participation and college student academic success.
        Recreat Sports J. 2019; 43: 55-66
        • Ward TP.
        The effects of intramural sports on college students.
        Honors Projects. 2014; : 10
        • Zonfrillo MR
        • Kim KH
        • Arbogast KB.
        Emergency department visits and head computed tomography utilization for concussion patients from 2006 to 2011.
        Acad Emerg Med. 2015; 22: 872-877
        • Castellanos J
        • Phoo CP
        • Eckner JT
        • et al.
        Predicting risk of sport-related concussion in collegiate athletes and military cadets: a machine learning approach using baseline data from the CARE Consortium Study.
        Sports Med. 2021; 51: 567-579
        • Schmidt JD
        • Rizzone K
        • Hoffman NL
        • et al.
        Age at first concussion influences the number of subsequent concussions.
        Pediatr Neurol. 2018; 81: 19-24
        • Guskiewicz KM
        • Weaver NL
        • Padua DA
        • Garrett WE.
        Epidemiology of concussion in collegiate and high school football players.
        Am J Sports Med. 2000; 28: 643-650
      2. Migraine Research Foundation. Migraine facts. Available at:https://migraineresearchfoundation.org/about-migraine/migraine-facts/. Accessed April 26, 2021.

        • Olsen J
        • Steiner TJ.
        The international classification of headache disorders.
        J Neurol Neurosurg Psychiatry. 2004; 75: 807-808
        • Eckner JT
        • Seifert T
        • Pescovitz A
        • Zeiger M
        • Kutcher JS.
        Is migraine headache associated with concussion in athletes? A case-control study.
        Clin J Sport Med. 2017; 27: 266-270
        • Kontos AP
        • Reches A
        • Elbin RJ
        • et al.
        Preliminary evidence of reduced brain network activation in patients with post-traumatic migraine following concussion.
        Brain Imaging Behav. 2016; 10: 594-603
        • Iverson GL
        • Gioia G.
        Returning to school following sport-related concussion.
        Phys Med Rehabil Clin N Am. 2016; 27: 429-436
        • Delaney JS
        • Lamfookon C
        • Bloom GA
        • Al-Kashmiri A
        • Correa JA.
        Why university athletes choose not to reveal their concussion symptoms during a practice or game.
        Clin J Sport Med. 2015; 25: 113
        • Madrigal L
        • Wurst K
        • Gill DL.
        The role of mental toughness in coping and injury response in female roller derby and rugby athletes.
        J Clin Sport Psychol. 2016; 10: 137-154
        • Nicholls AR
        • Polman RCJ
        • Levy AR
        • Backhouse SH.
        Mental toughness in sport: achievement level, gender, age, experience, and sport type differences.
        Personal Individ Differ. 2009; 47: 73-75
        • Stadden SA.
        The influence of athletic identity, expectation of toughness, and attitude toward pain and injury on athletes’ help-seeking tendencies.
        NC Docks. 2007; : 185
        • Broglio SP
        • Cantu RC
        • Gioia GA
        • et al.
        National Athletic Trainers’ Association position statement: management of sport concussion.
        J Athl Train. 2014; 49: 245-265
        • Harmon KG
        • Drezner JA
        • Gammons M
        • et al.
        American Medical Society for Sports Medicine position statement: concussion in sport.
        Br J Sports Med. 2013; 47: 15-26
        • McCrory P
        • Meeuwisse W
        • Dvorak J
        • et al.
        Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016.
        Br J Sports Med. 2017; 51: 838-847
        • Conway FN
        • Domingues M
        • Monaco R
        • et al.
        Concussion symptom underreporting among incoming National Collegiate Athletic Association Division I college athletes.
        Clin J Sport Med. 2020; 30: 203-209
        • Delaney Caron JG
        • Correa JA
        • Bloom GA.
        Why professional football players chose not to reveal their concussion symptoms during a practice or game.
        Clin J Sport Med. 2018; 28: 1-12
        • Meier TB
        • Brummel BJ
        • Singh R
        • Nerio CJ
        • Polanski DW
        • Bellgowan PSF.
        The underreporting of self-reported symptoms following sports-related concussion.
        J Sci Med Sport. 2015; 18: 507-511
        • Abeare CA
        • Messa I
        • Zuccato BG
        • Merker B
        • Erdodi L.
        Prevalence of invalid performance on baseline testing for sport-related concussion by age and validity indicator.
        JAMA Neurol. 2018; 75: 697
        • Higgins KL
        • Denney RL
        • Maerlender A.
        Sandbagging on the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) in a high school athlete population.
        Arch Clin Neuropsychol. 2017; 32: 259-266
        • Schatz Glatts C.
        Sandbagging” baseline test performance on ImPACT, without detection, is more difficult than it appears.
        Arch Clin Neuropsychol. 2013; 28: 236-244
        • Czerniak LL
        • Liebel SW
        • Garcia GGP
        • et al.
        Sensitivity and specificity of computer-based neurocognitive tests in sport-related concussion: findings from the NCAA-DoD CARE Consortium.
        Sports Med. 2021; 51: 351-365
        • Parsons TD
        • Notebaert AJ
        • Shields EW
        • Guskiewicz KM.
        Application of reliable change indices to computerized neuropsychological measures of concussion.
        Int J Neurosci. 2009; 119: 492-507
        • Bandelow B
        • Michaelis S.
        Epidemiology of anxiety disorders in the 21st century.
        Clin Res. 2015; 17: 9
        • Chrisman SPD
        • Richardson LP.
        Prevalence of diagnosed depression in adolescents with history of concussion.
        J Adolesc Health. 2014; 54: 582-586