Concussion in Professional Football: Repeat Injuries—Part 4

Albert Einstein College of Medicine, New York, New York, United States
Neurosurgery (Impact Factor: 3.62). 11/2004; 55(4):860-73; discussion 873-6. DOI: 10.1227/01.NEU.0000137657.00146.7D
Source: PubMed


A 6-year study was conducted to determine the signs, symptoms, and management of repeat concussion in National Football League players.
From 1996 to 2001, concussions were reported by 30 National Football League teams using a standardized reporting form filled out by team physicians with input from athletic trainers. Signs and symptoms were grouped by general symptoms, somatic complaints, cranial nerve effects, cognition problems, memory problems, and unconsciousness. Medical actions taken and management were recorded.
Data were captured for 887 concussions in practices and games involving 650 players. A total of 160 players experienced repeat injury, with 51 having three or more concussions during the study period. The median time between injuries was 374.5 days, with only six concussions occurring within 2 weeks of the initial injury. Repeat concussions were more prevalent in the secondary (16.9%), the kick unit on special teams (16.3%), and wide receivers (12.5%). The ball return carrier on special teams (odds ratio [OR] = 2.08, P = not significant) and quarterbacks (OR = 1.92, P < 0.1) had elevated odds for repeat injury, followed by the tight end (OR = 1.24, P = not significant) and linebackers (OR = 1.22, P = not significant). There were similar signs and symptoms with single and repeat concussion, except for a higher prevalence of somatic complaints in players on their repeat concussions compared with their first concussion (27.5% versus 18.8%, P < 0.05). More than 90% of players were managed by rest, and 57.5% of those with second injuries returned to play within a day. Players with three or more concussions had signs, symptoms, and treatment similar to those with only a single injury.
The most vulnerable players for repeat concussion in professional football are the ball return carrier on special teams and quarterbacks. Single and repeat concussions are managed conservatively with rest, and most players return quickly to play.

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Available from: John W Powell, Jan 30, 2014
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    • "Epidemiological studies reveal that ~ 60% of retired National Football League (NFL) football players sustained at least one concussion during their careers (Guskiewicz et al. 2005) and ~ 25% experienced repeat injury (Pellman et al. 2004; Guskiewicz et al. 2005). The issue of how sports-related rmTBI may lead to chronic psychiatric and neuropathological disorders is highly contentious and has significant medicolegal ramifications. "
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    ABSTRACT: Sports-related head impact and injury has become a very highly contentious public health and medico-legal issue. Near-daily news accounts describe the travails of concussed athletes as they struggle with depression, sleep disorders, mood swings and cognitive problems. Some of these individuals have developed chronic traumatic encephalopathy, a progressive and debilitating neurodegenerative disorder. Animal models have always been an integral part of the study of traumatic brain injury in humans but, historically, they have concentrated on acute, severe brain injuries. This review will describe a small number of new and emerging animal models of sports-related head injury that have the potential to increase our understanding of how multiple mild head impacts, starting in adolescence, can have serious psychiatric, cognitive and histopathological outcomes much later in life. This article is protected by copyright. All rights reserved.
    Journal of Neurochemistry 02/2014; 129(6). DOI:10.1111/jnc.12690 · 4.28 Impact Factor
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    • "A recent review of the current practice of concussion management and time until return to play in the National Football League over a 5 year period from 1996–2001 showed that 50% of players returned to the same game after sustaining a concussion. The number of sub-concussive head hits has been estimated to be of the orders of hundreds per season [1], [2]. Clinically, concussions can produce symptoms that are of short or long duration lasting from several minutes to several months. "
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    ABSTRACT: The acknowledgement of risks for traumatic brain injury in American football players has prompted studies for sideline concussion diagnosis and testing for neurological deficits. While concussions are recognized etiological factors for a spectrum of neurological sequelae, the consequences of sub-concussive events are unclear. We tested the hypothesis that blood-brain barrier disruption (BBBD) and the accompanying surge of the astrocytic protein S100B in blood may cause an immune response associated with production of auto-antibodies. We also wished to determine whether these events result in disrupted white matter on diffusion tensor imaging (DT) scans. Players from three college football teams were enrolled (total of 67 volunteers). None of the players experienced a concussion. Blood samples were collected before and after games (n = 57); the number of head hits in all players was monitored by movie review and post-game interviews. S100B serum levels and auto-antibodies against S100B were measured and correlated by direct and reverse immunoassays (n = 15 players; 5 games). A subset of players underwent DTI scans pre- and post-season and after a 6-month interval (n = 10). Cognitive and functional assessments were also performed. After a game, transient BBB damage measured by serum S100B was detected only in players experiencing the greatest number of sub-concussive head hits. Elevated levels of auto-antibodies against S100B were elevated only after repeated sub-concussive events characterized by BBBD. Serum levels of S100B auto-antibodies also predicted persistence of MRI-DTI abnormalities which in turn correlated with cognitive changes. Even in the absence of concussion, football players may experience repeated BBBD and serum surges of the potential auto-antigen S100B. The correlation of serum S100B, auto-antibodies and DTI changes support a link between repeated BBBD and future risk for cognitive changes.
    PLoS ONE 03/2013; 8(3):e56805. DOI:10.1371/journal.pone.0056805 · 3.23 Impact Factor
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    • "Most studies rely on a cross-sectional methodology of examining small [28, 29, 34, 41] or large [2, 22, 27, 32, 35, 38–40, 42] groups of athletes during baseline preseason testing. Some studies, however, have followed multiply concussed athletes prospectively [2, 22, 29, 32–34, 38, 43, 44]. "
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    ABSTRACT: Background. The literature on lingering or "cumulative" effects of multiple concussions is mixed. The purpose of this study was to examine whether athletes with a history of three or more concussions perform more poorly on neuropsychological testing or report more subjective symptoms during a baseline, preseason evaluation. Hypothesis. Athletes reporting three or more past concussions would perform more poorly on preseason neurocognitive testing. Study Design. Case-control study. Methods. An archival database including 786 male athletes who underwent preseason testing with a computerized battery (ImPACT) was used to select the participants. Twenty-six athletes, between the ages of 17 and 22 with a history of three or more concussions, were identified. Athletes with no history of concussion were matched, in a case-control fashion, on age, education, self-reported ADHD, school, sport, and, when possible, playing position and self-reported academic problems. Results. The two groups were compared on the four neuropsychological composite scores from ImPACT using multivariate analysis of variance followed by univariate ANOVAs. MANOVA revealed no overall significant effect. Exploratory ANOVAs were conducted using Verbal Memory, Visual Memory, Reaction Time, Processing Speed, and Postconcussion Scale composite scores as dependent variables. There was a significant effect for only the Verbal Memory composite. Conclusions. Although inconclusive, the results suggest that some athletes with multiple concussions could have lingering memory deficits.
    02/2012; 2012:316575. DOI:10.1155/2012/316575
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