Stephen W Marshall

University of North Carolina at Chapel Hill, North Carolina, United States

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Publications (276)1194.71 Total impact

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    ABSTRACT: Background: Previous studies examining nondisclosure among athletes in various settings have found substantial proportions of athletes with undisclosed concussions. Substantial gaps exist in our understanding of the factors influencing athletes' disclosure of sports-related concussions. Purpose: To examine the prevalence of, and factors associated with, nondisclosure of recalled concussions in former collegiate athletes. Study design: Cross-sectional study; Level of evidence, 3. Methods: Former collegiate athletes (N = 797) completed an online questionnaire. Respondents recalled self-identified sports-related concussions (SISRCs) that they sustained while playing sports in high school, college, or professionally, and whether they disclosed these SISRCs to others. Respondents also recalled motivations for nondisclosure. The prevalence of nondisclosure was calculated among those who recalled SISRCs. Multivariate binomial regression estimated adjusted prevalence ratios (PRs) with 95% CIs, controlling for sex, level of contact in sports, and year the athletes began playing collegiate sports. Results: A total of 214 respondents (26.9%) reported sustaining at least 1 SISRC. Of these, 71 (33.2%) reported not disclosing at least 1 SISRC. Former football athletes were most likely to report nondisclosure (68.3% of those recalling SISRCs); female athletes who participated in low/noncontact sports were the least likely to report nondisclosure (11.1% of those recalling SISRC). The prevalence of nondisclosure was higher among men than women in the univariate analysis (PR, 2.88; 95% CI, 1.62-5.14), multivariate analysis (PR, 2.11; 95% CI, 1.13-3.96), and multivariate analysis excluding former football athletes (PR, 2.11; 95% CI, 1.12-3.94). The most commonly reported motivations were as follows: did not want to leave the game/practice (78.9%), did not want to let the team down (71.8%), did not know it was a concussion (70.4%), and did not think it was serious enough (70.4%). Conclusion: Consistent with previous studies, a substantial proportion of former athletes recalled SISRCs that were not disclosed. Male athletes were less likely to disclose all of their SISRCs than female athletes.
    The American Journal of Sports Medicine 11/2015; DOI:10.1177/0363546515612082 · 4.36 Impact Factor
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    ABSTRACT: Background: Scuba diving mishaps, caused by equipment problems or human errors, increase the occurrence of injuries and fatalities while diving. Pre-dive checklists may mitigate mishaps. This study evaluated the effect of using a pre-dive checklist on the incidence of diving mishaps in recreational divers. Methods: A multi-location cluster-randomized trial with parallel groups and allocation concealment was conducted between 1 June and 17 August 2012. The participants had to be at least 18 years of age, permitted to dive by the dive operator and planning to dive on the day of participation. They were recruited at the pier and dive boats at four locations. The intervention group received a pre-dive checklist and post-dive log. The control group received a post-dive log only. The outcomes, self-reported major and minor mishaps, were prompted by a post-dive questionnaire. Mishap rates per 100 dives were compared using Poisson regression with generalized estimating equations. Intent-to-treat, per-protocol and marginal structural model analyses were conducted. Results: A total of 1043 divers (intervention = 617; control = 426) made 2041 dives, on 70 location-days (intervention = 40; control = 30) at four locations. Compared with the control group, the incidence of major mishaps decreased in the intervention group by 36%, minor mishaps by 26% and all mishaps by 32%. On average, there was one fewer mishap in every 25 intervention dives. Conclusions: In this trial, pre-dive checklist use prevented mishaps which could lead to injuries and fatalities. Pre-dive checklists can increase diving safety and their use should be promoted. Trial registration: ID NCT01960738.
    International Journal of Epidemiology 11/2015; DOI:10.1093/ije/dyv292 · 9.18 Impact Factor
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    ABSTRACT: Background: American youth football leagues are typically structured using either age-only (AO) or age-and-weight (AW) playing standard conditions. These playing standard conditions group players by age in the former condition and by a combination of age and weight in the latter condition. However, no study has systematically compared injury risk between these 2 playing standards.
    09/2015; 3(9). DOI:10.1177/2325967115603979
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    ABSTRACT: Wearable sensors can measure head impact frequency and magnitude in football players. Our goal was to quantify the impact detection rate and validity of the direction and peak kinematics of two wearable sensors: a helmet system (HITS) and a mouthguard system (X2). Using a linear impactor, modified Hybrid-III headform and one helmet model, we conducted 16 impacts for each system at 12 helmet sites and 5 speeds (3.6-11.2 m/s) (N = 896 tests). Peak linear and angular accelerations (PLA, PAA), head injury criteria (HIC) and impact directions from each device were compared to reference sensors in the headform. Both sensors detected ~96% of impacts. Median angular errors for impact directions were 34° for HITS and 16° for X2. PLA, PAA and HIC were simultaneously valid at 2 sites for HITS (side, oblique) and one site for X2 (side). At least one kinematic parameter was valid at 2 and 7 other sites for HITS and X2 respectively. Median relative errors for PLA were 7% for HITS and -7% for X2. Although sensor validity may differ for other helmets and headforms, our analyses show that data generated by these two sensors need careful interpretation.
    Annals of Biomedical Engineering 08/2015; DOI:10.1007/s10439-015-1420-6 · 3.20 Impact Factor
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    ABSTRACT: Background: The epidemiology of sports-related concussion is not well-described in the literature. This paper presents a descriptive epidemiology of concussion in seven high school and collegiate sports. Methods: We used the data from Concussion Prevention Initiative (CPI), which enrolled 8905 athletes at 210 high schools and 26 colleges in a prospective cohort study of 7 sports (football, men’s and women’s soccer, men’s and women’s lacrosse, and men’s and women’s ice hockey) between 1999 and 2001. Injury risks and injury rates were used to characterize the incidence of concussion, and changes in symptoms over time were described. Results: A total of 375 concussions were observed. The incidence of concussion was highest in football, followed by women’s lacrosse, men’s lacrosse, men’s soccer, and women’s soccer (only 10 ice hockey teams were included, too few to quantify incidence). The rate of incident concussion was strongly associated with history of concussion in the previous 24 months (rate ratio = 5.5; 95 %CI: 3.9, 7.8, for 2 or more concussions relative to no previous concussion). The most common symptoms at time of injury were headache (87 %), balance problems/dizziness (77 %), and feeling “in a fog” (62 %). Loss of consciousness and amnesia were present in relatively few cases (9 and 30 %). The most common mechanism of injury was collision with another player. Conclusions: Sports-related concussions present with a diverse range of symptoms and are associated with previous concussion history.
    06/2015; 2(1):13. DOI:10.1186/s40621-015-0045-4
  • Thomas P Dompier · Stephen W Marshall · Zachary Y Kerr · Ross Hayden ·

    Journal of athletic training 06/2015; DOI:10.4085/1062-6050-50.5.04 · 2.02 Impact Factor
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    ABSTRACT: A report by the Institute of Medicine called for comprehensive nationwide concussion incidence data across the spectrum of athletes aged 5 to 23 years. To describe the incidence of concussion in athletes participating in youth, high school, and collegiate American football. Data were collected by athletic trainers at youth, high school, and collegiate football practices and games to create multiple prospective observational cohorts during the 2012 and 2013 football seasons. Data were collected from July 1, 2012, through January 31, 2013, for the 2012 season and from July 1, 2013, through January 31, 2014, for the 2013 season. The Youth Football Surveillance System included 118 youth football teams, providing 4092 athlete-seasons. The National Athletic Treatment, Injury and Outcomes Network program included 96 secondary school football programs, providing 11 957 athlete-seasons. The National Collegiate Athletic Association Injury Surveillance Program included 24 member institutions, providing 4305 athlete-seasons. All injuries regardless of severity, including concussions, and athlete exposure information were documented by athletic trainers during practices and games. Injury rates, injury rate ratios, risks, risk ratios, and 95% CIs were calculated. Concussions comprised 9.6%, 4.0%, and 8.0% of all injuries reported in the Youth Football Surveillance System; National Athletic Treatment, Injury and Outcomes Network; and National Collegiate Athletic Association Injury Surveillance Program, respectively. The game concussion rate was higher than the practice concussion rate across all 3 competitive levels. The game concussion rate for college athletes (3.74 per 1000 athlete exposures) was higher than those for high school athletes (injury rate ratio, 1.86; 95% CI, 1.50-2.31) and youth athletes (injury rate ratio, 1.57; 95% CI, 1.17-2.10). The practice concussion rate in college (0.53 per 1000 athlete exposures) was lower than that in high school (injury rate ratio, 0.80; 95% CI, 0.67-0.96). Youth football had the lowest 1-season concussion risks in 2012 (3.53%) and 2013 (3.13%). The 1-season concussion risk was highest in high school (9.98%) and college (5.54%) in 2012. Football practices were a major source of concussion at all 3 levels of competition. Concussions during practice might be mitigated and should prompt an evaluation of technique and head impact exposure. Although it is more difficult to change the intensity or conditions of a game, many strategies can be used during practice to limit player-to-player contact and other potentially injurious behaviors.
    05/2015; 169(7). DOI:10.1001/jamapediatrics.2015.0210
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    ABSTRACT: To examine statewide emergency department (ED) visit data for motorcycle crash morbidity and healthcare utilization due to traumatic brain injuries (TBIs) and non-TBIs. North Carolina ED data (2010-2012) and hospital discharge data (2009-2011). Statewide ED visits and hospitalizations due to injuries from traffic-related motorcycle crashes stratified by TBI status. Descriptive study. Descriptive statistics include age, sex, mode of transport, disposition, expected source of payment, hospital length of stay, and hospital charges. Over the study period, there were 18 780 ED visits and 3737 hospitalizations due to motorcycle crashes. Twelve percent of ED visits for motorcycle crashes and 26% of hospitalizations for motorcycle crashes had a diagnosis of TBI. Motorcycle crash-related hospitalizations with a TBI diagnosis had median hospital charges that were nearly $9000 greater than hospitalizations without a TBI diagnosis. Emergency department visits and hospitalizations due to motorcycle crashes with a TBI diagnosis consumed more healthcare resources than motorcycle crash-related ED visits and hospitalizations without a TBI diagnosis. Increased awareness of motorcyclists by other road users and increased use of motorcycle helmets are 2 strategies to mitigate the incidence and severity of motorcycle crash injuries, including TBIs.
    The Journal of head trauma rehabilitation 05/2015; 30(3):175-84. DOI:10.1097/HTR.0000000000000096 · 2.92 Impact Factor
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    ABSTRACT: Overuse injuries result from microtrauma due to repetitive loading combined with insufficient tissue recovery time and can result in both immediate and long-term time loss from sports. Overuse injury rates and patterns differ across college and high school populations, sport, and sex. Descriptive epidemiology study. Surveillance data for 16 sports from the National Collegiate Athletic Association's Injury Surveillance System (NCAA ISS; 2004-2005 through 2008-2009) and 14 sports from High School Reporting Information Online (High School RIO; 2006-2007 through 2012-2013) were analyzed. All reported injuries had an injury mechanism of overuse/gradual onset (college) or overuse/chronic (high school). Overuse injury incidence rates were calculated, and rate ratios with 95% CIs were used to compare subgroups. The rate of overuse injury was 3.28 times higher in college than high school sports (95% CI, 3.12-3.44). The rate of overuse injury among sex-comparable sports was higher in female than male athletes in both populations (college rate ratio, 1.25; 95% CI, 1.16-1.35; high school rate ratio, 1.55; 95% CI, 1.43-1.68). The lower extremity was the most commonly injured body site (college, 69.4%; high school, 70.4%). A larger proportion of overuse injuries among college athletes resulted in time loss of more than 21 days (college, 20.4%; high school, 7.7%) and surgery (college, 5.2%, high school, 2.5%). Overuse injuries can impose a significant burden on college and high school athletes. Interventions addressing prevention of overuse injury are needed. © 2015 The Author(s).
    The American Journal of Sports Medicine 04/2015; 43(7). DOI:10.1177/0363546515580790 · 4.36 Impact Factor
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    ABSTRACT: We evaluated how attention deficit-hyperactivity disorder (ADHD) and learning disability (LD) are associated with concussion history and performance on standard concussion assessment measures. Based on previous reports that developmental disorders are associated with increased injury proneness and poorer cognitive performance, we anticipated that ADHD and LD would be associated with increased history of concussion and poorer baseline performance on assessment measures. Cross-sectional study. Clinical research center. The study sample aggregated data from two separate projects: the National Collegiate Athletic Association Concussion Study and Project Sideline. We analyzed preseason baseline data from 8056 high school and collegiate athletes (predominantly male football players) enrolled in prior studies of sport-related concussion. Measures included demographic/health history, symptoms, and cognitive performance. Attention deficit-hyperactivity disorder and LD were associated with 2.93 and 2.08 times the prevalence, respectively, of 3+ historical concussions (for comorbid ADHD/LD the prevalence ratio was 3.38). In players without histories of concussion, individuals with ADHD reported more baseline symptoms, and ADHD and LD were associated with poorer performance on baseline cognitive tests. Interactive effects were present between ADHD/LD status and concussion history for self-reported symptoms. Neurodevelopmental disorders and concussion history should be jointly considered in evaluating concussed players. Clinical judgments of self-reported symptoms and cognitive performance should be adjusted based on athletes' individual preinjury baselines or comparison with appropriate normative samples.
    Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine 04/2015; Publish Ahead of Print. DOI:10.1097/JSM.0000000000000207 · 2.27 Impact Factor
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    ABSTRACT: Background: Activity-related patient-reported outcome measures are an important component of assessment after knee ligament injury in young and physically active patients; however, normative data for most activity scales are limited. Objective: To present reference values by sex for the Marx Activity Rating Scale (MARS) within a young and physically active population while accounting for knee ligament injury history and sex. Study Design: Cross-sectional study. Level of Evidence: Level 2. Methods: All incoming freshman entering a US Service Academy in June of 2011 were recruited to participate in this study. MARS was administered to 1169 incoming freshmen (203 women) who consented to participate within the first week of matriculation. All subjects were deemed healthy and medically fit for military service on admission. Subjects also completed a baseline questionnaire that asked for basic demographic information and injury history. We calculated means with standard deviations, medians with interquartile ranges, and percentiles for ordinal and continuous variables, and frequencies and proportions for dichotomous variables. We also compared median scores by sex and history of knee ligament injury using the Kruskal-Wallis test. MARS was the primary outcome of interest. Results: The median MARS score was significantly higher for men when compared with women (χ2 = 13.22, df = 1, P < 0.001) with no prior history of knee ligament injury. In contrast, there was no significant difference in median MARS scores between men and women (χ2 = 0.47, df = 1, P = 0.493) who reported a history of injury. Overall, median MARS scores were significantly higher among those who reported a history of knee ligament injury when compared with those who did not (χ2 = 9.06, df = 1, P = 0.003). Conclusion: Assessing activity as a patient-reported outcome after knee ligament injury is important, and reference values for these instruments need to account for the influence of prior injury and sex.
    Sports Health A Multidisciplinary Approach 03/2015; DOI:10.1177/1941738115576121
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    ABSTRACT: BACKGROUND North Carolina requires motorcyclists of all ages to wear federally approved safety helmets. The purpose of this article is to estimate the impact of this state law in terms of hospital admissions for traumatic brain injury (TBI) and associated hospital charges. METHODS Hospital admissions of North Carolina motorcyclists with TBIs and associated hospital charges in 2011 were extracted from the North Carolina Hospital Discharge Data system. We estimated hospital admissions and charges for the same year under the counterfactual condition of North Carolina without a universal motorcycle helmet law by using various substitutes (Florida, Pennsylvania, and South Carolina residents treated in North Carolina). RESULTS North Carolina's universal helmet law prevented an estimated 190 to 226 hospital admissions of North Carolina motorcyclists with TBI in 2011. Averted hospital charges to taxpayer-funded sources (ie, government and public charges) were estimated to be between $9.5 million and $11.6 million for 2011, and total averted hospital charges for 2011 were estimated to be between $25.3 million and $31.0 million. LIMITATIONS Cost estimates are limited to inpatients during the initial period of hospital care. This study was unable to capture long-term health care costs and productivity losses incurred by North Carolina's TBI patients and their caregivers. CONCLUSIONS North Carolina's universal motorcycle helmet law generates health and economic benefits for the state and its taxpayers.
    North Carolina medical journal 03/2015; 76(2):70-5. DOI:10.18043/ncm.76.2.70
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    ABSTRACT: Objective: The study described initial pharmacological treatment of children in the United Kingdom diagnosed as having ADHD and assessed predictors of medication persistence. Methods: U.K. children ages 3-16 diagnosed as having ADHD between 1994 and 2006 were identified from primary care practice data. Child characteristics, prescription patterns, and initial medication prescribed were described over the study period. The associations of child and clinical factors with medication persistence (defined as initial treatment length greater than six months) were estimated by using binomial regression. Results: Of 2,878 children with an ADHD diagnosis, 46% (N=1,314) received at least one prescription for ADHD medication within two years of diagnosis. The mean initial treatment length was 10.7±.5 months. Only 35% (N=464) of pharmacologically treated children had a treatment length greater than six months after initial medication prescription when the analysis used a 30-day grace period; 57% were persistent in treatment when a less stringent 60-day grace period was used. Children who were initially prescribed long-acting methylphenidate were more likely to persist in treatment than those prescribed standard methylphenidate (risk ratio=1.2, 95% confidence interval=1.1-1.4). Conclusions: A large proportion of children who received medication for ADHD in primary care did not continue in initial treatment for more than six months. Few child or clinical factors were associated with treatment persistence. Epidemiological research about the effects of long-term ADHD medication use should account for the observed limited persistence in medication treatment.
    Psychiatric services (Washington, D.C.) 03/2015; 66(6):appips201300148. DOI:10.1176/ · 2.41 Impact Factor
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    ABSTRACT: Over the past decade, there has been significant debate regarding the effect of cumulative subconcussive head impacts on short and long-term neurological impairment. This debate remains unresolved because valid epidemiological estimates of athletes' total contact exposure are lacking. We present a measure to estimate the total hours of contact exposure in football over the majority of an athlete's lifespan. Through a structured oral interview, former football players provided information related to primary position played and participation in games and practice contacts during the pre-season, regular season, and post-season of each year of their high school, college, and professional football careers. Spring football for college was also included. We calculated contact exposure estimates for n=64 former football players (n=32 college football only, n=32 professional and college football). The Head Impact Exposure Estimate (HIEE) discriminated between individuals who stopped after college football, and individuals who played professional football (P<0.001). The HIEE measure was independent of concussion history (P=0.82). Estimating total hours of contact exposure may allow for the detection of differences between individuals with variation in subconcussive impacts, regardless of concussion history. This measure is valuable for the surveillance of subconcussive impacts and their associated potential negative effects.
    Journal of Neurotrauma 01/2015; 32(14). DOI:10.1089/neu.2014.3666 · 3.71 Impact Factor
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    ABSTRACT: Athlete-recalled and clinically documented concussion histories have been used in research on former athletes, but both have limitations. Comparisons of these 2 types of concussion histories are needed to improve the accuracy of estimates of concussion history for future research and clinical care. To estimate the agreement between athlete-recalled and clinically documented concussion histories during college and to explore reasons for differences. Cohort study (diagnosis); Level of evidence, 3. Athlete-recalled concussion histories were provided by a convenience sample of 130 former collegiate athletes using an online questionnaire, and they were individually linked to previously collected clinical data that tracked medically diagnosed concussions at the host institution from 1996 to 2012. The intraclass correlation coefficient (ICC2,1) was used to assess agreement between athlete-recalled and clinically documented concussion histories. Descriptive analyses were performed to assess reasons for disagreement. Agreement between athlete-recalled and clinically documented concussion histories was low (ICC2,1 = 0.21; 95% confidence interval, 0.05-0.37), but it was higher for women (ICC2,1 = 0.65; 95% confidence interval, 0.44-0.79) and for athletes playing more recently (2005-2012; ICC2,1 = 0.39; 95% confidence interval, 0.01-0.67). Of the 53 athletes who self-reported college sports-related concussions, 40% believed that they sustained impacts that should have been diagnosed as concussions but were undetected, and 21% admitted nondisclosure of suspected concussions. Common reasons for nondisclosure included the following: did not think injury was serious enough (91%), did not know it was a concussion (73%), and did not want to leave the game/practice (73%). Given the low agreement between athlete-recalled and clinically documented concussion histories, methodologic research is needed to improve the quality of tools used to assess concussion histories in former athletes. © 2015 The Author(s).
    The American Journal of Sports Medicine 01/2015; 43(3). DOI:10.1177/0363546514562180 · 4.36 Impact Factor
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    ABSTRACT: Both high and low indoor relative humidity (RH) directly impact indoor air quality (IAQ), an important school health concern. Prior school studies reported a high prevalence of mold, roaches, and water damage; however, few examined associations between modifiable classroom factors and RH, a quantitative indicator of dampness. We recorded RH longitudinally in 134 North Carolina classrooms (n= 9066 classroom-days) to quantify the relationships between modifiable classroom factors and average daily RH below, within, or above levels recommended to improve school IAQ (30-50% or 30-60% RH). The odds of having high RH (>60%) were 5.8 (95% Confidence Interval (CI): 2.9, 11.3) times higher in classrooms with annual compared to quarterly heating, ventilating, and air conditioning (HVAC) system maintenance, and 2.5 (95% CI: 1.5, 4.2) times higher in classrooms with HVAC economizers compared to those without economizers. Classrooms with direct expansion split systems compared to chilled water systems had 2.7 (95% CI: 1.7, 4.4) times higher odds of low RH (60%) of those without setbacks. This research suggests actionable decision points for school design and maintenance to prevent high or low classroom RH. This article is protected by copyright. All rights reserved.
    Indoor Air 12/2014; DOI:10.1111/ina.12176 · 4.90 Impact Factor
  • Zachary Kerr · Stephen W. Marshall · Johna Register-Mihalik ·
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    ABSTRACT: Background: Recurrent concussion may result in neuro-dementia. However, athletes may not disclose sport-related concussion symptoms to others. Research is needed on factors influencing nondisclosure of concussion symptoms by athletes. Methods: Former collegiate athletes who played between 1987-2012 (n=797) completed an online self-administered questionnaire about impacts sustained during sport participation that should have been diagnosed by team medical staff as concussions, but were not. We asked why concussions went undiagnosed and what sources of information influenced respondents’ knowledge of concussions. Results: Of the 214 respondents self-reporting sport-related concussions (26.9% of sample), 44.9% stated that they had sustained impacts that should have been diagnosed by medical staff as concussions, but were not. Common reported factors associated with non-diagnosis were not telling team medical staff (33.2%) and no team medical staff being present (19.2%). Among those with non-disclosed concussions, common self-reported reasons for non-disclosure included: not wanting to leave the game/practice (78.9%); not wanting to let team down (71.8%); and not knowing it was a concussion (70.4%). Sources of knowledge that helped respondents realize impacts may have been undiagnosed concussions were continuing education (20.8%); friends (14.6%); and the media (71.9%), particularly ESPN (32.3%). Conclusion: Among those former collegiate athletes self-reporting sport-related concussions, nearly half of former collegiate athletes reported sustaining undiagnosed sport-related concussions. External influences such as perceived peer expectations and media coverage were influential in former athletes’ concussion reporting. This information may assist in refining public health campaigns that seek to improve disclosure of symptoms (e.g. CDC’s Heads-Up program).
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Background: Young athletes suffering from a concussion should be assessed by a trained health care provider. However, many concussions are never diagnosed because children and their parents do not seek care. We examined whether parents’ knowledge and attitudes towards concussion were associated with post-concussion care-seeking for their children. Methods: A cohort of 214 youth sport parents [(63% female; parent age: 44.1(±6.5 yrs); child age: 11.6±(1.9 yrs)] completed a pre-validated concussion knowledge (max possible score=28), attitudes (max possible score=63) and care-seeking survey. Higher knowledge and attitude scores represented more favorable scores. Parents reported number of: diagnosed concussions, times their child displayed signs/symptoms of concussion following a head impact, and care-seeking behaviors following these events. The main outcome was care-seeking for all potential concussions (all-care group) vs. not (lower-care group). Results: Twenty-six percent (n=55) of parents reported that their child had ≥ 1 potential concussion. The majority of these parents (72%, n=40) did not follow-up with a medical provider after each event. Mean attitude score was 51.5(±1.6) in the all-care group and 48.1(±4.2) in the lower-care group. Mean knowledge score was 23.6(±2.5) in the all-care group and 23.6±(2.9) in the lower-care group. More favorable parental attitudes towards concussion were positively associated with care-seeking (OR: 1.7; 95% CI: 1.1, 2.8). Parents’ knowledge was not associated with better care-seeking (OR: 0.9; 95% CI: 0.7, 1.3). Conclusions: While concussion knowledge is undoubtedly important, parental attitudes were more important in predicting care-seeking. Future parental interventions should stress the importance of prompt care for all potential concussions.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Objective: To compare the odds of sustaining moderate and severe head impacts, rather than mild, between high school football players with high and low visual performance. Design: Prospective quasi-experimental. Setting: Clinical Research Center/On-field. Participants: Thirty-seven high school varsity football players. Interventions: Athletes completed the Nike SPARQ Sensory Station visual assessment before the season. Head impact biomechanics were captured at all practices and games using the Head Impact Telemetry System. Main Outcome Measures: Each player was classified as either a high or low performer using a median split for each of the following visual performance measures: visual clarity, contrast sensitivity, depth perception, near-far quickness, target capture, perception span, eye-hand coordination, go/no go, and reaction time. We computed the odds of sustaining moderate and severe head impacts against the reference odds of sustaining mild head impacts across groups of high and low performers for each of the visual performance measures. Results: Players with better near-far quickness had increased odds of sustaining moderate [odds ratios (ORs), 1.27; 95% confidence intervals (CIs), 1.04-1.56] and severe head impacts (OR, 1.45; 95% CI, 1.05-2.01) as measured by Head Impact Technology severity profile. High and low performers were at equal odds on all other measures. Conclusions: Better visual performance did not reduce the odds of sustaining higher magnitude head impacts. Visual performance may play less of a role than expected for protecting against higher magnitude head impacts among high school football players. Further research is needed to determine whether visual performance influences concussion risk. Clinical Relevance: Based on our results, we do not recommend using visual training programs at the high school level for the purpose of reducing the odds of sustaining higher magnitude head impacts. Copyright
    Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine 11/2014; Publish Ahead of Print. DOI:10.1097/JSM.0000000000000143 · 2.27 Impact Factor
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    ABSTRACT: The existing research on the association between concussion and mental health outcomes is largely limited to former professional athletes. This cross-sectional study estimated the association between recurrent concussion and depression, impulsivity, and aggression in former collegiate athletes. Former collegiate athletes who played between 1987–2012 at a Division I university completed an online questionnaire. The main exposure, total number of self-recalled concussions (sport-related and non-sport-related), were categorized as: zero (referent), one, two, or three or more concussions. The main outcomes were the depression module of The Patient Health Questionnaire (PHQ-9), the Short Form of the Barratt Impulsiveness scale (BIS15); and the 12-item Short Form of the Buss-Perry Aggression Questionnaire (BPAQ-SF). Depression was categorized into a binomial severity classification that differentiated between no or mild depression (PHQ-9 scores <10) and moderate to severe depression (PHQ-9 scores ≥10). Impulsivity and aggression were kept as continuous outcomes. Binomial regression estimated adjusted prevalence ratios (PR). Linear regression estimated adjusted mean differences (MD). Of the 797 respondents with complete data (21.9% completion rate), 38.8% reported at least one concussion. Controlling for alcohol dependence and family history of depression, the prevalence of moderate to severe depression among former collegiate athletes reporting three or more concussions in total was 2.4 times that of those reporting zero concussions [95% Confidence Interval (CI): 1.0, 5.7]. Controlling for alcohol dependence, family history of anxiety, relationship status, obtaining a post-graduate degree, and playing primary college sport professionally, former collegiate athletes reporting two or more concussions in total had higher mean scores for impulsivity, compared to those reporting no concussions (2 concussions MD = 2.7; 95% CI: 1.2, 4.1; 3+ concussions MD = 1.9; 95% CI: 0.6, 3.2). Controlling for alcohol dependence, sex, and relationship status, former collegiate athletes reporting three or more concussions in total had a higher mean score for aggression, compared to those reporting no concussions (MD = 3.0; 95% CI: 1.4, 4.7). Our study found an association between former concussion and greater risk of severe depression and higher levels of impulsivity and aggression among former collegiate athletes. Additional prospective studies better addressing causality and ascertaining valid lifetime concussion histories and medical histories are needed.
    11/2014; 1(1):28. DOI:10.1186/s40621-014-0028-x

Publication Stats

10k Citations
1,194.71 Total Impact Points


  • 1996-2015
    • University of North Carolina at Chapel Hill
      • • Department of Epidemiology
      • • Department of Exercise and Sport Science
      • • Injury Prevention Research Center
      North Carolina, United States
  • 2013
    • WakeMed Health & Hospitals
      Raleigh, North Carolina, United States
  • 2012
    • United States Military Academy
      • Department of Mathematical Sciences
      West Point, New York, United States
  • 2011
    • University of Georgia
      • Department of Kinesiology
      Athens, GA, United States
  • 2008
    • University of North Carolina at Charlotte
      Charlotte, North Carolina, United States
    • Iowa State University
      • Department of Industrial and Manufacturing Systems Engineering
      Ames, Iowa, United States
  • 2007
    • Indiana University Bloomington
      Bloomington, Indiana, United States
  • 2006
    • University of Minnesota Duluth
      Duluth, Minnesota, United States
  • 2003
    • Boston University
      Boston, Massachusetts, United States
  • 1992-1997
    • University of Otago
      • Injury Prevention Research Unit
      Dunedin, Otago, New Zealand
  • 1994
    • Population Services International
      Washington, Washington, D.C., United States