Return to play and risk of repeat concussion in collegiate football players

Comparative analysis from the NCAA Concussion Study (1999-2001) and CARE Consortium (2014-2017)

Michael McCrea, Steven Broglio, Thomas McAllister, Wenxian Zhou, Shi Zhao, Barry Katz, Maria Kudela, Jaroslaw Harezlak, Lindsay Nelson, Timothy Meier, Stephen William Marshall, Kevin M. Guskiewicz

Research output: Contribution to journalArticle

Abstract

Objective: We compared data from the National Collegiate Athletic Association (NCAA) Concussion Study (1999-2001) and the NCAA-Department of Defense Concussion Assessment, Research and Education (CARE) Consortium (2014-2017) to examine how clinical management, return to play (RTP) and risk of repeat concussion in collegiate football players have changed over the past 15 years. Methods: We analysed data on reported duration of symptoms, symptom-free waiting period (SFWP), RTP and occurrence of within-season repeat concussion in collegiate football players with diagnosed concussion from the NCAA Study (n=184) and CARE (n=701). Results: CARE athletes had significantly longer symptom duration (CARE median=5.92 days, IQR=3.02-9.98 days; NCAA median=2.00 days, IQR=1.00-4.00 days), SFWP (CARE median=6.00 days, IQR=3.49-9.00 days; NCAA median=0.98 days, IQR=0.00-4.00 days) and RTP (CARE median=12.23 days, IQR=8.04-18.92 days; NCAA median=3.00 days, IQR=1.00-8.00 days) than NCAA Study athletes (all p<0.0001). In CARE, there was only one case of repeat concussion within 10 days of initial injury (3.7% of within-season repeat concussions), whereas 92% of repeat concussions occurred within 10 days in the NCAA Study (p<0.001). The average interval between first and repeat concussion in CARE was 56.41 days, compared with 5.59 days in the NCAA Study (M difference=50.82 days; 95% CI 38.37 to 63.27; p<0.0001). Conclusion: Our findings indicate that concussion in collegiate football is managed more conservatively than 15 years ago. These changes in clinical management appear to have reduced the risk of repetitive concussion during the critical period of cerebral vulnerability after sport-related concussion (SRC). These data support international guidelines recommending additional time for brain recovery before athletes RTP after SRC.

Original languageEnglish (US)
JournalBritish Journal of Sports Medicine
DOIs
StatePublished - Jan 1 2019

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Football
Sports
Education
Research
Athletes
Return to Sport
Guidelines

Keywords

  • concussion
  • injury prevention
  • mild traumatic brain injury
  • sports injuries

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Return to play and risk of repeat concussion in collegiate football players : Comparative analysis from the NCAA Concussion Study (1999-2001) and CARE Consortium (2014-2017). / McCrea, Michael; Broglio, Steven; McAllister, Thomas; Zhou, Wenxian; Zhao, Shi; Katz, Barry; Kudela, Maria; Harezlak, Jaroslaw; Nelson, Lindsay; Meier, Timothy; Marshall, Stephen William; Guskiewicz, Kevin M.

In: British Journal of Sports Medicine, 01.01.2019.

Research output: Contribution to journalArticle

McCrea, Michael ; Broglio, Steven ; McAllister, Thomas ; Zhou, Wenxian ; Zhao, Shi ; Katz, Barry ; Kudela, Maria ; Harezlak, Jaroslaw ; Nelson, Lindsay ; Meier, Timothy ; Marshall, Stephen William ; Guskiewicz, Kevin M. / Return to play and risk of repeat concussion in collegiate football players : Comparative analysis from the NCAA Concussion Study (1999-2001) and CARE Consortium (2014-2017). In: British Journal of Sports Medicine. 2019.
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abstract = "Objective: We compared data from the National Collegiate Athletic Association (NCAA) Concussion Study (1999-2001) and the NCAA-Department of Defense Concussion Assessment, Research and Education (CARE) Consortium (2014-2017) to examine how clinical management, return to play (RTP) and risk of repeat concussion in collegiate football players have changed over the past 15 years. Methods: We analysed data on reported duration of symptoms, symptom-free waiting period (SFWP), RTP and occurrence of within-season repeat concussion in collegiate football players with diagnosed concussion from the NCAA Study (n=184) and CARE (n=701). Results: CARE athletes had significantly longer symptom duration (CARE median=5.92 days, IQR=3.02-9.98 days; NCAA median=2.00 days, IQR=1.00-4.00 days), SFWP (CARE median=6.00 days, IQR=3.49-9.00 days; NCAA median=0.98 days, IQR=0.00-4.00 days) and RTP (CARE median=12.23 days, IQR=8.04-18.92 days; NCAA median=3.00 days, IQR=1.00-8.00 days) than NCAA Study athletes (all p<0.0001). In CARE, there was only one case of repeat concussion within 10 days of initial injury (3.7{\%} of within-season repeat concussions), whereas 92{\%} of repeat concussions occurred within 10 days in the NCAA Study (p<0.001). The average interval between first and repeat concussion in CARE was 56.41 days, compared with 5.59 days in the NCAA Study (M difference=50.82 days; 95{\%} CI 38.37 to 63.27; p<0.0001). Conclusion: Our findings indicate that concussion in collegiate football is managed more conservatively than 15 years ago. These changes in clinical management appear to have reduced the risk of repetitive concussion during the critical period of cerebral vulnerability after sport-related concussion (SRC). These data support international guidelines recommending additional time for brain recovery before athletes RTP after SRC.",
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AU - McAllister, Thomas

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