TY - JOUR
T1 - Medical Disqualification Following Concussion in Collegiate Student-Athletes
T2 - Findings from the CARE Consortium
AU - Care Consortium Investigators
AU - Schmidt, Julianne D.
AU - Rawlins, Michelle L.Weber
AU - Lynall, Robert C.
AU - D’Lauro, Christopher
AU - Clugston, James R.
AU - McAllister, Tom W.
AU - McCrea, Michael
AU - Broglio, Steven P.
AU - Hoy, April
AU - Hazzard, Joseph
AU - Kelly, Louise
AU - Master, Christina
AU - Ortega, Justus
AU - Port, Nicholas
AU - Campbell, Darren
AU - Svoboda, Steven J.
AU - Putukian, Margot
AU - Chrisman, Sara P.D.
AU - Langford, Dianne
AU - McGinty, Gerald
AU - Jackson, Jonathan C.
AU - Cameron, Kenneth L.
AU - Houston, Megan N.
AU - Susmarski, Adam James
AU - Goldman, Joshua T.
AU - Giza, Christopher
AU - Benjamin, Holly
AU - Buckley, Thomas
AU - Kaminski, Thomas
AU - Feigenbaum, Luis
AU - Eckner, James T.
AU - Mihalik, Jason P.
AU - Anderson, Scott
AU - Kontos, Anthony
AU - Brooks, M. Alison
AU - Duma, Stefan M.
AU - Rowson, Steve
AU - Miles, Christopher
AU - Lintner, Laura
N1 - Funding Information:
This publication was made possible, in part, with support from the Grand Alliance Concussion Assessment, Research, and Education (CARE) Consortium, funded, in part by the National Collegiate Athletic Association (NCAA) and the Department of Defense (DOD). The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick MD 21702-5014 is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under Award NO W81XWH-14-2-0151. Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Department of Defense (DHP funds). This manuscript was also made possible, in part, with support from the Air Force Research Laboratory’s Summer Faculty Fellowship Program.
Funding Information:
CARE Consortium Investigators (institution): April Hoy MS, ATC, CSCS (School of Behavioral and Applied Sciences, Azusa Pacific University). Joseph Hazzard, Jr., PhD, ATC (Department of Exercise Science, Bloomsburg University). Louise Kelly, PhD (Department of Exercise Science, California Lutheran University). Christina Master, MD (Division of Orthopedics, Children?s Hospital of Philadelphia). Justus Ortega, PhD (Department of Kinesiology & Recreation Administration, Humboldt State University). Nicholas Port, PhD (School of Optometry, Indiana University). Darren Campbell MD, Col USAF (retired) (Intermountain Sports Medicine). Steven J. Svoboda, MD,?Colonel, US Army(retired)?(MedStar Orthopaedic Institute). Margot Putukian, MD (Athletic Medicine, Princeton University). Sara P.D. Chrisman MD, MPH (Center for Child Health, Behavior and Development, Seattle Children?s Research Institute). Dianne Langford, PhD (Lewis Katz School of Medicine, Temple University). Gerald McGinty, PT, DPT (United States Air Force Academy). Jonathan C. Jackson MD (United States Air Force Academy). Kenneth L. Cameron, PhD, MPH, ATC, FNATA (Keller Army Hospital, United States Military Academy). Megan N. Houston, PhD, ATC (Keller Army Hospital, United States Military Academy). Adam James Susmarski, DO (Department Head Brigade Orthopaedics and Sports Medicine, United States Naval Academy). Joshua T. Goldman, MD, MBA (Departments of Family Medicine & Orthopaedic Surgery, University of California, Los Angeles). Christopher Giza, MD (Department of Pediatrics, University of California, Los Angeles). Holly Benjamin, MD (Department of Rehabilitation Medicine and Pediatrics, University of Chicago). Thomas Buckley, PhD (Department of Kinesiology & Applied Physiology, University of Delaware). Thomas Kaminski, PhD, ATC (Department of Kinesiology & Applied Physiology, University of. Delaware). Luis Feigenbaum, DPT, ATC (Department of Physical Therapy, Miller School of Medicine, University of Miami). James T. Eckner, M.D., M.S. (Department of PM&R, University of Michigan). Jason P. Mihalik, PhD, CAT(C), ATC, FACSM (Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill). Scott Anderson ATC (University of Oklahoma). Anthony Kontos, PhD (Department of Orthopaedic Surgery, University of Pittsburgh). M. Alison Brooks, MD, MPH (Department of Orthopedics, University of Wisconsin, Madison). Stefan M. Duma, PhD (Institute for Critical Technology and Applied Science, Virginia Tech). Steve Rowson, PhD (Department of Biomedical Engineering and Mechanics, Virginia Tech). Christopher Miles, MD (Department of Family and Community Medicine, Wake Forest University). Laura Lintner, DO (Wake Forest School of Medicine Family Medicine, Winston Salem State University).
Funding Information:
Julianne Schmidt, Michelle Weber Rawlins, James Clugston, Steven Broglio, Michael McCrea, and Thomas McAllister received funding from the National Collegiate Athletic Association and the Department of Defense to complete this investigation and cover travel costs related to the study. The remaining authors declare that they have no conflicts of interest.
Publisher Copyright:
© 2020, Springer Nature Switzerland AG.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Background: The absence of evidence-based guidelines make medical disqualification (MDQ) following concussion one of the most challenging decision-making processes faced by sports medicine professionals. Objective: We aimed to compare premorbid and postmorbid factors between student-athletes that were and were not medically disqualified from sport following a concussion. Methods: Among 1832 student-athletes diagnosed with concussion within the CARE Consortium, 53 (2.9%) were medically disqualified (MDQ +) and 1779 (97.1%) were not medically disqualified (MDQ−). We used contingency tables and descriptive statistics for an initial evaluation of a broad list of premorbid and postmorbid factors. For those factors showing association with MDQ status, we calculated odds ratios and 95% confidence intervals for the odds of being MDQ + in the presence of the identified factor. Results: History of 2 (OR: 3.2, 95% CI 1.5, 6.9) or 3 + (OR: 7.4, 95% CI 3.4, 15.9) previous concussions; 1 + headaches in past 3 months (OR: 1.8, 95% CI 1.0, 3.2); immediate removal from play (OR: 2.4, 95% CI 1.2, 4.9); alcohol (OR: 2.6, 95% CI 1.2, 5.4), tobacco (OR: 3.3, 95% CI 1.1, 9.5), or marijuana use since injury (OR: 5.4, 95% CI 1.5, 19.0); as well as prolonged recovery due to mental health alterations (OR: 5.3, 95% CI 2.0, 14.1) or motivation/malingering (OR: 7.5, 95% CI 3.3, 17.0) increased odds of being MDQ +. The MDQ + group took longer to become asymptomatic relative to the MDQ− group (MDQ + : 23.5 days, 95% CI 15.8, 31.2; MDQ−: 10.6 days, 95% CI 9.5, 11.6; p ' 0.001). Conclusions: MDQ following concussion was relatively rare. We identified three patterns related to MDQ following concussion: (1) concussion and headache history were the only premorbid factors that differed (2) initial concussion presentation was more severe and more immediate in the MDQ + group, and (3) post-concussion recovery outcomes expressed the greatest differences between groups.
AB - Background: The absence of evidence-based guidelines make medical disqualification (MDQ) following concussion one of the most challenging decision-making processes faced by sports medicine professionals. Objective: We aimed to compare premorbid and postmorbid factors between student-athletes that were and were not medically disqualified from sport following a concussion. Methods: Among 1832 student-athletes diagnosed with concussion within the CARE Consortium, 53 (2.9%) were medically disqualified (MDQ +) and 1779 (97.1%) were not medically disqualified (MDQ−). We used contingency tables and descriptive statistics for an initial evaluation of a broad list of premorbid and postmorbid factors. For those factors showing association with MDQ status, we calculated odds ratios and 95% confidence intervals for the odds of being MDQ + in the presence of the identified factor. Results: History of 2 (OR: 3.2, 95% CI 1.5, 6.9) or 3 + (OR: 7.4, 95% CI 3.4, 15.9) previous concussions; 1 + headaches in past 3 months (OR: 1.8, 95% CI 1.0, 3.2); immediate removal from play (OR: 2.4, 95% CI 1.2, 4.9); alcohol (OR: 2.6, 95% CI 1.2, 5.4), tobacco (OR: 3.3, 95% CI 1.1, 9.5), or marijuana use since injury (OR: 5.4, 95% CI 1.5, 19.0); as well as prolonged recovery due to mental health alterations (OR: 5.3, 95% CI 2.0, 14.1) or motivation/malingering (OR: 7.5, 95% CI 3.3, 17.0) increased odds of being MDQ +. The MDQ + group took longer to become asymptomatic relative to the MDQ− group (MDQ + : 23.5 days, 95% CI 15.8, 31.2; MDQ−: 10.6 days, 95% CI 9.5, 11.6; p ' 0.001). Conclusions: MDQ following concussion was relatively rare. We identified three patterns related to MDQ following concussion: (1) concussion and headache history were the only premorbid factors that differed (2) initial concussion presentation was more severe and more immediate in the MDQ + group, and (3) post-concussion recovery outcomes expressed the greatest differences between groups.
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U2 - 10.1007/s40279-020-01302-y
DO - 10.1007/s40279-020-01302-y
M3 - Article
C2 - 32557231
AN - SCOPUS:85086735106
VL - 50
SP - 1843
EP - 1855
JO - Sports Medicine
JF - Sports Medicine
SN - 0112-1642
IS - 10
ER -