Abstract

Background

Concussion, or mild traumatic brain injury, is a major public health concern affecting 42 million individuals globally each year. However, little is known regarding concussion risk factors across all concussion settings as most concussion research has focused on only sport-related or military-related concussive injuries.

Methods

The current study is part of the Concussion, Assessment, Research, and Education (CARE) Consortium, a multi-site investigation on the natural history of concussion. Cadets at three participating service academies completed annual baseline assessments, which included demographics, medical history, and concussion history, along with the Sport Concussion Assessment Tool (SCAT) symptom checklist and Brief Symptom Inventory (BSI-18). Clinical and research staff recorded the date and injury setting at time of concussion. Generalized mixed models estimated concussion risk with service academy as a random effect. Since concussion was a rare event, the odds ratios were assumed to approximate relative risk.

Results

Beginning in 2014, 10,604 (n = 2421, 22.83% female) cadets enrolled over 3 years. A total of 738 (6.96%) cadets experienced a concussion, 301 (2.84%) concussed cadets were female. Female sex and previous concussion were the most consistent estimators of concussion risk across all concussion settings. Compared to males, females had 2.02 (95% CI: 1.70–2.40) times the risk of a concussion regardless of injury setting, and greater relative risk when the concussion occurred during sport (Odds Ratio (OR): 1.38 95% CI: 1.07–1.78). Previous concussion was associated with 1.98 (95% CI: 1.65–2.37) times increased risk for any incident concussion, and the magnitude was relatively stable across all concussion settings (OR: 1.73 to 2.01). Freshman status was also associated with increased overall concussion risk, but was driven by increased risk for academy training-related concussions (OR: 8.17 95% CI: 5.87–11.37). Medical history of headaches in the past 3 months, diagnosed ADD/ADHD, and BSI-18 Somatization symptoms increased overall concussion risk.

Conclusions

Various demographic and medical history factors are associated with increased concussion risk. While certain factors (e.g. sex and previous concussion) are consistently associated with increased concussion risk, regardless of concussion injury setting, other factors significantly influence concussion risk within specific injury settings. Further research is required to determine whether these risk factors may aid in concussion risk reduction or prevention.

Details

Title
A cohort study to identify and evaluate concussion risk factors across multiple injury settings: findings from the CARE Consortium
Author
Van Pelt, Kathryn L 1   VIAFID ORCID Logo  ; Allred, Dain 2 ; Cameron, Kenneth L 3 ; Campbell, Darren E 2 ; Christopher J D’Lauro 2 ; He, Xuming 4 ; Houston, Megan N 3 ; Johnson, Brian R 2 ; Kelly, Tim F 5 ; McGinty, Gerald 2 ; Meehan, Sean 6 ; Patrick G O’Donnell 7 ; Peck, Karen Y 3 ; Svoboda, Steven J 8 ; Pasquina, Paul 9 ; McAllister, Thomas 10 ; McCrea, Michael 11 ; Broglio, Steven P 1 

1  NeuroTrauma Research Laboratory, University of Michigan, Ann Arbor, MI, USA 
2  United States Air Force Academy, U.S. Air Force Academy, CO, USA 
3  John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Community Hospital, West Point, NY, USA 
4  Department of Statistics, University of Michigan, Ann Arbor, MI, USA 
5  Department of Intercollegiate Athletics, United States Military Academy, West Point, NY, USA 
6  School of Kinesiology, University of Michigan, Ann Arbor, MI, USA 
7  United States Coast Guard Academy, New London, CT, USA 
8  MedStar, Washington DC, USA 
9  Department of Rehabilitation Medicine, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, USA 
10  Indiana University School of Medicine, Indianapolis, IN, USA 
11  Medical College of Wisconsin, Department of Neurosurgery, Milwaukee, WI, USA 
Pages
1-11
Publication year
2019
Publication date
Jan 2019
Publisher
Springer Nature B.V.
e-ISSN
21971714
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1186/s40621-018-0178-3
ProQuest document ID
2166662359
Copyright
Injury Epidemiology is a copyright of Springer, (2019). All Rights Reserved., © 2019. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.