Advancing Knowledge of Sports Concussion

Principal Investigator: Kristen Dams-O’Connor, PhD; Co-Principal Investigator: Robin Wellington, PhD; Project period: 2015-2017

From 1.6 to 3.6 million recreation and sports-related brain injuries occur each year in the U.S., most of which are mild in severity (mTBI). However, research has inadequately documented the long-term impact of single or multiple concussions on the life of young adult athletes, the age groups where the majority of these TBIs occur. In evaluating outcomes of sports concussion, most research fails to account for the potential confounding role of lifetime mTBI history, history of neurological disorders or history of learning disorders. There is also a paucity of research on mTBI among female athletes and athletes in sports other than American football. Most studies of sports concussion have focused on short-term symptom reports, return to play, and imaging findings. Research has not systematically examined meaningful longer-term outcomes that are commonly seen in non-athletes with TBI, such as mood and personality changes, increased health risk behaviors and increased risk for subsequent injury (TBI and other injuries). These outcomes are of particular interest in college athletes, given the high stakes of competitive sports juxtaposed with high expectations for academic, social and vocational success.

Through its outreach, training and professional development activities, the MS-ICRC has established a strong collaboration with Robin Wellington, PhD, head of the TBI Research Program at St. John’s University (SJU), which has put into place the infrastructure needed for the proposed project. The goals of the project are to: (a) characterize the incidence, prevalence and enduring consequences of concussions/ mTBI in a sample of college athletes who are followed longitudinally, and (b) refine data collection methods and procedures to provide a solid basis for establishing a large-scale College Athlete Concussion Registry.

  • Aim 1: Identify the lifetime prevalence and correlates of mTBIs (sports-related and non-sports-related) sustained prior to the start of the college athletic career in a sample of first-year pre-season male and female athletes from a wide variety of contact and noncontact sports (n=600)
    • Lifetime prevalence will be established by obtaining historical information on previous incidents of mTBI/concussion from college athletes at the point of entry to the study.
    • College athletes who have and have not sustained at least one prior mTBI will be compared across the following domains: cognitive functioning, mood and health risk behaviors (i.e., substance use, unsafe driving, impulsivity, aggression, violence), to identify correlates of lifetime mTBI in college athletes.
    • Exploratory analyses will be conducted to investigate whether a direct relationship (i.e., a dose-response relationship) exists between the number of reported concussions (mTBIs) and level of functioning in the domains enumerated above.
  • Aim 2: Identify the incidence and consequences of mTBIs sustained during the athletic season, through annual pre-season evaluations and post-concussion assessments in a sample of college athletes (n=600)
    • The rates of concussion (per season and per hour of practice/play) will be calculated across a variety of contact and noncontact sports.
    • College athletes who do and do not sustain at least one concussion after study enrollment will be compared at 1-year follow-up across the following domains: pre-enrollment concussion history, cognitive functioning, mood and the health risk behaviors enumerated above).
  • Aim 3: Characterize the longitudinal course of functioning (n=330 athletes with ≥3 assessments) during and after college of athletes who have and have not sustained mTBIs across the following domains: cognitive functioning, mood and health risk behaviors (i.e., substance use, unsafe driving, impulsivity, aggression, violence). The group being followed will include athletes who are no longer in college; additional domains of functioning relevant to a non-student young adult population will be assessed in this subgroup: vocational status and progress, income, life satisfaction, social support. Different trajectories of functioning will be determined by fitting latent growth models to the data and identifying factors (e.g., mTBI history) that predict outcome trajectories.
  • Aim 4: We will develop a web-based protocol that details the infrastructure, key roles and data collection methodology and instruments necessary to collect the data elements adopted and found useful in R4. This protocol can be disseminated to colleges and universities interested in participating in the development of a College Athlete Concussion Registry, which will create a large-scale data repository for the comprehensive investigation of mTBI risk and long-term outcomes in this population. (If the MS-ICRC is not funded again after the proposed funding period, this form of dissemination and establishment of a nation-wide College Athlete Concussion Registry will be assumed by the BIRC-MS.)

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