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What are the real risks of sport-related concussion, and are they modifiable?

Published online by Cambridge University Press:  01 July 2009

CHRISTOPHER RANDOLPH  and
MICHAEL W. KIRKWOOD
CHRISTOPHER RANDOLPH*
Affiliation:
Department of Neurology, Loyola University Medical Center, Maywood, Illinois
MICHAEL W. KIRKWOOD
Affiliation:
Department of Physical Medicine & Rehabilitation, University of Colorado at Denver and The Children’s Hospital, Aurora, Colorado
*
*Correspondence and reprint requests to: Christopher Randolph, 1 East Erie, Suite 355, Chicago, Illinois 60611. E-mail: crandol@lumc.edu
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Abstract

Over the past two decades, the management of sport-related concussion has been the topic of increased attention in the scientific literature and in the popular media. Despite a proliferation of competing guidelines for concussion management, the widespread use of neuropsychological “baseline” testing designed to monitor postinjury recovery, and several prospective controlled studies of the natural history of concussion, there has been virtually no attempt to quantify the risks associated with sport-related concussion or to determine whether these risks are modifiable via management strategies. Using American football as a model, the short- and long-term risks of sport-related concussion are reviewed. It is concluded that serious short-term consequences of sport-related concussion are extremely rare and unlikely to be significantly modified via management strategies that rely on baseline testing. Other less serious short-term adverse outcomes are also quite rare, transient, and not likely to be altered by specific management guidelines. The long-term consequences of multiple sport-related head trauma remain unclear but are potentially of greater public health concern and should be the focus of increased research. Based on available evidence, there is little rationale for the use of rigid strategies or guidelines in the place of individual clinical decision-making in the management of these injuries. (JINS, 2009, 15, 512–520.)

Keywords

Brain injuryNeuropsychological testsGuidelinesBrain swellingPost-concussion syndromePsychometrics
Type
Critical Review
Information
Journal of the International Neuropsychological Society , Volume 15 , Issue 4 , July 2009 , pp. 512 - 520
Copyright
Copyright © The International Neuropsychological Society 2009

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References

REFERENCES

Belanger, H.G. & Vanderploeg, R.D. (2005). The neuropsychological impact of sports-related concussion: A meta-analysis. Journal of International Neuropsychological Society, 11(4), 345–357.CrossRefGoogle ScholarPubMed
Borenstein, A.R., Copenhaver, C.I., & Mortimer, J.A. (2006). Early-life risk factors for Alzheimer disease. Alzheimer Disease and Associated Disorders, 20(1), 63–72.CrossRefGoogle ScholarPubMed
Borg, J., Holm, L., Peloso, P.M., Cassidy, J.D., Carroll, L.J., von Holst, H., Paniak, C., & Yates, D. (2004). Non-surgical intervention and cost for mild traumatic brain injury: Results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Journal of Rehabilitation Medicine (Suppl. 43), 36, 76–83.CrossRefGoogle Scholar
Broglio, S.P., Ferrara, M.S., Macciocchi, S.N., Baumgartner, T.A., & Elliott, R. (2007). Test-retest reliability of computerized concussion assessment programs. Journal of Athletic Training, 42(4), 509–514.Google ScholarPubMed
Broglio, S.P., Ferrara, M.S., Piland, S.G., & Anderson, R.B. (2006). Concussion history is not a predictor of computerized neurocognitive performance. British Journal of Sports Medicine, 40, 802–805.CrossRefGoogle ScholarPubMed
Bruce, D.A., Alavi, A., Bilaniuk, L., Dolinskas, C., Obrist, W., & Uzzell, B. (1981). Diffuse cerebral swelling following head injuries in children: The syndrome of “malignant brain edema.” Journal of Neurosurgery, 54(2), 170–178.CrossRefGoogle ScholarPubMed
Cantu, R. (1997). Reflections on head injuries in sport and the concussion controversy. Clinical Journal of Sport Medicine, 7, 83–84.CrossRefGoogle ScholarPubMed
Cavanaugh, J.T., Guskiewicz, K.M., & Stergiou, N. (2005). A nonlinear dynamic approach for evaluating postural control: New directions for the management of sport-related cerebral concussion. Sports Medicine, 35(11), 935–950.CrossRefGoogle ScholarPubMed
Collie, A., McCrory, P., & Makdissi, M. (2006). Does history of concussion affect current cognitive status? British Journal of Sports Medicine, 40(6), 550–551.CrossRefGoogle ScholarPubMed
Delaney, J.S., Lacroix, V.J., Leclerc, S., & Johnston, K.M. (2000). Concussions during the 1997 Canadian Football League season. Clinical Journal of Sport Medicine, 10(1), 9–14.CrossRefGoogle ScholarPubMed
Duma, S.M., Manoogian, S.J., Bussone, W.R., Brolinson, P.G., Goforth, M.W., Donnenwerth, J.J., Greenwald, R.M., Chu, J.J., & Crisco, J.J. (2005). Analysis of real-time head accelerations in collegiate football players. Clinical Journal of Sport Medicine, 15(1), 3–8.CrossRefGoogle ScholarPubMed
Echemendia, R.J., Putukian, M., Mackin, R.S., Julian, L., & Shoss, N. (2001). Neuropsychological test performance prior to and following sports-related mild traumatic brain injury. Clinical Journal of Sport Medicine, 11(1), 23–31.CrossRefGoogle ScholarPubMed
Fratiglioni, L. & Wang, H.X. (2007). Brain reserve hypothesis in dementia. Journal of Alzheimer’s Disease, 12(1), 11–22.CrossRefGoogle ScholarPubMed
Giza, C.G. & Hovda, D.A. (2001). The neurometabolic cascade of concussion. Journal of Athletic Training, 36(3), 228–235.Google ScholarPubMed
Grindel, S.H. (2006). The use, abuse, and future of neuropsychologic testing in mild traumatic brain injury. Current Sports Medicine Reports, 5(1), 9–14.CrossRefGoogle ScholarPubMed
Guo, Z., Cupples, L.A., Kurz, A., Auerbach, S.H., Volicer, L., Chui, H., Green, R.C., Sadovnick, A.D., Duara, R., DeCarli, C., Johnson, K., Growdon, J.H., Haines, J.L., Kukull, W.A., & Farrer, L.A. (2000). Head injury and the risk of AD in the MIRAGE study. Neurology, 54(6), 1316–1323.CrossRefGoogle ScholarPubMed
Guskiewicz, K.M., Marshall, S.W., Bailes, J., McCrea, M., Cantu, R.C., Randolph, C., & Jordan, B.D. (2005). Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery, 57(4), 719–726; discussion 719–726.CrossRefGoogle ScholarPubMed
Guskiewicz, K.M., McCrea, M., Marshall, S.W., Cantu, R.C., Randolph, C., Barr, W., Onate, J.A., & Kelly, J.P. (2003). Cumulative effects associated with recurrent concussion in collegiate football players: The NCAA Concussion Study. The Journal of the American Medical Association, 290(19), 2549–2555.CrossRefGoogle ScholarPubMed
Guskiewicz, K.M., Ross, S.E., & Marshall, S.W. (2001). Postural stability and neuropsychological deficits after concussion in collegiate athletes. Journal of Athletic Training, 36(3), 263–273.Google ScholarPubMed
Guskiewicz, K.M., Weaver, N.L., Padua, D.A., & Garrett, W.E. Jr. (2000). Epidemiology of concussion in collegiate and high school football players. The American Journal of Sports Medicine, 28(5), 643–650.CrossRefGoogle ScholarPubMed
Helzner, E.P., Scarmeas, N., Cosentino, S., Portet, F., & Stern, Y. (2007). Leisure activity and cognitive decline in incident Alzheimer disease. Archives of Neurology, 64(12), 1749–1754.CrossRefGoogle ScholarPubMed
Hovda, D.A., Prins, M., Becker, D.P., Lee, S., Bergsneider, M., & Martin, N.A. (1999). Neurobiology of concussion. In Bailes, J.E., Lovel, M.R. & Maroon, J.C. (Eds.), Sports-related concussion 12–51. St. Louis, MO: Quality Medical Publishing, Inc. http://www.unc.edu/depts/nccsi/.Google Scholar
Iverson, G.L., Brooks, B.L., Lovell, M.R., & Collins, M.W. (2005). No cumulative effects for one or two previous concussions. British Journal of Sports Medicine, 40, 72–75.CrossRefGoogle Scholar
Iverson, G.L., Gaetz, M., Lovell, M.R., & Collins, M.W. (2004). Cumulative effects of concussion in amateur athletes. Brain Injury, 18(5), 433–443.CrossRefGoogle ScholarPubMed
Iverson, G.L. & Lange, R.T. (2003). Examination of “postconcussion-like” symptoms in a healthy sample. Applied Neuropsychology, 10(3), 137–144.CrossRefGoogle Scholar
Johnston, K.M., McCrory, P., Mohtadi, N.G., & Meeuwisse, W. (2001). Evidence-based review of sport-related concussion: Clinical science. Clinical Journal of Sport Medicine, 11(3), 150–159.CrossRefGoogle ScholarPubMed
Kelly, J.P. & Rosenberg, J.H. (1997). Diagnosis and management of concussion in sports. Neurology, 48(3), 575–580.CrossRefGoogle ScholarPubMed
Kemppainen, N.M., Aalto, S., Karrasch, M., Nagren, K., Savisto, N., Oikonen, V., Kailajarui, M., Scheinen, M, Parkkola, R., & Rinn, J.O. (2008). Cognitive reserve hypothesis: Pittsburgh Compound B and fluorodeoxyglucose positron emission tomography in relation to education in mild Alzheimer’s disease. Annals of Neurology, 63, 112–118.CrossRefGoogle ScholarPubMed
Kors, E.E., Terwindt, G.M., Vermeulen, F.L., Fitzsimons, R.B., Jardine, P.E., Heywood, P., Love, S., van den Maagdenberg, A., Haan, J., Frants, R.R., & Ferrari, M.D. (2001). Delayed cerebral edema and fatal coma after minor head trauma: Role of the CACNA1A calcium channel subunit gene and relationship with familial hemiplegic migraine. Annals of Neurology, 49, 753–760.CrossRefGoogle ScholarPubMed
Laurer, H.L., Bareyre, F.M., Lee, V.M., Trojanowski, J.Q., Longhi, L., Hoover, R., Saatman, K.E., Raghupathi, R., Hoshino, S., Grady, M.S., & McIntosh, T.K. (2001). Mild head injury increasing the brain’s vulnerability to a second concussive impact. Journal of Neurosurgery, 95(5), 859–870.CrossRefGoogle ScholarPubMed
Longhi, L., Saatman, K.E., Fujimoto, S., Raghupathi, R., Meaney, D.F., Davis, J., Mcmillan, B.S.A., Conte, V., Laurer, H.L., Stein, S., Stocchetti, N., & McIntosh, T.K. (2005). Temporal window of vulnerability to repetitive experimental concussive brain injury. Neurosurgery, 56(2), 364–374; discussion 364–374.CrossRefGoogle ScholarPubMed
Luis, C.A., Vanderploeg, R.D., & Curtiss, G. (2003). Predictors of postconcussion symptom complex in community dwelling male veterans. Journal of International Neuropsychological Society, 9, 1001–1015.CrossRefGoogle ScholarPubMed
Macciocchi, S.N., Barth, J.T., Alves, W., Rimel, R.W., & Jane, J.A. (1996). Neuropsychological functioning and recovery after mild head injury in collegiate athletes. Neurosurgery, 39(3), 510–514.CrossRefGoogle ScholarPubMed
Macciocchi, S.N., Barth, J.T., Littlefield, L.M., & Cantu, R. (2001). Multiple concussions and neuropsychological functioning in collegiate football players. Journal of Athletic Training, 36, 303–306.Google ScholarPubMed
Mandera, M., Wencel, T., Bazowski, P., & Krauze, J. (2000). How should we manage children after mild head injury? Child’s Nervous System, 16, 156–160.CrossRefGoogle ScholarPubMed
McCrea, M., Guskiewicz, K.M., Marshall, S.W., Barr, W., Randolph, C., Cantu, R.C., Onate, J.A., Yang, J., & Kelly, J.P. (2003). Acute effects and recovery time following concussion in collegiate football players: The NCAA Concussion Study. The Journal of the American Medical Association, 290(19), 2556–2563.CrossRefGoogle ScholarPubMed
McCrory, P. (2001). Does second impact syndrome exist? Clinical Journal of Sport Medicine, 11(3), 144–149.CrossRefGoogle ScholarPubMed
McCrory, P. & Berkovic, S.F. (1998). Second impact syndrome. Neurology, 50(3), 677–683.CrossRefGoogle ScholarPubMed
McCrory, P., Johnston, K., Meeuwisse, W., Aubry, M., Cantu, R., Dvorak, J., Graf-Baumann, T., Kelly, J.P., Lovell, M., & Schamasch, P. (2005). Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. British Journal of Sports Medicine, 39(4), 196–204.CrossRefGoogle ScholarPubMed
Mickeviciene, D., Schrader, H., Obelieniene, D., Surkiene, D., Kunickas, R., Stovner, L.J., & Sand, T. (2004). A controlled prospective inception cohort study on the post-concussion syndrome outside the medicolegal context. European Journal of Neurology, 11(6), 411–419.CrossRefGoogle ScholarPubMed
Mihalik, J.P., Bell, D.R., Marshall, S.W., & Guskiewicz, K.M. (2007). Measurement of head impacts in collegiate football players: An investigation of positional and event-type differences. Neurosurgery, 61(6), 1229–1235; discussion 1235.CrossRefGoogle ScholarPubMed
Mittenberg, W., Canyock, E.M., Condit, D., & Patton, C. (2001). Treatment of post-concussion syndrome following mild head injury. Journal of Clinical and Experimental Neuropsychology, 23(6), 829–836.CrossRefGoogle ScholarPubMed
Mori, T., Katayama, Y., & Kawamata, T. (2006). Acute hemispheric swelling associated with thin subdural hematomas: Pathophysiology of repetitive head injury in sports. Acta Neurochirurgica. Supplement, 96, 40–43.CrossRefGoogle ScholarPubMed
Notebaert, A.J. & Guskiewicz, K. (2005). Current trends in athletic training practice for concussion assessment and management. Journal of Athletic Training, 40(4), 320–325.Google ScholarPubMed
Nunnally, J.C. & Bernstein, I.H. (1994). Psychometric theory (3rd ed.). New York: McGraw-Hill, Inc.Google Scholar
Paniak, C., Toller-Lobe, G., Reynolds, S., Melnyk, A., & Nagy, J. (2000). A randomized trial of two treatments for mild traumatic brain injury: 1 year follow-up. Brain Injury, 14(3), 219–226.Google Scholar
Peterson, C.L., Ferrara, M.S., Mrazik, M., Piland, S., & Elliot, R. (2003). Evaluation of neuropsychological domain scores and postural following cerebral concussion in sports. Clinical Journal of Sport Medicine, 13, 230–237.CrossRefGoogle ScholarPubMed
Piland, S.G., Motl, R.W., Ferrara, M.S., & Peterson, C.L. (2003). Evidence for the Factorial and Construct Validity of a Self-Report Concussion Symptoms Scale. Journal of Athletic Training, 38(2), 104–112.Google ScholarPubMed
Ponsford, J., Willmott, C., Rothwell, A., Cameron, P., Kelly, A.M., Nelms, R., Curran, C., & Ng, K. (2002). Impact of early intervention on outcome following mild head injury in adults. Journal of Neurology, Neurosurgery, and Psychiatry, 73(3), 330–332.CrossRefGoogle ScholarPubMed
Potter, G.G., Helms, M.J., & Plassman, B.L. (2008). Associations of job demands and intelligence with cognitive performance among men in late life. Neurology, 70(19Pt 2), 1803–1808.CrossRefGoogle ScholarPubMed
Powell, J.W. & Barber-Foss, K.D. (1999). Traumatic brain injury in high school athletes. The Journal of the American Medical Association, 282(10), 958–963.CrossRefGoogle ScholarPubMed
Randolph, C., McCrea, M., & Barr, W.B. (2005). Is neuropsychological testing useful in the medical management of sport-related concussion? Journal of Athletic Training, 40(3), 136–151.Google ScholarPubMed
Schnebel, B., Gwin, J.T., Anderson, S., & Gatlin, R. (2007). In vivo study of head impacts in football: A comparison of National Collegiate Athletic Association Division I versus high school impacts. Neurosurgery, 60(3), 490–495; discussion 495–496.CrossRefGoogle Scholar
Snoek, J.W., Minderhoud, J.M., & Wilmink, J.T. (1984). Delayed deterioration following mild head injury in children. Brain, 107(Pt 1), 15–36.CrossRefGoogle ScholarPubMed
Thurman, D.J., Branche, C.M., & Sniezek, J.E. (1998). The epidemiology of sports-related traumatic brain injuries in the United States: Recent developments. Journal of Head Trauma Rehabilitation, 13(2), 1–8.Google ScholarPubMed
Trahan, D.E., Ross, C.E., & Trahan, S.L. (2001). Relationships among postconcussional-type symptoms, depression, and anxiety in neurologically normal young adults and victims of mild brain injury. Archives of Clinical Neuropsychology, 16(5), 435–445.CrossRefGoogle ScholarPubMed
Wechsler, D. (1997). Wechsler Adult Intelligence Scale (3rd ed.). San Antonio, TX: Psychological Corporation. www.impacttest.com.Google Scholar