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  • Mechanisms of Injury as a Diagnostic Predictor of Sport Related Concussion Severity in Football, Basketball, and Soccer: Results from a Regional Concussion Registry

    Final Number:

    Scott L. Zuckerman MD; Doug Totten; Kolin Rubel; Andrew W Kuhn BS; Aaron M Yengo-Kahn MD; Gary Solomon PhD; Allen K. Sills MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Through a single-institution sport-related concussion (SRC) registry, we sought to: 1) provide a descriptive analysis of mechanisms of SRC in football, basketball, and soccer, and 2) determine if mechanism of injury was associated with symptom duration.

    Methods: A retrospective cohort study was conducted through in-depth patient interviews. Complete data were collected for 295 patients. Mechanisms were stratified into 3 components: a contact mechanism, a player mechanism, and an awareness mechanism. For each sport, each mechanism was compared via one-way Chi-square (?2) analyses. Symptom duration data were represented with Kaplan Meier survival plots and Cox proportional hazards models to estimate the relationship between the exposure (concussion mechanism) to the time variable outcome (days of symptom duration).

    Results: The majority of athletes were male (70%) with an average age of 15.9 (±2.0) years. Football was the most represented sport (51%). The most common contact mechanisms were helmet-to-helmet contact in football (74%), ground/equipment in basketball (40%), and player to head in soccer (33%). Helmet-to-helmet contact was significantly overrepresented in football (?2 = 69.267, df=2, p<0.0001). Within the player mechanism, tackling (33%) and blocking (32%) predominated in football, rebounding (45%) and defense/loose-ball (33%) were most common in basketball, and challenging a player (44%) along with the act of heading (40%) were most commonly reported in soccer. Within the awareness mechanism, basketball (?2 = 8.805, df=1, p=0.003) and soccer (?2 = 11.255, df=1, p=0.0008) players were more likely to be unaware of the oncoming collision. For soccer, being unaware of the oncoming collision was associated with a 2.54 (95% CI 1.14-5.69) times increased risk of not achieving asymptomatic status.

    Conclusions: The current study analyzed mechanisms of SRC via a regional sports concussion outcomes registry. In middle school, high school, and collegiate athletes: (1) a helmet-to-helmet collision was most common football mechanism; (2) ground and surrounding equipment and player elbows predominated in basketball; (3) challenging a player and heading were the most common mechanisms of SRC in soccer; and (4) “awareness” of an oncoming collision in soccer was the only mechanism associated with a decreased the risk of prolonged symptom recovery.

    Patient Care: The conclusions from our study will aid physicians, trainers, and coaches understand the mechanisms most responsible for sports concussions and which ones have a higher chance of long term symptom duration.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) describe the 3 mechanistic ways sports concussions occur, 2) discuss the most common mechanisms seen in football, basketball, and soccer, 3) identify what mecahnisms affect duration of symptoms after sport-related concussion.


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