Publications by authors named "Zachary Y Kerr"

202 Publications

Evaluating Concussion Nondisclosure in College Athletes using a Health Disparities Framework and Appreciation for Social Determinants of Health.

J Athl Train 2021 Jun 15. Epub 2021 Jun 15.

The University of North Carolina at Chapel Hill, Department of Exercise and Sport Science, Assistant Professor, 313 Woollen Gym, CB#8700, Chapel Hill, NC 27599-8700.

Context: There is limited research concerning the relationship between social determinants of health, including race, healthcare access, socioeconomic status (SES), and physical environment; and, concussion nondisclosure in college-athletes. However, in high school athletes, disparities have been noted, with Black athletes attending under-resourced schools and lacking access to an athletic trainer (AT) disclosing fewer concussions.

Objective: To investigate whether concussion nondisclosure disparities exist by 1) race, 2) SES, and 3) AT healthcare access prior to college; and to understand the differential reasons for concussion nondisclosure between Black and White college-athletes.

Design: Cross-sectional Setting: College athletics Participants: 735 college-athletes (84.6% White, 15.4% Black) Main Outcome Measures: Participants completed a questionnaire that directly assessed concussion nondisclosure, including reasons for not reporting a suspected concussion. With the premise of investigating social determinants of health, race was the primary exposure of interest. The outcome of interest, nondisclosure, was assessed with a binary (yes/no) question, "Have you ever sustained a concussion that you did not report to your coach, athletic trainer, parent, teammate, or anyone else?"

Results: Overall, among White and Black athletes 15.6% and 17.7% respectively reported a history of concussion nondisclosure. No significant differences were found by race for distributions of history of concussion nondisclosure (p=0.57). Race was not associated with concussion nondisclosure when evaluated as an effect modification measure or confounder; and, no significant associations were noted by SES or high school AT access. Differences by race for reported reasons for nondisclosure were found for: "At the time I did not think it was a concussion" (p=0.045) and "I thought my teammates would think I am weak" (p=0.03) with Black athletes reporting these more frequently than White athletes.

Conclusions: These data help to contextualize race and its intersection with other social determinants of health that could influence concussion nondisclosure outcomes in college-athletes.
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http://dx.doi.org/10.4085/1062-6050-0054.21DOI Listing
June 2021

Assessing Differences in Concussion Symptom Knowledge and Sources of Information Among Black and White Collegiate-Athletes.

J Head Trauma Rehabil 2021 May-Jun 01;36(3):139-148

Department of Health Science, University of Alabama, Tuscaloosa; Department of Athletic Training, Duquesne University, Pittsburgh, Pennsylvania (Dr Beidler); Department of Exercise and Sport Science, University of North Carolina at Chapel Hill (Drs Kerr and Register-Mihalik); and Department of Kinesiology, Michigan State University, East Lansing (Mss Hibbler and Anderson).

Objective: Basic concussion symptom knowledge is fundamental to concussion identification; however, racial disparities in concussion knowledge exist in high school and youth sports. It is unknown whether similar differences exist in collegiate-athletes. Identifying racial disparities in concussion knowledge and sources of concussion information is essential to inform equitable approaches to knowledge translation and educational interventions. This study examined how Black and White collegiate-athletes differed in their knowledge of concussion symptoms and use of concussion information sources.

Setting: National Collegiate Athletic Association (NCAA) institutions.

Participants: Collegiate-athletes.

Design: Cross-sectional.

Main Measures: Collegiate-athletes completed a questionnaire that assessed personal and sports demographics, concussion symptom knowledge, and use of concussion information sources. Fisher's exact tests and Wilcoxon rank-sum tests examined differences in outcome measures between Black and White collegiate-athletes. A multivariable Poisson regression model examined the association between race and concussion symptom knowledge scores while accounting for sex, sports contact level, NCAA division, concussion history, and specific concussion information sources. Incidence rate ratios (IRRs) with 95% CIs excluding 1.00 were deemed significant.

Results: A total of 768 (82.6% White, 17.4% Black) collegiate-athletes completed the questionnaire. Black athletes were more likely to have lower concussion symptom knowledge scores than White athletes (P < .001). In the multivariable Poisson regression model controlling for covariates, this finding was retained (IRR = 0.97; 95% CI, 0.94-0.997). White athletes were more likely to report school-based professional (P < .001), online medical sources (P = .02), and the NCAA (P = .008) as sources of concussion information. Black athletes were more likely to report referees (P = .03) as a source of concussion knowledge.

Conclusion: Despite NCAA concussion education requirements for athletes, Black collegiate-athletes were found to have lower concussion knowledge than White collegiate-athletes. The findings highlight the need for equitable strategies to disseminate concussion information to diverse populations by improving the physician-patient relationship and investing in culturally appropriate educational materials.
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http://dx.doi.org/10.1097/HTR.0000000000000672DOI Listing
May 2021

Rule Modifications to Reduce Checking-Related Injuries in High School Boys' Lacrosse.

J Athl Train 2021 Apr;56(4):437-445

Injury Prevention Research Center, University of North Carolina at Chapel Hill.

Context: The National Federation of State High School Associations previously implemented 2 lacrosse rule modifications: Rule 5.4 in the 2012-2013 academic year to heighten the penalty for a head or neck hit to the head, face, or neck (HFN) and Rule 5.3.5 in the 2013-2014 academic year to minimize body checking.

Objective: To determine if the rates of overall injury, HFN injuries, and concussions due to intentional contact (checking) differed for boys' high school lacrosse players after Rule 5.4 and 5.3.5 modifications were enacted.

Design: Descriptive epidemiology study.

Setting: Web-based online surveillance system.

Patients Or Other Participants: Boys' high school lacrosse players during the 2008-2009 to 2016-2017 seasons whose teams involved athletic trainers participating in the High School Reporting Information Online sports injury-surveillance system.

Intervention(s): Rule 5.4 in the 2012-2013 academic year increased the penalty for any intentional hits to the HFN, and Rule 5.3.5 in the 2013-2014 year eliminated body checking to a player in a defenseless position.

Main Outcome Measure(s): Overall, HFN, and concussion injury rate ratios (IRRs) by checking mechanism; overall and checking-related injury ratios by competitions and practices.

Results: A decrease was shown in checking-related HFN injuries (IRR = 0.29, 95% CI = 0.13, 0.65) and checking-related concussions (IRR = 0.29, 95% CI = 0.12, 0.70) during practices in the seasons after both rule modifications were imposed, but no decreases occurred in any checking-related injuries during competitions. By injury mechanism, no decreases were evident after the Rule 5.4 modification. When both rule modifications (Rules 5.4 and 5.3.5) were enacted together, concussion rates due to delivering body checks (IRR = 0.51, 95% CI = 0.29, 0.91) and overall injury risk due to being body checked (IRR = 0.72, 95% CI = 0.53, 0.97) decreased.

Conclusions: When both Rule 5.4 and 5.3.5 modifications were in effect, concussion and overall injury risks decreased for the body checker and the player being body checked, respectively.
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http://dx.doi.org/10.4085/1062-6050-0489.19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063663PMC
April 2021

Roundtable on Preseason Heat Safety in Secondary School Athletics: Heat Acclimatization.

J Athl Train 2021 Apr;56(4):352-361

Springville High School, UT.

Objective: To provide best-practice recommendations for developing and implementing heat-acclimatization strategies in secondary school athletics.

Data Sources: An extensive literature review on topics related to heat acclimatization and heat acclimation was conducted by a group of content experts. Using the Delphi method, action-oriented recommendations were developed.

Conclusions: A period of heat acclimatization consisting of ≥14 consecutive days should be implemented at the start of fall preseason training or practices for all secondary school athletes to mitigate the risk of exertional heat illness. The heat-acclimatization guidelines should outline specific actions for secondary school athletics personnel to use, including the duration of training, the number of training sessions permitted per day, and adequate rest periods in a cool environment. Further, these guidelines should include sport-specific and athlete-specific recommendations, such as phasing in protective equipment and reintroducing heat acclimatization after periods of inactivity. Heat-acclimatization guidelines should be clearly detailed in the secondary school's policy and procedures manual and disseminated to all stakeholders. Heat-acclimatization guidelines, when used in conjunction with current best practices surrounding the prevention, management, and care of secondary school student-athletes with exertional heat stroke, will optimize their health and safety.
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http://dx.doi.org/10.4085/1062-6050-596-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063667PMC
April 2021

Preseason Cerebrovascular Function in Adolescent Athletes.

Ann Biomed Eng 2021 Mar 22. Epub 2021 Mar 22.

Matthew Gfeller Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, 2207 Stallings Evans Sports Medicine Complex, Campus Box 8700, Chapel Hill, NC, 27599, USA.

The purpose of this study was to investigate the effects of sport participation, concussion history, and age of first exposure to football on preseason cerebrovascular function in adolescent athletes. Athletes (n = 53, age = 15.8 ± 1.2 years) were examined based on three exposure groupings: (1) sport participation (football vs. non-collision), (2) concussion history (none vs. ≥ 1), and (3) age of first exposure (football participants only). Transcranial Doppler assessed cerebrovascular reactivity (CVR) and neurovascular coupling (NVC), and separate independent samples t-tests evaluated group differences in CVR and NVC outcomes. Separate univariate linear regressions determined how age of first exposure related to CVR and NVC outcomes. Linear mixed effects models assessed group differences in CVR and NVC relative response curves. Differential response to NVC visual task response was significantly greater in non-collision sport athletes (F = 38.69, p < 0.0001) and athletes without a concussion history (F = 25.23, p < 0.0001). Older age of first exposure significantly predicted reduced breath-holding CVR response (F = 2.92, p = 0.03). Healthy adolescent athletes have similar pre-season cerebrovascular function despite different sport participation and concussion history. However, age of first exposure may predict CVR in adolescent football athletes. Developmental literature identifies cerebrovascular function as dynamically changing throughout adolescence. Our study provides fundamental data informing the clinical meaningfulness of short- and long-term physiological function changes.
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http://dx.doi.org/10.1007/s10439-021-02764-5DOI Listing
March 2021

Strategies for engaging "multiple disciplinary" teams in sport- and exercise-related research.

J Sci Med Sport 2021 Mar 10. Epub 2021 Mar 10.

School of Medical and Health Sciences, Edith Cowan University, Australia.

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http://dx.doi.org/10.1016/j.jsams.2021.03.002DOI Listing
March 2021

Association Between Previous Concussion Education and Concussion Care-Seeking Outcomes Among National Collegiate Athletic Association Division I Student-Athletes.

J Athl Train 2021 Feb 22. Epub 2021 Feb 22.

Keller Army Community Hospital, West Point, NY.

Context: Limited data exist concerning differences in concussion-education exposure and how education exposures relate to care seeking and symptom disclosure, specifically by National Collegiate Athletic Association Division I student-athletes.

Objective: To investigate demographic characteristics associated with concussion-education exposure and examine whether overall education exposure (yes versus no) and education-source exposure number (multiple sources versus a single source) affect concussion care-seeking and disclosure factors in Division I student-athletes.

Design: Cross-sectional study.

Setting: Classroom or online survey.

Patients Or Other Participants: Division I student-athletes (n = 341).

Main Outcome Measure(s): Frequencies and proportions were computed for sex, race, school year, sport, and concussion history across concussion-education groups. Prevalence ratios (PRs) and 95% CIs were calculated to quantify the associations between student-athlete characteristics and (1) overall concussion-education exposure and (2) source-exposure number. Separate multivariable linear regression models estimated adjusted mean differences (MDs) and 95% CIs, which allowed us to assess differences in concussion knowledge, attitudes, and perceived social norms relative to concussion-education exposure and exposure to multiple sources. Separate multivariable binomial regression models were performed to estimate adjusted PRs and 95% CIs in order to evaluate associations of intention, perceived control, and care-seeking or disclosure behaviors and overall concussion-education exposure and exposure to multiple sources. All models controlled for sex, sport, and concussion history.

Results: Overall, 276 (80.9%) participants reported previous concussion education, with 179 (64.9%) being exposed to multiple sources. Student-athletes who participated in a contact sport (adjusted PR = 1.24; 95% CI = 1.06, 1.44) and those who had a concussion history (adjusted PR = 1.19; 95% CI = 1.09, 1.31) had higher prevalences of concussion-education exposure. Females had a lower prevalence of reporting multiple sources (adjusted PR = 0.82; 95% CI = 0.68, 0.99). Overall concussion-education exposure was significantly associated with more favorable perceived social norms surrounding concussion care seeking (adjusted MD = 1.37; 95% CI = 0.13, 2.61).

Conclusions: These findings highlighted the potential differences in overall concussion-education exposure and provide clinicians with information on groups who may benefit from additional targeted education.
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http://dx.doi.org/10.4085/1062-6050-0211.20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010936PMC
February 2021

Disparate Associations of Years of Football Participation and a Metric of Head Impact Exposure with Neurobehavioral Outcomes in Former Collegiate Football Players.

J Int Neuropsychol Soc 2021 Feb 10:1-13. Epub 2021 Feb 10.

Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.

Objectives: Years of sport participation (YoP) is conventionally used to estimate cumulative repetitive head impacts (RHI) experienced by contact sport athletes. The relationship of this measure to other estimates of head impact exposure and the potential associations of these measures with neurobehavioral functioning are unknown. We investigated the association between YoP and the Head Impact Exposure Estimate (HIEE), and whether associations between the two estimates of exposure and neurobehavioral functioning varied.

Methods: Former American football players (N = 58; age = 37.9 ± 1.5 years) completed in-person evaluations approximately 15 years following sport discontinuation. Assessments consisted of neuropsychological assessment and structured interviews of head impact history (i.e., HIEE). General linear models were fit to test the association between YoP and the HIEE, and their associations with neurobehavioral outcomes.

Results: YoP was weakly correlated with the HIEE, p = .005, R2 = .13. Higher YoP was associated with worse performance on the Symbol Digit Modalities Test, p = .004, R2 = .14, and Trail Making Test-B, p = .001, R2 = .18. The HIEE was associated with worse performance on the Delayed Recall trial of the Hopkins Verbal Learning Test-Revised, p = .020, R2 = .09, self-reported cognitive difficulties (Neuro-QoL Cognitive Function), p = .011, R2 = .10, psychological distress (Brief Symptom Inventory-18), p = .018, R2 = .10, and behavioral regulation (Behavior Rating Inventory of Executive Function for Adults), p = .017, R2 = .10.

Conclusions: YoP was marginally associated with the HIEE, a comprehensive estimate of head impacts sustained over a career. Associations between each exposure estimate and neurobehavioral functioning outcomes differed. Findings have meaningful implications for efforts to accurately quantify the risk of adverse long-term neurobehavioral outcomes potentially associated with RHI.
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http://dx.doi.org/10.1017/S1355617721000047DOI Listing
February 2021

Exertional heat illness risk factors and physiological responses of youth football players.

J Sport Health Sci 2021 01 7;10(1):91-98. Epub 2019 Mar 7.

Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC 27599-8700, USA.

Objective: To determine which intrinsic and extrinsic exertional heat illness (EHI) risk factors exist in youth American football players and observe perceptual and physiological responses of players during events (games and practices).

Methods: Cross-sectional cohort study observing 63 youth football players, varying in position. Independent variables were league (weight-restricted (WR, n = 27) and age-restricted (AR, n = 36)) and event type. Dependent variables were anthropometrics, work-to-rest ratio, and wet bulb globe temperature. Descriptive variables included preparticipation examination and uniform configuration. A subset of 16 players participated in physiological variables (heart rate and gastrointestinal temperature). Data collection occurred on 7 AR and 8 WR nonconsecutive practices and the first 3 games of the season.

Results: Mean values for anthropometric variables were higher (p < 0.05) in the AR league than the WR league. Work time (χ (1,111) = 4.232; p = 0.039) and rest time (χ (1,111) = 43.41; p < 0.001) were significantly greater for games, but ratios were significantly higher for practices (χ (1,111) = 40.62; p < 0.001). The majority of events (77%) observed were in black and red flag wet bulb globe temperature risk categories. A total of 57% of the players had a preparticipation examination, and up to 82% of events observed were in full uniforms. Individual gastrointestinal temperature and heart rate responses ranged widely and no players reached critical thresholds.

Conclusion: Extrinsic (disproportionate work ratios, environmental conditions) and intrinsic (higher body mass index) EHI risk factors exist in youth football. Certain risk factors may be influenced by event and league type. National youth football organizations need to create thorough guidelines that address EHI risk factors for local leagues to adopt.
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http://dx.doi.org/10.1016/j.jshs.2019.03.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7856561PMC
January 2021

Estimating local arterial stiffness using mixed-effects model-based residuals: a novel approach.

Hypertens Res 2021 Jun 28;44(6):727-729. Epub 2021 Jan 28.

Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

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http://dx.doi.org/10.1038/s41440-021-00616-2DOI Listing
June 2021

Musculoskeletal Injury History Is Associated With Lower Physical and Mental Health in a Historical Cohort of Former National Football League Players.

J Sport Rehabil 2021 Jan 25;30(5):760-767. Epub 2021 Jan 25.

Context: Little research has examined health-related quality of life in former National Football League (NFL) players.

Objective: Examine the association of musculoskeletal injury history and current self-reported physical and mental health in former NFL players.

Setting: Cross-sectional questionnaire.

Patients Or Other Participants: Historical cohort of 2,103 former NFL players that played at least one season between 1940 and 2001.

Intervention: Players were grouped by self-reported professional career musculoskeletal injury history and whether injuries affected current health: (1) no musculoskeletal injury history; (2) musculoskeletal injury history, currently affected by injuries; and (3) musculoskeletal injury history, not currently affected by injuries.

Main Outcome Measure: The Short Form 36 Measurement Model for Functional Assessment of Health and Well-Being (SF-36) yielded physical and mental health composite scores (PCS and MCS, respectively); higher scores indicated better health. Multivariable linear regression computed mean differences (MD) among injury groups. Covariates included demographics, playing history characteristics, surgical intervention for musculoskeletal injuries, and whether injury resulted in premature end to career. MD with 95% CI excluding 0.00 were deemed significant.

Results: Overall, 90.3% reported at least one musculoskeletal injury during their professional football careers, of which 74.8% reported being affected by their injuries at time of survey completion. Adjusting for covariates, mean PCS in the "injury and affected" group was lower than the "no injury" (MD = -3.2; 95% CI: -4.8, -1.7) and "injury and not affected" groups (MD = -4.3; 95% CI: -5.4, -3.3); mean MCS did not differ.

Conclusion: Many players reported musculoskeletal injuries, highlighting the need for developing and evaluating injury management interventions.
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http://dx.doi.org/10.1123/jsr.2020-0231DOI Listing
January 2021

Health-promoting behaviours and concussion history are associated with cognitive function, mood-related symptoms and emotional-behavioural dyscontrol in former NFL players: an NFL-LONG Study.

Br J Sports Med 2021 Jun 4;55(12):683-690. Epub 2021 Jan 4.

Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Objectives: To examine the relationships among self-reported sport-related concussion (SRC) history and current health-promoting behaviours (exercise frequency, diet quality and sleep duration) with self-reported measures of brain health (cognitive function, symptoms of depression and anxiety and emotional-behavioural dyscontrol) in former NFL players.

Methods: In this cross-sectional study, a questionnaire was sent to former NFL players. Respondents reported SRC history (categorical: 0; 1-2; 3-5; 6-9; 10+ concussions), number of moderate-to-vigorous aerobic and resistance exercise sessions per week, diet quality (Rapid Eating Assessment for Participants-Shortened) and average nightly sleep duration. Outcomes were Patient-Reported Outcomes Measurement Information System Cognitive Function, Depression, and Anxiety, and Neuro-QoL Emotional-Behavioral Dyscontrol domain T-scores. Multivariable linear regression models were fit for each outcome with SRC history, exercise frequency, diet quality and sleep duration as explanatory variables alongside select covariates.

Results: Multivariable regression models (n=1784) explained approximately 33%-38% of the variance in each outcome. For all outcomes, SRC history (0.144≤|β|≤0.217) was associated with poorer functioning, while exercise frequency (0.064≤|β|≤0.088) and diet quality (0.057≤|β|≤0.086) were associated with better functioning. Sleeping under 6 hours per night (0.061≤|β|≤0.093) was associated with worse depressive symptoms, anxiety and emotional-behavioural dyscontrol.

Conclusion: Several variables appear to be associated with mood and perceived cognitive function in former NFL players. SRC history is non-modifiable in former athletes; however, the effects of increasing postplaying career exercise frequency, making dietary improvements, and obtaining adequate sleep represent important potential opportunities for preventative and therapeutic interventions.
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http://dx.doi.org/10.1136/bjsports-2020-103400DOI Listing
June 2021

Barriers and facilitators faced by athletic trainers implementing NATA-IATF preseason heat-acclimatization guidelines in United States high school football.

J Athl Train 2020 Nov 5. Epub 2020 Nov 5.

2. Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Context: The National Athletic Trainers' Association Inter-Association Task Force (NATA-IATF) preseason heat acclimatization guidelines aim to acclimatize high school athletes to the environment during the first two weeks of the preseason and reduce risk of exertional heat illness.

Objective: Identify barriers and facilitators that high school athletic trainers encountered when implementing NATA-IATF guidelines.

Design: This qualitative investigation included a consensual qualitative research tradition/framework based in phenomenology and grounded theory.

Setting: Individual phone interviews with all participants.

Patients Or Other Participants: 33 athletic trainers (16 males, 17 females; age=36.0±12.0 years; athletic training experience=12.9±10.5 years) representing 19 states (4 with state mandate) were interviewed, achieving saturation. Participants were purposefully sampled from a larger investigation based on stratification of US Census region and pre-identified high school compliance with NATA-IATF guidelines.

Interventions: A cross-sectional semi-structured phone interview (6 steps) was conducted with each participant and then transcribed verbatim.

Main Outcome Measures: A 7-person research team (5 coders, 2 auditors) coded the data into themes and categories focusing on consensus of data placement to reduce bias and ensure accuracy.

Results: This manuscript focused on facilitators and barriers (theme) that influence successful guideline implementation. Categories included: 1) perceived stakeholder access, 2) perceived stakeholder role, 3) capability and capacity, 4) school culture, 5) logistical support, 6) resources, 7) physical environment, and 8) consistency of guidelines. Overall, participants discussed facilitators and barriers within each category dependent on their experiences and circumstance.

Conclusions: Athletic trainers face numerous issues when addressing compliance with NATA-IATF guidelines. Multiple levels of influence should be targeted to improve implementation. These factors include: intrapersonal, through giving athletic trainers the education and self-efficacy to support advocacy of implementation; interpersonal, through establishing strong collaborative networks for change; community/environmental, through optimizing school culture and community resources for implementation; and policy through establishing consistent guidelines across all bodies.
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http://dx.doi.org/10.4085/321-20DOI Listing
November 2020

Association Between Previous Concussion Education and Concussion Care-Seeking Outcomes among NCAA Division I Student-Athletes.

J Athl Train 2020 Nov 5. Epub 2020 Nov 5.

1. Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Context: There are limited data concerning differences in concussion education exposure and how education exposures relates to care-seeking and symptom disclosure, specifically in Division I student-athletes.

Objective: Investigate demographic characteristics associated with concussion education exposure and examine whether overall education exposure (yes vs. no) and education source exposure number (multiple sources vs. single source) affects concussion care-seeking and disclosure factors in Division I student-athletes.

Design: Cross-sectional survey.

Setting: Classroom or online.

Participants: NCAA Division I student-athletes (n=341).

Main Outcome Measure(s): Frequencies and proportions were computed for sex, race, school year, sport, and concussion history across concussion education groups. Prevalence ratios (PR) and 95% confidence intervals (CI) quantified the association between student-athlete characteristics and 1) overall concussion education exposure and 2) source exposure number. Separate multivariable linear regression models estimated adjusted mean differences (MD) and 95%CI to assess differences in concussion knowledge, attitudes, and perceived social norms relative to concussion education exposure and exposure to multiple sources. Separate multivariable binomial regression models estimated adjusted PRs and 95%CI to assess associations of intention, perceived control, and care-seeking/disclosure behaviors and overall concussion education exposure and exposure to multiple sources. All models controlled for sex, sport, and concussion history.

Results: Overall, n=276 (80.9%) reported previous concussion education, with 179 (64.9%) exposed to multiple sources. Student-athletes that participated in a contact sport (adjusted PR=1.24, 95%CI=1.06,1.44) and those who had a concussion history (adjusted PR=1.19, 95%CI=1.09,1.31) had higher prevalence of previous concussion education exposure. Females had a lower prevalence of reporting multiple sources (adjusted PR=0.82, 95%CI=0.68, 0.99). Overall concussion education exposure was significantly associated with more favorable perceived social norms surrounding concussion care-seeking (adjusted MD=1.37, 95%CI=0.13,2.61).

Conclusions: Findings highlight potential differences in overall concussion education exposure and provide clinicians with information on groups who may benefit from targeted additional education.
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http://dx.doi.org/10.4085/211-20DOI Listing
November 2020

Universal Healthcare in the United States of America: A Healthy Debate.

Medicina (Kaunas) 2020 Oct 30;56(11). Epub 2020 Oct 30.

Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

This commentary offers discussion on the pros and cons of universal healthcare in the United States. Disadvantages of universal healthcare include significant upfront costs and logistical challenges. On the other hand, universal healthcare may lead to a healthier populace, and thus, in the long-term, help to mitigate the economic costs of an unhealthy nation. In particular, substantial health disparities exist in the United States, with low socio-economic status segments of the population subject to decreased access to quality healthcare and increased risk of non-communicable chronic conditions such as obesity and type II diabetes, among other determinants of poor health. While the implementation of universal healthcare would be complicated and challenging, we argue that shifting from a market-based system to a universal healthcare system is necessary. Universal healthcare will better facilitate and encourage sustainable, preventive health practices and be more advantageous for the long-term public health and economy of the United States.
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http://dx.doi.org/10.3390/medicina56110580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692272PMC
October 2020

Targeting sedentary behavior as a feasible health strategy during COVID-19.

Transl Behav Med 2021 04;11(3):826-831

Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Sedentary behavior is associated with poor physical and mental health. Targeting sedentary behavior is a simple strategy that may help counter physical and mental health concerns associated with COVID-19-related social restrictions. Of course, traditional strategies such as achieving optimal exercise and physical activity levels are also important and should be recommended. However, even under normal circumstances, the difficulty in promoting lasting exercise habits at multiple levels (e.g. individual, environment, policy) are well documented, and chances of maintaining or improving these factors is now even lower. Thus, relative to other lifestyle behaviors - sedentary behavior may be more amenable to change. Moreover, reducing sedentary behavior may be less susceptible to influence from factors associated with health disparities such as age, race, and socio-economic status compared to exercise or physical activity. Sedentary behavior is a feasible health strategy that should be targeted during COVID-19.
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http://dx.doi.org/10.1093/tbm/ibaa101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7665775PMC
April 2021

Repetitive Head Impact Exposure and Cerebrovascular Function in Adolescent Athletes.

J Neurotrauma 2021 Apr 23;38(7):837-847. Epub 2020 Nov 23.

Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

The purpose of this study was to determine how subconcussive head impact exposure in high school collision sport student-athletes influenced cerebrovascular function. Transcranial Doppler was used to assess pre- to post-season changes in: (1) resting middle (MCA) and posterior cerebral arteries (PCA), (2) cerebrovascular reactivity (CVR) via breath-holding index (BHI), vasomotor reactivity response (VMRr) and overall MCA response curve, and (3) neurovascular coupling (NVC) via NVC response magnitude and overall PCA response curve. Fifty-three high school-aged athletes (age = 15.8 ± 1.2years, height = 175.8 ± 8.1cm, mass = 69.4 ± 13.5kg) were recruited into two groups (collision vs. non-collision sport). All participants completed a pre-season cerebrovascular function assessment. Following a 4- to 5-month window (118.6 ± 12.2 days), 48 athletes from the original sample (age = 16.0 ± 1.2 years, height = 175.5 ± 8.1 cm, mass = 68.6 ± 4.0 kg) repeated the cerebrovascular assessment. There were no group differences in any cerebrovascular measures at pre-season testing ( > 0.05). At post-season testing, collision sport athletes demonstrated greater positive change in BHI (t = -2.21,  = 0.03) while non-collision sport athletes demonstrated greater negative change in the NVC response magnitude to the reading task (t = 1.98,  = 0.048), and lower overall PCA response curve to the reading task ( = 101.54,  < 0.001). All other pre- to post-season change values were non-significant ( > 0.05). Our data indicate that single-season changes in cerebrovascular outcomes may differ between collision and non-collision sport athletes. Although the clinical interpretation is still unclear, our study demonstrates that CVR and NVC assessments may be sensitive to the dynamic cerebrovascular changes occurring in adolescent athletes. Future research should continue to assess these outcomes following both subconcussive head impact exposure and throughout the recovery trajectory following concussion.
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http://dx.doi.org/10.1089/neu.2020.7350DOI Listing
April 2021

Concussion Knowledge, Attitudes, and Self-Reporting Intentions in Youth Athletes.

J Athl Train 2020 Oct;55(10):1027-1034

Department of Exercise Science, University of South Carolina, Columbia.

Context: Although it has been suggested that developmental and sociological factors play a role in concussion reporting, the empirical evidence related to this is limited.

Objective: To examine the influences of sex, school level, school location, concussion-reporting history, and socioeconomic status on concussion-related knowledge, attitudes, and reporting intentions among middle school and high school athletes.

Design: Cross-sectional study.

Setting: Master students and High School athletes attending pre-participation examinations (PPEs) were asked to complete paper-based surveys.

Patients Or Other Participants: Overall, 541 athletes representing 18 sports returned fully completed surveys.

Main Outcome Measure(s): Outcomes were concussion-related knowledge, perceived seriousness, positive feelings about reporting, and self-reporting intentions. We examined group differences in these outcomes across levels of the explanatory variables of sex, school level (middle school versus high school), school location (urban versus rural), concussion self-reporting history (yes or no), and socioeconomic status (free or reduced-price lunch versus no free or reduced-price lunch) using Wilcoxon rank sum tests. Then we used multivariable ordinal logistic regression models to identify predictors of higher score levels for each outcome. Odds ratio (OR) estimates with 95% confidence intervals (CIs) excluding 1.00 were deemed significant.

Results: Odds of higher levels of knowledge were higher in urban versus rural school student-athletes (ORAdjusted = 1.81; 95% CI = 1.03, 3.17), and lower in student-athletes on free or reduced-price lunch versus those not on free or reduced-price lunch (ORAdjusted = 0.52; 95% CI = 0.36, 0.77). Similarly, odds of higher levels of seriousness were lower in male versus female student-athletes (ORAdjusted = 0.48; 95% CI = 0.32, 0.72). Further, odds of higher levels of self-reporting intentions were lower among male versus female student-athletes (ORAdjusted = 0.53; 95% CI = 0.37, 0.75).

Conclusions: Developmental and sociological factors were differentially associated with concussion-related knowledge, attitudes, and self-reporting intentions. These results can inform medical providers, parents, and coaches with regard to context-specific clinical assessments of concussion symptoms.
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http://dx.doi.org/10.4085/1062-6050-232-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594602PMC
October 2020

Exertional Heat Illness Preparedness Strategies: Environmental Monitoring Policies in United States High Schools.

Medicina (Kaunas) 2020 Sep 23;56(10). Epub 2020 Sep 23.

Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA.

Environmental monitoring allows for an analysis of the ambient conditions affecting a physically active person's ability to thermoregulate and can be used to assess exertional heat illness risk. Using public health models such as the precaution adoption process model (PAPM) can help identify individual's readiness to act to adopt environmental monitoring policies for the safety of high school athletes. The purpose of this study was to investigate the adoption of policies and procedures used for monitoring and modifying activity in the heat in United States (US) high schools. Using a cross-sectional design, we distributed an online questionnaire to athletic trainers (ATs) working in high schools in the US. The questionnaire was developed based on best practice standards related to environmental monitoring and modification of activity in the heat as outlined in the 2015 National Athletic Trainers' Association Position Statement: Exertional Heat Illness. The PAPM was used to frame questions as it allows for the identification of ATs' readiness to act. PAPM includes eight stages: and Invitations were sent via email and social media and resulted in 529 complete responses. Data were aggregated and presented as proportions. Overall, 161 (161/529, 30.4%) ATs report they do not have a written policy and procedure for the prevention and management of exertional heat stroke. The policy component with the highest adoption was modifying the use of protective equipment (acting = 8.2%, maintaining = 77.5%). In addition, 28% of ATs report adoption of all seven components for a comprehensive environmental monitoring policy. These findings indicate a lack of adoption of environmental monitoring policies in US high schools. Secondarily, the PAPM, facilitators and barriers data highlight areas to focus future efforts to enhance adoption.
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http://dx.doi.org/10.3390/medicina56100486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7597963PMC
September 2020

Exertional Heat-Stroke Management Practices and Intentions Among Secondary School Football Athletic Trainers.

J Athl Train 2020 Oct;55(10):1081-1088

Department of Exercise and Sport Science, University of North Carolina at Chapel Hill.

Context: Athletic trainers (ATs) are educated and trained in appropriate exertional heat-stroke (EHS) management strategies, yet disparities may exist between intended and actual uses in clinical practice.

Objective: To examine the intended and actual uses of EHS management strategies among those who did and those who did not treat patients with suspected cases of EHS during the 2017 high school (HS) American football preseason.

Design: Cross-sectional study.

Setting: Online questionnaire.

Patients Or Other Participants: A total of 1016 ATs who oversaw patient care during the 2017 HS American football preseason.

Main Outcome Measure(s): Responding HS ATs recorded whether they had or had not managed patients with suspected EHS events during the 2017 HS American football preseason. Those who had managed patients with suspected cases of EHS reported the management strategies used; those who had not managed such patients described their intended management strategies. For each management strategy, z tests compared the proportions of actual use among ATs who managed patients with suspected EHS with the proportions of intended use among ATs who did not manage such patients.

Results: Overall, 124 (12.2%) ATs treated patients with suspected EHS cases during the 2017 HS American football preseason. Generally, the proportions of intended use of management strategies among ATs who did not treat patients with suspected EHS were higher than the actual use of those strategies among ATs who did. For example, ATs who did treat patients with suspected EHS were more likely than those who did not treat such patients to intend to take rectal temperature (19.6% versus 3.2%, P < .001) and immerse the athlete in ice water (90.1% versus 51.6%, P < .001).

Conclusions: Inconsistencies occurred between intended and actual use of EHS management strategies. The standard of care for managing patients with suspected cases of EHS was not consistently used in clinical practice, although ATs who did not treat EHS stated they intended to use these management strategies more frequently. Future researchers should identify factors that preclude ATs from using the standard of care when treating patients with suspected cases of EHS.
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http://dx.doi.org/10.4085/1062-6050-474-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594601PMC
October 2020

COVID-19 Impact on Behaviors across the 24-Hour Day in Children and Adolescents: Physical Activity, Sedentary Behavior, and Sleep.

Children (Basel) 2020 Sep 16;7(9). Epub 2020 Sep 16.

Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

In the wake of the COVID-19 pandemic, social restrictions to contain the spread of the virus have disrupted behaviors across the 24-h day including physical activity, sedentary behavior, and sleep among children (5-12 years old) and adolescents (13-17 years old). Preliminary evidence reports significant decreases in physical activity, increases in sedentary behavior, and disrupted sleep schedules/sleep quality in children and adolescents. This commentary discusses the impact of COVID-19-related restrictions on behaviors across the 24-h day in children and adolescents. Furthermore, we suggest recommendations through the lens of a socio-ecological model to provide strategies for lasting behavior change to insure the health and well-being of children and adolescents during the COVID-19 pandemic.
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http://dx.doi.org/10.3390/children7090138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7552759PMC
September 2020

Factors associated with concussion-symptom knowledge and attitudes toward concussion care seeking in a national survey of parents of middle-school children in the US.

J Sport Health Sci 2021 03 10;10(2):113-121. Epub 2020 Sep 10.

Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, NC 27599-8700, USA; Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27510, USA.

Background: Developing appropriate concussion prevention and management paradigms in middle school (MS) settings requires understanding parents' general levels of concussion-related knowledge and attitudes. This study examined factors associated with concussion-symptom knowledge and care-seeking attitudes among parents of MS children (aged 10-15 years).

Methods: A panel of 1224 randomly selected U.S. residents, aged ≥ 18 years and identifying as parents of MS children, completed an online questionnaire capturing parental and child characteristics. The parents' concussion-symptom knowledge was measured using 25 questions, with possible answers being "yes", "maybe", and "no". Correct answers earned 2 points, "maybe" answers earned 1 point, and incorrect answers earned 0 point (range: 0-50; higher scores = better knowledge). Concussion care-seeking attitudes were also collected using five 7-point scale items (range: 5-35; higher scores = more positive attitudes). Multivariable ordinal logistic regression models identified predictors of higher scores. Models met proportional odds assumptions. Adjusted odds ratios (aORs) with 95% confidence intervals (95%CIs) (excluding 1.00) were deemed statistically significant.

Results: Median scores were 39 (interquartile range: 32-44) for symptom knowledge and 32 (interquartile range: 28-35) for care-seeking attitude. In multivariable models, odds of better symptom knowledge were higher in women vs. men (aOR = 2.28; 95%CI: 1.71-3.05), white/non-Hispanics vs. other racial or ethnic groups (aOR = 1.88; 95%CI: 1.42-2.49), higher parental age (10-year-increase aOR = 1.47; 95%CI: 1.26-1.71), and greater competitiveness (10%-scale-increase aOR = 1.24; 95%CI: 1.13-1.36). Odds of more positive care-seeking attitudes were higher in white/non-Hispanics vs. other racial or ethnic groups (aOR = 1.45; 95%CI: 1.06-1.99) and in older parental age (10-year-increase aOR = 1.24; 95%CI: 1.05-1.47).

Conclusion: Characteristics of middle school children's parents (e.g., sex, race or ethnicity, age) are associated with their concussion-symptom knowledge and care-seeking attitudes. Parents' variations in concussion knowledge and attitudes warrant tailored concussion education and prevention.
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http://dx.doi.org/10.1016/j.jshs.2020.09.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987565PMC
March 2021

Influence of State-Level Emergency Planning Policy Requirements on Secondary School Adoption.

J Athl Train 2020 Oct;55(10):1062-1069

Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, CT.

Context: Emergency action plans (EAPs) are a critical component in the management of catastrophic sport-related injury. Some state high school athletics associations and state legislation have required that schools develop EAPs, but little research exists on the influence of a statewide policy requirement on local adoption of these policies.

Objective: To examine the efficacy of a statewide policy requirement on local adoption of an EAP.

Design: Cross-sectional study.

Setting: Online questionnaire.

Patients Or Other Participants: Secondary school athletic trainers were invited to complete a survey (n = 9642); 1136 completed the survey, yielding an 11.7% response rate.

Main Outcome Measure(s): Survey responses on the adoption of EAPs along with cardiopulmonary resuscitation and automated external defibrillator (CPR/AED) requirements were cross-referenced with published statewide policies to determine the prevalence of EAP adoption. We evaluated the adoption of emergency action plan components based on the National Athletic Trainers' Association's emergency planning position statement along with CPR/AED requirements to determine component-specific prevalence. We compared the prevalence of EAP and component adoption between states that required EAPs and specific components of EAPs and states without such requirements.

Results: Athletic trainers in states that required adoption of an EAP reported including more components of the emergency planning position statement (mean = 8 ± 4, median = 9) than in states without a requirement (mean = 7 ± 4, median = 8). The adoption of EAP components did not differ between states that required specific components of the EAP versus development of the EAP only. However, schools in states with both EAP and CPR/AED training requirements reported higher rates of CPR/AED training implementation (95.5%) than states that only required CPR/AED training (81.6%, prevalence ratio = 1.10, 95% confidence interval = 1.01, 1.20).

Conclusions: Based on these data, statewide policy requirements for the development of an EAP may be associated with increasing adoption of EAPs.
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http://dx.doi.org/10.4085/1062-6050-118-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594600PMC
October 2020

Approaching community priorities in youth sports injury prevention research.

Inj Epidemiol 2020 Jul 6;7(1):35. Epub 2020 Jul 6.

Department of Exercise and Sport Science, Injury Prevention Research Center, University of North Carolina, 125 Fetzer Hall CB#8700, Chapel Hill, NC, 27599-8700, USA.

Background: Research in youth sports is often complex. As interest in youth sports injury prevention grows, scientists should consider community priorities beyond a specific research study.

Main Text: This commentary discusses the authors' personal experiences researching concussion prevention in middle school sports, as the overarching community faced multiple challenges. These challenges included a series of weather-related emergencies that resulted in a shift in the community's priorities, multi-day school closures, and cancellations of sports activities and meetings. We discuss the importance of considering community priorities and providing support as scientists, colleagues, and members of the communities in which we conduct research.

Conclusion: Scientists should consider the changing circumstances and dynamics surrounding community priorities in order to help drive their research-based decisions and ensure successful and respectful applications of research based on community values and priorities.
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http://dx.doi.org/10.1186/s40621-020-00261-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335636PMC
July 2020

Benefits of team sport participation versus concerns of chronic traumatic encephalopathy: prioritizing the health of our youth.

Concussion 2020 May 14;5(2):CNC75. Epub 2020 May 14.

Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27154, USA.

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http://dx.doi.org/10.2217/cnc-2020-0006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270841PMC
May 2020

Use of sport-related concussion information sources among parents of United States middle school children.

J Sport Health Sci 2020 May 14. Epub 2020 May 14.

Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, NC 27599-8700, USA; Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27510, USA.

Objective: Parents may use various information sources to obtain information about sport-related concussions (SRC). This study examined SRC-related information sources used by parents of United States middle school children (age: 10-15 years).

Methods: A panel of 1083 randomly selected U.S. residents, aged ≥18 years and identifying as parents of middle school children, completed an online questionnaire capturing parental and child characteristics, and utilization and perceived trustworthiness of various sources of SRC-related information. Multivariable logistic regression models identified factors associated with utilizing each source. Adjusted odds ratios (OR) with 95% confidence intervals (CIs) excluding 1.00 were deemed significant.

Results: Doctors/healthcare providers (49.9%) and other healthcare-related resources (e.g., Centers for Disease Control and Prevention, WebMD) (37.8%) were common SRC-related information sources; 64.0% of parents utilized ≥1 of these sources. Both sources were considered "very" or "extremely" trustworthy for SRC-related information among parents using these sources (doctors/healthcare providers: 89.8%; other healthcare-related resources: 70.9%). A 10-year increase in parental age was associated with higher odds of utilizing doctors/healthcare providers (adjusted odd ratio (OR) = 1.09, 95%CI: 1.02-1.16) and other healthcare-related resources (OR = 1.11, 95%CI: 1.03-1.19). The odds of utilizing doctors/healthcare providers (OR = 0.58, 95%CI: 0.40-0.84) and other healthcare-related resources (OR = 0.64, 95%CI: 0.44-0.93) were lower among parents whose middle school children had concussion histories versus the parents of children who did not have concussion histories.

Conclusion: One-third of parents did not report using doctors/healthcare providers or other healthcare-related resources for SRC-related information. Factors associated with underutilization of these sources may be targets for future intervention. Continuing education for healthcare providers and educational opportunities for parents should highlight accurate and up-to-date SRC-related information.
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http://dx.doi.org/10.1016/j.jshs.2020.04.008DOI Listing
May 2020

Sports Medicine Staffing Patterns and Incidence of Injury in Collegiate Men's Ice Hockey.

J Athl Train 2020 Jun;55(6):587-593

Division of Sports Medicine, Sports Concussion Clinic, Boston Children's Hospital, MA.

Context: The relative availability of clinicians as well as the types and training of health care providers have been associated with morbidity and mortality in non-athletic health care settings. Whether staffing variations are associated with injury incidence in collegiate athletes is unknown.

Objective: To evaluate whether the institutional ratio of athletes to athletic trainers (patient load) or the ratio of staff to nonstaff (graduate assistant and certified intern) athletic trainers or both is associated with the incidence of injuries sustained by male ice hockey athletes at the school.

Design: Descriptive epidemiology study.

Setting: National Collegiate Athletic Association (NCAA) men's ice hockey teams.

Patients Or Other Participants: Collegiate men's ice hockey athletes.

Main Outcome Measure(s): The NCAA Injury Surveillance Program collected data from collegiate men's ice hockey athletes. Staffing patterns were obtained through telephone interviews. Injury counts, injury rates per 1000 athlete-exposures, and injury rate ratios with 95% confidence intervals were calculated and compared between the following groups: (1) schools with high (versus low) patient load and (2) schools with high (versus low) ratio of staff to nonstaff (graduate assistant and certified intern) athletic trainers.

Results: Both the patient load and relative number of staff athletic trainers were associated with variations in the incidences and types of diagnosed injuries in male ice hockey players. Specifically, fewer injuries were diagnosed by clinicians at institutions with high patient loads. The rates of injury overall and non-time-loss injuries were lower in the high patient-load group. Time-loss injury rates, severe injury rates, concussion rates, and overall rates of injury during competition were greater in the group with a higher proportion of staff athletic trainers, whereas non-time-loss injury rates were lower.

Conclusions: In this study of collegiate men's ice hockey players, athlete health outcomes were directly related to the number and types of clinicians available. Future researchers should evaluate whether this finding extends beyond men's ice hockey.
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http://dx.doi.org/10.4085/1062-6050-0464.19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7319740PMC
June 2020

A comparison of recreational skiing- and snowboarding-related injuries at a Colorado ski resort, 2012/13-2016/17.

Res Sports Med 2020 Jul-Sep;28(3):413-425. Epub 2020 Apr 23.

Department of Family Medicine, University of Colorado School of Medicine , Denver, CO, USA.

The purpose of this study was to compare injury patterns between recreational skiers and snowboarders. Injured skiers (n = 3,961) and snowboarders (n = 2,428) presented to a mountainside medical clinic, 2012/13-2016/17. Variables investigated for analysis included demographics/characteristics, injury event information, and injury information. Skiers were older than snowboarders (34.3 ± 19.3 vs. 23.2 ± 10.5 years, p < 0.001); a greater proportion of skiers were female (46.3% vs. 27.8%, p < 0.001). Most skiers (84.4%) and snowboarders (84.5%) were helmeted at the time of injury (p = 0.93). Snowboarders were most frequently beginners (38.9%), skiers were intermediates (37.8%). Falls to snow (skiers = 72.3%, snowboarders = 84.8%) and collisions with natural objects (skiers = 9.7%, snowboarders = 7.4%) were common injury mechanisms. Common skiing injuries were knee sprains (20.5%) and head trauma (8.9%); common snowboarding injuries were wrist fractures (25.7%), shoulder separations (9.1%), and head trauma (9.0%). Given that injury patterns significantly differ between sports, it is important for clinicians, ski patrollers, and resorts to develop and deliver sport-specific injury prevention interventions to most effectively decrease injury burden.
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http://dx.doi.org/10.1080/15438627.2020.1754821DOI Listing
December 2020

Concussion Symptom Characteristics and Resolution in 20 United States High School Sports, 2013/14-2017/18 Academic Years.

Neurosurgery 2020 09;87(3):573-583

Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee.

Background: High school (HS) sport-related concussions (SRCs) remain a public health concern in the United States.

Objective: To describe patterns in symptom prevalence, symptom resolution time (SRT), and return-to-play time (RTP) for SRCs sustained in 20 HS sports during the 2013/14-2017/18 academic years.

Methods: A convenience sample of athletic trainers reported concussion information to the HS RIOTM surveillance system. Symptom prevalence, average number of symptoms, and SRT and RTP distributions were examined and compared by event type (practice, competition), injury mechanism (person contact, nonperson contact), sex, and contact level (collision, high contact, and low contact) with chi-square tests and Wilcoxon rank-sum tests.

Results: Among all SRCs (n = 9542), headache (94.5%), dizziness (73.8%), and difficulty concentrating (56.0%) were commonly reported symptoms. On average, 4.7 ± 2.4 symptoms were reported per SRC. Overall, 51.3% had symptoms resolve in <7 d, yet only 7.9% had RTP < 7 d. Differential prevalence of amnesia was seen between practice and competition-related SRCs (8.8% vs 13.0%; P < .001); nonperson-contact and person-contact SRCs (9.3% vs 12.7%; P < .001); and female and male SRCs in low-contact sports (5.8% vs 17.5%; P < .001). Differential prevalence of loss of consciousness was seen between practice and game-related SRCs (1.3% vs 3.2%; P < .001); and female and male SRCs in high contact sports (1.2% vs 4.0%; P < .001). Differential longer SRT (>21 d) was seen between new and recurrent SRCs (9.4% vs 15.9%; P < .001).

Conclusion: Headache was the most commonly reported symptom. Notable group differences in the prevalence of amnesia, loss of consciousness, and SRT may be associated with more severe SRCs, warranting further attention.
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http://dx.doi.org/10.1093/neuros/nyaa091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8133332PMC
September 2020
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