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Premorbid Risk Factors and Acute Injury Characteristics of Sport-Related Concussion Across the National Collegiate Athletic Association: Findings from the Concussion Assessment, Research, and Education (CARE) Consortium

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Abstract

Background

Previous sport-related concussion research highlights post-injury characteristics that influence recovery trajectories; however, there is limited information regarding premorbid factors that affect sport-related concussion risk.

Objective

We aimed to (a) compare premorbid demographic factors among a large cohort of collegiate student athletes who did or did not sustain a sport-related concussion and (b) assess differences in acute injury characteristics based on biological sex and contact level.

Methods

We conducted a cohort study of university student athletes from 22 sports enrolled in the Concussion Assessment, Research, and Education (CARE) Consortium study from 2014 to 2021 (n = 1804 student athletes with sport-related concussions; n = 21,702 student athletes without sport-related concussions).

Results

Statistical analyses indicated student athletes who self-identified as Black (odds ratio [OR] = 1.61; 95% confidence interval [CI] = 1.42, 1.81) or multiracial (OR = 1.32; 95% CI 1.10, 1.59) demonstrated greater odds of experiencing sport-related concussions than White-identifying student athletes. Additional findings suggest male athletes (OR = 1.47; 95% CI 1.20, 1.81) and contact sport student athletes (OR = 1.40; 95% CI 1.16, 1.70) may be at increased odds for sport-related concussions if they were previously diagnosed with attention deficit hyperactive disorder. Notable post-injury characteristics across sexes included differences in the incident loss of consciousness (male: 5.9%, female: 2.6%; p < 0.001), post-traumatic amnesia (male: 13.6%, female: 5.1%; p < 0.001), and retrograde amnesia (male: 6.8%, female: 2.8%; p < 0.001). A greater proportion of contact-sport student athletes experienced an altered mental status (52.7%) than limited contact (36.2%) and non-contact (48.6%) [p < 0.001]. Last, student athletes participating at lower contact levels were more likely to have a longer delay in removal from activity following injury (contact: 73.6 ± 322.2 min; limited contact: 139.1 ± 560.0 min; non-contact: 461.4 ± 1870.8 min; p = 0.005).

Conclusions

The present study provides contemporary pre- and post-sport-related concussion injury characteristics using a considerably sized cohort of collegiate student athletes. These findings support previous work suggesting sport-related concussion results in complex individualized clinical presentations, which may influence management strategies.

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Acknowledgements

CARE Consortium Investigators are listed alphabetically by institution: April Hoy, MS, ATC, (Azusa Pacific University); Louise A. Kelly, PhD (California Lutheran University); Justus D. Ortega, PhD (California State Polytechnic University, Humboldt); Nicholas Port, PhD (Indiana University); Adam Susmarski, DO (United States Naval Academy); Carlos Estevez, DPT (United States Coast Guard Academy); Kenneth L. Cameron, PhD, MPH, ATC (United States Military Academy); Christopher C. Giza, MD (University of California—Los Angeles); Thomas Buckley, EdE, ATC, and Thomas W. Kaminski, PhD, ATC (University of Delaware); James R. Clugston, MD, MS (University of Florida); Julianne D. Schmidt, PhD, ATC (University of Georgia); James T. Eckner, MD, MS (University of Michigan); Christina L. Master, MD (University of Pennsylvania); Anthony P. Kontos, PhD (University of Pittsburgh); Steve Rowson, PhD (Virginia Tech). The authors also thank Jody Harland, Janetta Matesan, Michael Menser (Indiana University School of Medicine); Ashley Rettmann, Nicole L’Heureux, (University of Michigan); Melissa McEachern (Medical College of Wisconsin); Michael Jarrett, Vibeke Brinck, and Bianca Byrne, (Quesgen); Melissa Baker, Christy Collins, Will Felix, (Datalys Center for Sports Injury Research and Prevention); and the research, medical staff and student athletes at each of the CARE participation sites.

Author information

Authors and Affiliations

  1. Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, NM, 87131-0001, USA

    Allyssa K. Memmini

  2. Concussion Center, University of Michigan, Ann Arbor, MI, USA

    Allyssa K. Memmini & Steven P. Broglio

  3. Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA

    Kelly M. Mosesso & Susan M. Perkins

  4. Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Benjamin L. Brett & Michael A. McCrea

  5. Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA

    Benjamin L. Brett & Michael A. McCrea

  6. Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Paul F. Pasquina

  7. Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA

    Thomas W. McAllister

Authors
  1. Allyssa K. Memmini
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  2. Kelly M. Mosesso
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  3. Susan M. Perkins
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  4. Benjamin L. Brett
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  5. Paul F. Pasquina
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  6. Thomas W. McAllister
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  7. Michael A. McCrea
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  8. Steven P. Broglio
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Consortia

CARE Consortium Investigators

  • April Hoy
  • , Louise A. Kelly
  • , Justus D. Ortega
  • , Nicholas Port
  • , Adam Susmarski
  • , Carlos Estevez
  • , Kenneth L. Cameron
  • , Christopher C. Giza
  • , Thomas Buckley
  • , Thomas W. Kaminski
  • , James R. Clugston
  • , Julianne D. Schmidt
  • , James T. Eckner
  • , Christina L. Master
  • , Anthony P. Kontos
  • , Steve Rowson
  • , Jody Harland
  • , Janetta Matesan
  • , Michael Menser
  • , Ashley Rettmann
  • , Nicole L’Heureux
  • , Melissa McEachern
  • , Michael Jarrett
  • , Vibeke Brinck
  • , Bianca Byrne
  • , Melissa Baker
  • , Christy Collins
  •  & Will Felix

Corresponding author

Correspondence to Allyssa K. Memmini.

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Funding

This research was supported by the Grand Alliance Concussion Assessment, Research, and Education (CARE) Consortium, funded in part by the National Collegiate Athletic Association and the Department of Defense. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs, through the Combat Casualty Care Research Program, endorsed by the Department of Defense, under Award No. W81XWH1420151. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense.

Conflicts of Interests

Allyssa Memmini has no competing interests to report. Susan Perkins and Kelly Mosesso have received funding to Indiana University from the National Collegiate Athletic Association; the US Department of Defense; and the Henry M. Jackson Foundation for the Advancement of Military Medicine. Benjamin Brett has previously received the Career Development Award from the National Institutes of Health National Institute of on Aging, the Loan Repayment Program Award from the National Institutes of Health National Institute of Neurological Disorders and Stroke, and as well as speaker honoraria for the 10th Annual Sports Neuropsychology Society Conference from the Sports Neuropsychology Society. Michael McCrea has received research funding to the Medical College of Wisconsin from the US Department of Defense; National Collegiate Athletic Association; Centers for Disease Control and Prevention; National Football League; Veterans Affairs; and Abbott Laboratories; as well as book royalties from Oxford University Press. Paul Pasquina is an employee of the Department of Defense, and has previously received other Department of Defense-related grants. Thomas McAllister has received research support from the National Collegiate Athletic Association, US Department of Defense, and the National Institutes of Health. Thomas McAllister also reports textbook royalties from American Psychiatric Press Publishing, Inc. Last, Thomas McAllister serves on the Concussion Committee Scientific Advisory Board (unpaid) for the Australian Football League. Steven Broglio has current or past research funding from the National Institutes of Health; Centers for Disease Control and Prevention; Department of Defense—USA Medical Research Acquisition Activity, National Collegiate Athletic Association; National Athletic Trainers’ Association Foundation; National Football League/Under Armour/GE, Simbex, and ElMindA. Steven Broglio has consulted for US Soccer (paid), US Cycling (unpaid), University of Calgary SHRed Concussions external advisory board (unpaid), and medico-legal litigation, and received speaker honorarium and travel reimbursements for talks given. Steven Broglio is also a co-author of “Biomechanics of Injury (3rd edition)” and has a patent pending on “Brain Metabolism Monitoring Through CCO Measurements Using All-Fiber-Integrated Super-Continuum Source” (US Application No. 17/164,490). Last, Steven Broglio is on the and is/was on the editorial boards (all unpaid) for the Journal of Athletic Training (2015 to present), Concussion (2014 to present), Athletic Training & Sports Health Care (2008 to present), and the British Journal of Sports Medicine (2008–19).

Ethics Approval

Participants provided written informed consent prior to study participation. The Human Research Protection Office approved the study and each participating site’s institutional review board approved this study. All study operations were in accordance with the standards outlined in the Declaration of Helsinki.

Consent to Participate

All participants provided written informed consent prior to participation.

Availability of Data and Material

Data may be available upon reasonable request.

Code Availability

Not applicable.

Authors’ Contributions

AKM was involved in the study conception and design, as well as the interpretation of data, manuscript drafting, and final approval. KMM and SMP were involved in the study conception and design, statistical analyses, and interpretation, in addition to reviewing subsequent drafts of the manuscript and providing final approval of the manuscript. All remaining authors were responsible for the study conception, design, and providing generous feedback on manuscript drafts. All authors read and approved the final manuscript.

Additional information

Members of the CARE Consortium Investigators are listed in “Acknowledgements” section.

Supplementary Information

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Memmini, A.K., Mosesso, K.M., Perkins, S.M. et al. Premorbid Risk Factors and Acute Injury Characteristics of Sport-Related Concussion Across the National Collegiate Athletic Association: Findings from the Concussion Assessment, Research, and Education (CARE) Consortium. Sports Med 53, 1457–1470 (2023). https://doi.org/10.1007/s40279-023-01830-3

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