EFFECTS OF A SEASON OF SUBCONCUSSIVE CONTACT ON CHILD- SCAT3 SCORES IN 8-12 YEAR-OLD MALE ATHLETES. Epidemiology of sports-related concussion in seven US high school and collegiate sports Acute Effects and Recovery After Sport‐Related Concussion: A Neurocognitive and Quantitative Brain Electrical Activity Study Predicting and preventing postconcussive problems in paediatrics (5P) study: protocol for a prospective multicentre clinical prediction rule derivation study in children with concussion Physician Concussion Knowledge and the Effect of Mailing the CDC’s “Heads Up” Toolkit Cognition in the days following concussion: comparison of symptomatic versus asymptomatic athletes. Examining Concussion Rates and Return to Play in High School Football Players Wearing Newer Helmet Technology: A Three-Year Prospective Cohort Study Pediatric concussions in United States emergency departments in the years 2002 to 2006. Cognitive effects of one season of head impacts in a cohort of collegiate contact sport athletes Athletic Trainers' Concussion-Assessment and -Management Practices: An Update. Descriptive epidemiology of collegiate women's ice hockey injuries: National Collegiate Athletic Association Injury Surveillance System, 2000-2001 through 2003-2004. Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study. A prospective study of physician-observed concussions during junior ice hockey: implications for incidence rates. Injury Patterns in Big Ten Conference Football Subject-Specific Increases in Serum S-100B Distinguish Sports-Related Concussion from Sports-Related Exertion Comparison of Mouth Guard Designs and Concussion Prevention in Contact Sports: A Multicenter Randomized Controlled Trial The assessment of orientation following concussion in athletes.
BACKGROUND Each year , over 173,000 children and adolescents visit emergency departments due to sports and recreation related concussions , an increase of 60 % over the last decade due to the rise in the number of children participating in sport . While numerous authors have sought to address the epidemiology of concussions across multiple age groups who participate in contact sports , a recent review of literature did not reveal a substantial amount of published articles that addressed the issue of subconcussive contact . Multiple tools have been developed to assess acute episodes of concussion . Among the assessment protocol s many include an assessment of balance , short and long term memory recall , and balance . The Child-SCAT3 was design ed specifically to evaluate concussions in children 5 - 12 years of age . OBJECTIVE The purpose of this study was to determine the effect of a season of subconcussive contact on  Child-SCAT3  scores in 8 - 12 year old males compared to their age matched peers who participated in non-contact sports .  A secondary purpose was to evaluate how scores of the sub- components of the Child-SCAT3 compare between contact and non-contact athletes . DESIGN A prospect i ve cohort study was performed of 71 male athletes ( 58 football , 13 baseball ) ages 8 - 12 ( contact mean age 10.30 years , SD 1.20 ; non-contact mean age 10.03 years , SD 1.26 ) over the course of a season . METHODS Portions of The Child-SCAT3 were administered and scored in pre-adolescent athletes prior to and following a season of participation in football ( contact sport group ) and baseball ( non-contact sport group ) . The outcome measures of interest included the portions related to Cognitive ability , Balance , and Coordination . RESULTS No statistically significant differences were found in group , time or time and group interaction for any of the utilized portions of the Child-SCAT3 . Statistically significant differences were found between groups for preseason cognitive orientation and postseason immediate memory . Cognitive orientation and coordination were also found to be statistically significantly improved across both groups over the course of the season . LIMITATIONS This study was potentially limited by the number of control subjects tested . CONCLUSIONS A season of subconcussive contact in football was not detrimental to cognitive and balance scores on the Child-SCAT3 . LEVEL OF EVIDENCE 3 Background The epidemiology of sports-related concussion is not well-described in the literature . This paper presents a descriptive epidemiology of concussion in seven high school and collegiate sports . Methods We used the data from Concussion Prevention Initiative ( CPI ) , which enrolled 8905 athletes at 210 high schools and 26 colleges in a prospect i ve cohort study of 7 sports ( football , men ’s and women ’s soccer , men ’s and women ’s lacrosse , and men ’s and women ’s ice hockey ) between 1999 and 2001 . Injury risks and injury rates were used to characterize the incidence of concussion , and changes in symptoms over time were described . Results A total of 375 concussions were observed . The incidence of concussion was highest in football , followed by women ’s lacrosse , men ’s lacrosse , men ’s soccer , and women ’s soccer ( only 10 ice hockey teams were included , too few to quantify incidence ) . The rate of incident concussion was strongly associated with history of concussion in the previous 24 months ( rate ratio = 5.5 ; 95 % CI : 3.9 , 7.8 , for 2 or more concussions relative to no previous concussion ) . The most common symptoms at time of injury were headache ( 87 % ) , balance problems/dizziness ( 77 % ) , and feeling “ in a fog ” ( 62 % ) . Loss of consciousness and amnesia were present in relatively few cases ( 9 and 30 % ) . The most common mechanism of injury was collision with another player . Conclusions Sports-related concussions present with a diverse range of symptoms and are associated with previous concussion history Objective To investigate the clinical utility and sensitivity of a portable , automatic , frontal quantitative electroencephalographic ( QEEG ) acquisition device currently in development in detecting abnormal brain electrical activity after sport-related concussion . Design This was a prospect i ve , non-r and omized study of 396 high school and college football players , including cohorts of 28 athletes with concussion and 28 matched controls . All subjects underwent preseason baseline testing on measures of postconcussive symptoms , postural stability , and cognitive functioning , as well as QEEG . Clinical testing and QEEG were repeated on day of injury and days 8 and 45 postinjury for the concussion and control groups . Main Outcomes and Results The injured group reported more significant postconcussive symptoms during the first 3 days postinjury , which resolved by days 5 and 8 . Injured subjects also performed poorer than controls on neurocognitive testing on the day of injury , but no differences were evident on day 8 or day 45 . QEEG studies revealed significant abnormalities in electrical brain activity in the injured group on day of injury and day 8 postinjury , but not on day 45 . Conclusions Results from the current study on clinical recovery after sport-related concussion are consistent with early reports indicating a typical course of full recovery in symptoms and cognitive dysfunction within the first week of injury . QEEG results , however , suggest that the duration of physiological recovery after concussion may extend longer than observed clinical recovery . Further study is required to replicate and extend these findings in a larger clinical sample , and further demonstrate the utility of QEEG as a marker of recovery after sport-related concussion Introduction Persistent postconcussive symptoms ( PCSs ) is the persistence of somatic , cognitive , physical , psychological and /or behavioural changes lasting more than 1 month following concussion . Persistent concussion impacts the quality of life through impaired cognition , memory and attention affecting school performance , mood and social engagement . No large epidemiological studies have determined the true prevalence of persistent concussion symptoms . Vali date d , easy-to-use prognosticators do not exist for clinicians to identify children at highest risk . The goal of Predicting and Preventing Postconcussive Problems in Pediatrics study is to derive a clinical prediction rule for the development of persistent postconcussion symptoms in children and adolescents presenting to emergency department following acute head injury . Methods and analysis This study is a prospect i ve , multicentre cohort study across nine academic Canadian paediatric emergency departments . We will recruit the largest prospect i ve epidemiological cohort of children with concussion . Eligible children will be followed using  Post-Concussion Symptom Inventory , a vali date d tool in children as young as 5 years . Patients will follow-up at 1 , 2 , 4 , 8 and 12 weeks postinjury . The main outcome will be the presence/absence of PCSs defined as three or more persistent concussion symptoms 1 month following the injury .  1792 patients provide adequate power to derive a clinical decision rule using multivariate analyses to find predictor variables sensitive for detecting cases of persistent postconcussion symptoms . Ethics and dissemination Results of this large prospect i ve study will enable clinicians to identify children at highest risk , optimise treatment and provide families with realistic and appropriate anticipatory guidance . Ethics has been obtained through the Children 's Hospital of Eastern Ontario Research Ethics Board . Results will be disseminated at international conferences and in four manuscripts to peer- review ed journals . Trial registration This study is registered at Clinical trials.gov through the US National Institute of Health/National Library of Medicine ( NCT01873287 ; http:// clinical trials.gov/ct2/show/NCT01873287 ) Background . The Centers for Disease Control and Prevention ’s ( CDC ) “ Heads Up ” toolkit was design ed to educate physicians about concussion , but it has not been well studied . This study proposed to evaluate the effect of receiving the toolkit on physician concussion knowledge . Methods . The authors obtained a sample of physicians from the American Medical Association masterfile and r and omly selected half to be mailed the CDC ’s “ Heads Up ” toolkit .  All physicians were then sent a survey on concussion knowledge . Data were analyzed to evaluate the effect of the toolkit on concussion knowledge . Results . The survey was completed by 414 physicians ( 183 intervention , 231 control ) . There were no differences in general concussion knowledge between intervention and control groups , but physicians in the intervention group were significantly less likely to recommend next day return to play after a concussion ( adjusted odds ratio = 0.31 , 95 % confidence interval = 0.12 - 0.76 ) . Conclusions . Mailing the CDC ’s “ Heads Up ” toolkit appears to affect physicians ’ recommendations regarding returning to play after a concussion BACKGROUND Concussion is a common neurological injury occurring during contact sport . Current guidelines recommend that no athlete should return to play while symptomatic or displaying cognitive dysfunction . This study compared post-concussion cognitive function in recently concussed athletes who were symptomatic/asymptomatic at the time of assessment with that of non-injured ( control ) athletes . METHODS Prospect i ve study of 615 male Australian Rules footballers . Before the season , all participants ( while healthy ) completed a battery of baseline computerised ( CogSport ) and paper and pencil cognitive tasks .  Sixty one injured athletes ( symptomatic = 25 and asymptomatic = 36 ) were reassessed within 11 days of being concussed ; 84 controls were also reassessed . The serial cognitive function of the three groups was compared using analysis of variance . RESULTS The performance of the symptomatic group declined at the post-concussion assessment on computerised tests of simple , choice , and complex reaction times compared with the asymptomatic and control groups . The magnitude of changes was large according to conventional statistical criteria . On paper and pencil tests , the symptomatic group displayed no change at re assessment , whereas large improvements were seen in the other two groups . CONCLUSION Injured athletes experiencing symptoms of concussion displayed impaired motor function and attention , although their learning and memory were preserved . These athletes displayed no change in performance on paper and pencil tests in contrast with the improvement observed in asymptomatic and non-injured athletes . Athletes experiencing symptoms of concussion should be withheld from training and competition until both symptoms and cognitive dysfunction have resolved OBJECTIVE : The purpose of this study was to compare concussion rates and recovery times for athletes wearing newer helmet technology compared to traditional helmet design . METHODS : This was a three-year , prospect i ve , naturalistic , cohort study . Participants were 2,141 high school athletes from Western Pennsylvania . Approximately half of the sample wore the Revolution helmet manufactured by Riddell , Inc.  ( n = 1,173 ) and the remainder of the sample used  st and ard helmets ( n = 968 ) . Athletes underwent computerized neurocognitive testing through the use of ImPACT at the beginning of the study . Following a concussion , players were reevaluated at various time intervals until recovery was complete . RESULTS : In the total sample , the concussion rate in athletes wearing the Revolution was 5.3 % and in athletes wearing st and ard helmets was 7.6 % [ & khgr;2 ( 1 , 2 , 141 ) = 4.96 , P < 0.027 ] . The relative risk estimate was 0.69 ( 95 % confidence interval = 0.499– 0.958 ) . Wearing the Revolution helmet was associated with approximately a 31 % decreased relative risk and 2.3 % decreased absolute risk for sustaining a concussion in this cohort study . The athletes wearing the Revolution did not differ from athletes wearing st and ard helmets on the mechanism of injury ( e.g. , head-to-head strike ) , on-field concussion markers ( e.g. , amnesia or loss of consciousness ) , or on-field presentation of symptoms ( e.g. , headaches , dizziness , or balance problems ) . CONCLUSION : Recent sophisticated laboratory research has better eluci date d injury biomechanics associated with concussion in professional football players . This data has led to changes in helmet design and new helmet technology , which appears to have beneficial effects in reducing the incidence of cerebral concussion in high school football players OBJECTIVES To estimate the incidence and demographics of concussions in children coming to emergency departments ( EDs ) in the United States and describe the rates of neuroimaging and follow-up instructions in these patients . STUDY DESIGN This is a cross-sectional study of children 0 to 19 years old diagnosed with concussion from the National Hospital Ambulatory Medical Care Survey . National Hospital Ambulatory Medical Care Survey collects data on approximately 25,000 visits annually to 600 r and omly selected hospital emergency and outpatient departments . We examined visits to United States emergency departments between 2002 and 2006 . Simple descriptive statistics were used . RESULTS Of the 50,835 pediatric visits in the 5-year sample , 230 observations , representing 144,000 visits annually , were for concussions . Sixty-nine percent of concussion visits were by males . Thirty percent were sports-related . Sixty-nine percent of patients diagnosed with a concussion had head imaging . Twenty-eight percent of patients were discharged without specific instructions to follow-up with an outpatient provider for further treatment . CONCLUSIONS Approximately 144,000 pediatric patients present to emergency departments each year with a concussion . Most of these patients undergo  computed tomography of the head , and nearly one-third are discharged without specific instructions to follow-up with an outpatient provider for further treatment Objective : To determine whether exposure to repetitive head impacts over a single season negatively affects cognitive performance in collegiate contact sport athletes . Methods : This is a prospect i ve cohort study at 3 Division I National Collegiate Athletic Association athletic programs . Participants were 214 Division I college varsity football and ice hockey players who wore instrumented helmets that recorded the acceleration-time history of the head following impact , and 45 noncontact sport athletes . All athletes were assessed prior to and shortly after the season with a  cognitive screening battery ( ImPACT ) and a subgroup of athletes also were assessed with 7 measures from a neuropsychological test battery . Results : Few cognitive differences were found between the athlete groups at the preseason or postseason assessment s. However , a higher percentage of the contact sport athletes performed more poorly than predicted postseason on a measure of new learning ( California Verbal Learning Test ) compared to the noncontact athletes ( 24 % vs 3.6 % ; p < 0.006 ) . On 2 postseason cognitive measures ( ImPACT Reaction Time and Trails 4/B ) , poorer performance was significantly associated with higher scores on several head impact exposure metrics . Conclusion : Repetitive head impacts over the course of a single season may negatively impact learning in some collegiate athletes . Further work is needed to assess whether such effects are short term or persistent CONTEXT Athletic trainers ( ATs ) are often the first health care providers to conduct concussion assessment s and carry out postinjury management . Best practice s for concussion evaluation and management have changed rapidly in recent years , outdating previous reports of ATs ' concussion practice s. OBJECTIVE To examine ATs ' current concussion- assessment and -management techniques . DESIGN Cross-sectional study . SETTING Web-based survey . PATIENTS OR OTHER PARTICIPANTS A r and om convenience sample of 8777 ATs ( response rate = 15.0 % [ n = 1307 ] ; years certified = 15.0 ± 10.6 ) from the National Athletic Trainers ' Association membership . MAIN OUTCOME MEASURE(S ) Survey Web links were e-mailed to prospect i ve participants , with 2 follow-up e-mails sent by the National Athletic Trainers ' Association . The survey collected demographic information , the number of concussions assessed , the concussion-recovery patterns , and the assessment and return-to-participation ( RTP ) decision-making methods used . RESULTS The ATs reported assessing a median of 12.0 ( range = 0 - 218 ) concussions per year . A total of 95.3 % ( 953/1000 ) ATs cited clinical examination as the most frequently used concussion- assessment tool , followed by symptom assessment ( 86.7 % ; 867/1000 ) . A total of 52.7 % ( 527/1000 ) ATs described a 3-domain minimum multidimensional concussion- assessment battery . Published RTP guidelines were the most common RTP decision-making tool ( 91.0 % ; 864/949 ) , followed by clinical examination ( 88.2 % ; 837/949 ) . The ATs with master 's degrees were 1.36 times ( 95 % confidence interval [ CI ] = 1.02 , 1.81 ) more likely to use a 3-domain concussion- assessment battery than ATs with only bachelor 's degrees ( χ2 = 4.44 , P = .05 ) . Collegiate ATs were 2.12 ( 95 % CI = 1.59 , 2.84 ) and 1.63 ( 95 % CI = 1.03 , 2.59 ) times more likely to use a 3-domain concussion- assessment battery than high school and clinic-based ATs , respectively ( χ2 = 26.29 , P < .001 ) . CONCLUSIONS Athletic trainers were using the clinical examination , st and ardized assessment tools , and a 3-domain concussion- assessment -battery approach more frequently in clinical practice than previously reported . However , despite practice improvements , nearly half of ATs were not using a 3-domain minimum concussion- assessment battery . Clinicians should strive to implement multidimensional concussion assessment s in their practice s to ensure optimal diagnosis and management OBJECTIVE To review 4 years of National Collegiate Athletic Association ( NCAA ) injury surveillance data for women 's ice hockey and to identify potential areas for injury prevention initiatives . BACKGROUND The NCAA ISS prospect ively collects data on injuries sustained during collegiate participation . Women 's NCAA ice hockey began participation in the ISS during the 2000 - 2001 season . On average , over the 4 years , 15.6 % of the eligible schools elected to send their injury data . MAIN RESULTS Over the 4 years of study , the rate of injury in games was more than 5 times higher than the injury rate in practice s ( 12.6 versus 2.5 injuries per 1000 athlete-exposures , rate ratio = 5.0 , 95 % confidence interval = 4.2 , 6.1 , P < .01 ) . Preseason practice injury rates were almost twice as high as in-season practice rates ( 4.2 versus 2.3 injuries per 1000 athlete-exposures , rate ratio = 1.8 , 95 % confidence interval = 1.7 , 2.0 , P < .01 ) . Concussions were the most common injury in both games ( 21.6 % ) and practice s ( 13.2 % ) . The rate of concussions in games appeared to be trending upward over the study period . The greatest number of game injuries ( approximately 50 % ) result ed from player contact , whereas practice injuries were from either contact with another object or noncontact mechanisms . RECOMMENDATIONS Women 's ice hockey is an evolving NCAA sport . Only 4 years of ISS data are available and , therefore , data should be interpreted with caution . Women 's ice hockey does not allow for formal body checking ; however , approximately 50 % of all game injuries were reported to result from contact with another player . Future research ers need to evaluate the effectiveness of the no-checking rule . Additional years of data collection will be required to allow the data to become more stable , and to increase attention to mechanism-of-injury issues . We anticipate that the hypothesized inconsistencies in skill level across and within the various women 's teams also will be reduced as more consistently skilled players develop , allowing for more stability in the injury scenario CONTEXT Approximately 300 000 sport-related concussions occur annually in the United States , and the likelihood of serious sequelae may increase with repeated head injury . OBJECTIVE To estimate the incidence of concussion and time to recovery after concussion in collegiate football players . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study of 2905 football players from 25 US colleges were tested at preseason baseline in 1999 , 2000 , and 2001 on a variety of measures and followed up prospect ively to ascertain concussion occurrence . Players injured with a concussion were monitored until their concussion symptoms resolved and were followed up for repeat concussions until completion of their collegiate football career or until the end of the 2001 football season . MAIN OUTCOME MEASURES Incidence of concussion and repeat concussion ; type and duration of symptoms and course of recovery among players who were injured with a concussion during the seasons . RESULTS During follow-up of 4251 player-seasons , 184 players ( 6.3 % ) had a concussion , and 12 ( 6.5 % ) of these players had a repeat concussion within the same season . There was an association between reported number of previous concussions and likelihood of incident concussion .  Players reporting a history of 3 or more previous concussions were 3.0 ( 95 % confidence interval , 1.6 - 5.6 ) times more likely to have an incident concussion than players with no concussion history . Headache was the most commonly reported symptom at the time of injury ( 85.2 % ) , and mean overall symptom duration was 82 hours . Slowed recovery was associated with a history of multiple previous concussions ( 30.0 % of those with > or =3 previous concussions had symptoms lasting > 1 week compared with 14.6 % of those with 1 previous concussion ) . Of the 12 incident within-season repeat concussions , 11 ( 91.7 % ) occurred within 10 days of the first injury , and 9 ( 75.0 % ) occurred within 7 days of the first injury . CONCLUSIONS Our study suggests that players with a history of previous concussions are more likely to have future concussive injuries than those with no history ; 1 in 15 players with a concussion may have additional concussions in the same playing season ; and previous concussions may be associated with slower recovery of neurological function OBJECT The objective of this study was to measure the incidence of concussion ( scaled relative to number of athlete exposures ) and recurrent concussion within 2 teams of fourth-tier junior ice hockey players ( 16 - 21 years old ) during 1 regular season . METHODS A prospect i ve cohort study called the Hockey Concussion Education Project was conducted during 1 junior ice hockey regular season ( 2009 - 2010 ) involving 67 male fourth-tier ice hockey players ( mean age 18.2 ± 1.2 years , range 16 - 21 years ) from 2 teams . Prior to the start of the season , every player underwent baseline assessment s using the Sideline Concussion Assessment Tool 2 ( SCAT2 ) and the Immediate Post-Concussion Assessment and Cognitive Test ( ImPACT ) . The study protocol also required players who entered the study during the season to complete baseline SCAT2 and ImPACT testing . If the protocol was not followed , the postinjury test results of a player without true baseline test results would be compared against previously established age and gender group normative levels . Each regular season game was observed by a qualified physician and at least 1 other neutral nonphysician observer . Players who suffered a suspected concussion were evaluated at the game . If a concussion diagnosis was made , the player was subsequently examined in the physician 's office for a full clinical evaluation and the SCAT2 and ImPACT were repeated . Based on these evaluations , players were counseled on the decision of when to return to play . Athlete exposure was defined as 1 game played by 1 athlete . RESULTS Twenty-one concussions occurred during the 52 physician-observed games ( incidence 21.5 concussions per 1000 athlete exposures ) . Five players experienced repeat concussions . No concussions were reported during practice sessions . A concussion was diagnosed by the physician in 19 ( 36.5 % ) of the 52 observed games . One of the 5 individuals who suffered a repeat concussion sustained his initial concussion in a regular season game that was not observed by a physician , and as a result this single case was not included in the total of 21 total concussions . This initial concussion of the player was identified during baseline testing 2 days after the injury and was subsequently medically diagnosed and treated . CONCLUSIONS The incidence of game-related concussions ( per 100 [ corrected ] athlete exposures ) in these fourth-tier junior [ corrected ] ice hockey players was 7 [ corrected ] times higher than [ corrected ] previously reported in the literature . This difference may be the result of the use of st and ardized direct physician observation , diagnosis , and subsequent treatment . The results of this study demonstrate the need for follow-up studies involving larger and more diverse sample groups to reflect generalizability of the findings . These follow-up studies should involve other contact sports ( for example football and rugby ) and also include the full spectrum of gender , age , and skill levels Background In 1998 , the National Collegiate Athletic Association legislated a decrease in the number of scrimmages and full-contact practice s allowed during the spring season . Hypothesis A significantly increased risk of injury faced by the same player during the spring versus fall practice sessions does exist , but the National Collegiate Athletic Association regulations will not have the intended effect of reducing injury rates to equal or below those of the fall practice sessions . Study Design Retrospectively analyzed , descriptive study of prospect ively collected injury surveillance data followed by a prospect i ve , controlled , repeated- measures study after the rule change . Methods Phase 1 : the Big Ten Conference Sports Injury Surveillance System data base was review ed from spring 1992 through fall 1997 for all reportable injuries . Phase 2 : a prospect i ve investigation was instituted from spring 1998 through fall 2000 . This protocol was modified to also document up date d individual player position descriptions and string as well as exposures for the old fall and spring practice categories ( scrimmages , full contact , and limited contact ) and the new spring practice design ations ( full pads with and without tackling , helmets only , spring game , and other scrimmages ) . Results Phase 1 : There were 3950 fall injuries and 1007 spring injuries , with 469 of the 1007 attributable to the “ spring risk factor . ” There was a statistically significant increase in injury rate in the spring ( 19.8 ) versus fall ( 10.6 ) . Scrimmages ( incidence density ratio = 2.4 ) and limited-contact practice s ( incidence density ratio = 2.5 ) showed more than twice the fall injury rate . Phase 2 : There were 1502 fall injuries and 648 spring injuries , with 192 attributable to the spring risk factor . There was a 3-fold increase in injury rate in the spring ( incidence density ratio = 3.2 ) . Although the noncontact , helmets-only practice s produced the lowest injury rates , the nonspring game scrimmages and the limited-contact practice s defined as “ practice with pads but without tackling ” displayed the highest injury rates . In both spring and fall , nonplayers exhibited the highest injury rates for all string groups . Conclusions There was and still is a statistically significant increase in spring practice injury risk . The 1998 rule change result ed in an even greater increase in spring practice injury risk . If the goal is to minimize the number of spring practice injuries , it will be best accomplished by limiting the number of scrimmages and limited-contact sessions Background The on-field diagnosis of sports-related concussion ( SRC ) is complicated by the lack of an accurate and objective marker of brain injury . Purpose To compare subject-specific changes in the astroglial protein , S100B , before and after SRC among collegiate and semi-professional contact sport athletes , and compare these changes to differences in S100B before and after non-contact exertion . Study Design Longitudinal cohort study . Methods From 2009–2011 , we performed a prospect i ve study of athletes from Munich , Germany , and Rochester , New York , USA .  Serum S100B was measured in all SRC athletes at pre-season baseline , within 3 hours of injury , and at days 2 , 3 and 7 post-SRC . Among a subset of athletes , S100B was measured after non-contact exertion but before injury . All sample s were collected identically and analyzed using an automated electrochemiluminescent assay to quantify serum S100B levels . Results Forty-six athletes ( 30 Munich , 16 Rochester ) underwent baseline testing . Thirty underwent additional post-exertion S100B testing . Twenty-two athletes ( 16 Rochester , 6 Munich ) sustained a SRC , and 17 had S100B testing within 3 hours post-injury . The mean 3-hour post-SRC S100B was significantly higher than pre-season baseline ( 0.099±0.008 µg/L vs. 0.058±0.006 µg/L , p = 0.0002 ) . Mean post-exertion S100B was not significantly different than the preseason baseline . S100B levels at post-injury days 2 , 3 and 7 were significantly lower than the 3-hour level , and not different than baseline . Both the absolute change and proportional increase in S100B 3-hour post-injury were accurate discriminators of SRC from non-contact exertion without SRC ( AUC 0.772 and 0.904 , respectively ) . A 3-hour post-concussion S100B > 0.122 µg/L and a proportional S100B increase of > 45.9 % over baseline were both 96.7 % specific for SRC . Conclusions Relative and absolute increases in serum S100B can accurately distinguish SRC from sports-related exertion , and may be a useful adjunct to the diagnosis of SRC Objectives : To compare the effectiveness of the WIPSS mouth guard to other currently used mouth guards in the prevention of concussion injuries in athletes participating in varsity football and rugby . Design : Multicenter , cluster-r and omized , controlled trial comparing the WIPSS Brain-Pad mouth guard against the st and ard use mouth guard of choice . Teams were monitored by their respective athletic therapist , trainer , or sports physician for 1 playing season to diagnose and record incident concussion injuries and dental trauma . Concussion symptoms were also recorded at the time of injury . Setting : Five Ontario universities . Participants : University male football ( 394 ) and university male ( 129 ) and female ( 123 ) rugby athletes reporting to 2003 fall training camps . Main Outcome Measurements : The primary end point was the incidence of any diagnosed concussion events during the 2003 playing season as defined by the American Academy of Neurology Concussion Guidelines . Secondary endpoints included the incidence of dental trauma events and observed concussion symptoms . Results : There was no significant difference in the number of concussions observed between the intervention and control arms of this trial ( P = 0.79 ; odds ratio , 1.06 , in favor of controls ; 95 % CI , 0.51 , ≪1.61 ) . No dental trauma events occurred . The 5 most common symptoms experienced by concussed athletes were dizziness , general headache , nausea , loss of visual focus , and personality changes . Conclusions : In this study , concussion rates were not significantly different for varsity football and rugby players who wore the WIPSS Brain-Pad mouth guard compared with other types of mouth guards The purpose of this study was to investigate the sensitivity of  orientation and recent memory questions  in the diagnosis of concussion . In a prospect i ve study over 7 consecutive years ( 1985 - 1991 ) , all players at a professional Australian Rules Football club who sustained a concussive injury ( n = 28 ) were administered a set of questions evaluating orientation and recent memory .  Concussion was diagnosed independently on the basis of loss or disturbance of consciousness and clinical symptoms . A control group of age-matched nonconcussed players was administered the same set of questions . The results showed that items evaluating recently acquired information were more sensitive in the assessment of concussion than st and ard orientation items . The relative sensitivity of orientation questions must be considered when they are used in the clinical diagnosis of concussion in sport
Conditional recommendations are made supporting preventive interventions concussion education and rules prohibiting high-risk activity for both pediatric and adult amateur athletes and neck strengthening exercise in adult amateur athletes .
Strong recommendations are supported for head protective equipment in both pediatric and adult amateur athletes .
Strong recommendations regarding newer football helmet technology in adult amateur athletes and rules governing the implementation of body-checking in youth ice hockey are supported .
Background Awareness of the magnitude of contact sports-related concussions has risen exponentially in recent years .
Our objective is to conduct a prospect ively registered systematic review of the scientific evidence regarding interventions to prevent contact sports-related concussions .