Department of Biostatistics, Indiana University School of Medicine, Indiana University, 410 West Tenth Street, Indianapolis, IN, 46260, USA.
Department of Biostatistics, Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA.
Sports Med. 2018 Aug;48(8):1971-1985. doi: 10.1007/s40279-018-0875-7.
Sport-related concussion and repetitive head impact exposure in contact sports continue to receive increased attention in public and medical spheres. The Concussion Assessment, Research and Education (CARE) Consortium, a multicenter cooperative, was established to study the natural history of concussion in National Collegiate Athletic Association (NCAA) collegiate student-athletes across 29 colleges and universities in the United States. The purpose of this investigation is to provide normative data from the CARE Consortium and evaluate for differences between sport categories.
NCAA student-athletes were evaluated annually for general demographics and sport-specific characteristics before the start of the competitive season. We collected demographic and medical history information and evaluated each student-athlete's neurocognitive function, neurological status, postural stability, and self-reported symptoms. Sports were categorized by the amount of contact typically associated with the sport (i.e., contact, limited contact, non-contact). Comparisons between the three sport categories for the evaluated variables were made using linear or zero inflated negative binomial regression models adjusted for gender, concussion history, and household income.
Over a 2-year period (August 2014-July 2016), 15,681 NCAA athletes completed preseason evaluations. Overall, 53% of the athletes were in the contact sport group, 31% were in the limited contact group and 17% were in the non-contact group. After adjusting for covariates, there were statistically significant differences found between athlete groups, although the differences and effect sizes were small and not clinically significant. The contact sport group had better scores on Immediate Post-Concussion Assessment Testing (ImPACT) visual and verbal memory, Sport Concussion Assessment Tool (SCAT) symptom checklist, and Brief Symptom Inventory-18 (BSI-18), but slower ImPACT reaction time and worse scores on Standardized Assessment of Concussion (SAC). Further, the data indicate that some ImPACT score distributions were noticeably different from those presented in the technical manual.
In this large, racially and socio-economically diverse cohort of male and female college athletes, we found no evidence that student-athletes participating in contact sports have clinically meaningful deficits in pre-season cognitive and balance testing. They also did not report significantly more symptoms of psychological distress when compared with student-athletes in non-contact or limited contact sports. In addition, the data suggest potential limitations when using published ImPACT norms when evaluating injured athletes.
与运动相关的脑震荡和重复性头部撞击暴露在接触性运动中继续受到公众和医疗领域的关注。为了研究美国 29 所大学的全国大学生体育协会（NCAA）大学生运动员的脑震荡自然史，成立了多中心合作的脑震荡评估、研究和教育（CARE）联盟。本研究的目的是提供 CARE 联盟的规范数据，并评估运动类别之间的差异。
在竞争赛季开始前，每年对 NCAA 运动员进行一般人口统计学和特定运动特征的评估。我们收集了人口统计学和病史信息，并评估了每个学生运动员的神经认知功能、神经状态、姿势稳定性和自我报告的症状。运动分为与运动相关的接触量（即接触、有限接触、非接触）。使用线性或零膨胀负二项回归模型，根据性别、脑震荡史和家庭收入对三种运动类别进行了评估变量之间的比较。
在两年的时间里（2014 年 8 月至 2016 年 7 月），有 15681 名 NCAA 运动员完成了赛前评估。总体而言，53%的运动员在接触性运动组，31%在有限接触组，17%在非接触组。在调整了协变量后，发现运动员组之间存在统计学上的显著差异，尽管差异和效应大小较小，且无临床意义。接触性运动组在即时脑震荡后评估测试（ImPACT）视觉和言语记忆、运动脑震荡评估工具（SCAT）症状清单和简短症状清单-18（BSI-18）上的得分较好，但反应时间较慢，标准脑震荡评估（SAC）得分较差。此外，数据表明，一些 ImPACT 得分分布与技术手册中呈现的明显不同。
在这个由男性和女性大学生组成的大型、种族和社会经济多样化队列中，我们没有发现证据表明参加接触性运动的学生运动员在赛前认知和平衡测试中存在有临床意义的缺陷。与非接触性或有限接触性运动的运动员相比，他们报告的心理困扰症状也没有明显增加。此外，数据表明，在评估受伤运动员时，使用已发表的 ImPACT 规范可能存在潜在的局限性。
