Arakkal Alan T, Barón Anna E, Lamb Molly M, Fields Sarah K, Comstock R Dawn
Department of Epidemiology, College of Public Health, University of Iowa, 145 N Riverside Dr 100 CPHB, Iowa City, IA, 52242, USA.
Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA.
Inj Epidemiol. 2020 Apr 13;7(1):12. doi: 10.1186/s40621-020-00241-6.
Traumatic brain injury legislation varies across states. A comprehensive nationwide evaluation of state traumatic brain injury laws is vital given growing populations of high school athletes. This study evaluates the effectiveness of traumatic brain injury laws by examining longitudinal trends in incident and recurrent concussion rates and determines if state level variations in legislation's language affected the observed trends.
In this retrospective ecological study of a large national sample of US high schools from 2005/06 through 2017/18, piecewise regression models along with a profile likelihood approach were utilized to examine longitudinal trends in incident and recurrent concussion rates.
Overall incident concussion rates increased by an additional 1.85%/standardized month (STDM) (95% confidence interval (CI): 1.14, 2.56%) prior to law passage and decreased by an additional 1.08%/ STDM (95%CI: - 1.43, - 0.72%) after law passage. Similar trends were observed for overall recurrent concussion rates. Among states that specified the category of healthcare provider for return to play clearance, post-law recurrent concussion rates decreased on average by an additional 1.59%/STDM (95%CI: - 3.42, 0.22%) compared to states that did not specify the category of healthcare provider.
The passage of state level traumatic brain injury laws was associated with an increase in overall incident and recurrent concussion rates prior to law passage and a decrease in rates after law passage. Although not statistically significant, states with traumatic brain injury laws specifying the category of healthcare provider for return to play clearance had a greater rate of decline in post-law recurrent concussion rates compared to states not specifying the category of healthcare provider. The findings suggest that state traumatic brain injury laws may benefit from specifying the category of healthcare provider allowed to provide return to play clearance, if they do not already include such language.
各州关于创伤性脑损伤的立法各不相同。鉴于高中运动员人数不断增加，对各州创伤性脑损伤法律进行全面的全国性评估至关重要。本研究通过检查脑震荡发生率和复发性脑震荡率的纵向趋势来评估创伤性脑损伤法律的有效性，并确定立法语言在州层面的差异是否影响了观察到的趋势。
在这项对2005/06至2017/18年美国高中大型全国样本的回顾性生态研究中，采用分段回归模型和轮廓似然法来检查脑震荡发生率和复发性脑震荡率的纵向趋势。
在法律通过之前，总体脑震荡发生率额外增加了1.85%/标准月（STDM）（95%置信区间（CI）：1.14，2.56%），在法律通过之后，总体脑震荡发生率额外下降了1.08%/STDM（95%CI：-1.43，-0.72%）。总体复发性脑震荡率也观察到类似趋势。在指定了恢复比赛许可的医疗保健提供者类别的州中，与未指定医疗保健提供者类别的州相比，法律通过后复发性脑震荡率平均额外下降了1.59%/STDM（95%CI：-3.42，0.22%）。
州层面创伤性脑损伤法律的通过与法律通过之前总体脑震荡发生率和复发性脑震荡率的增加以及法律通过之后这些发生率的下降有关。尽管没有统计学意义，但与未指定恢复比赛许可的医疗保健提供者类别的州相比，制定了创伤性脑损伤法律并指定了恢复比赛许可的医疗保健提供者类别的州在法律通过后复发性脑震荡率的下降幅度更大。研究结果表明，如果州创伤性脑损伤法律尚未包含此类内容，那么明确允许提供恢复比赛许可的医疗保健提供者类别可能会使这些法律受益。
