Memmini Allyssa K, Snedden Traci R, Boltz Adrian J, Benson Benjamin A, Margolin Eric, Pasquina Paul F, McAllister Thomas W, McCrea Michael A, Broglio Steven P
Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, NM, 87131-0001, USA.
School of Nursing, University of Wisconsin-Madison, Madison, WI, USA.
Sports Med. 2024 Jul;54(7):1965-1977. doi: 10.1007/s40279-024-01999-1. Epub 2024 Feb 26.
The aim was to describe the demographic and post-injury factors that influence time to return to learn (RTL) among student-athletes enrolled in the Concussion Assessment, Research and Education (CARE) Consortium.
A total of 47,860 student-athletes enrolled in the National Collegiate Athletic Association-Department of Defense (NCAA-DoD) CARE Consortium study from 2014 to 2020, with 1485 sport-related concussions (SRCs) analyzed in the present dataset. Demographic and post-injury characteristics were calculated using descriptive statistics, followed by Kaplan-Meier estimates to examine median time to return to normal academic performance (i.e., RTL) by sex (male, female), baseline psychiatric conditions (depression, anxiety) and/or learning disorder, NCAA division (I, II, III), SRC history (0, 1, 2, 3+), NCAA sport category (contact, limited contact, non-contact sport), and median difference in baseline/post-injury symptom severity scores (< 21, ≥ 21). Further, a multivariable zero-inflated negative binomial (ZINB) regression model was used to examine their association with RTL.
Overall, time to RTL (mean = 4.96 ± 8.24 days, median = 3.0 [interquartile range = 0.0, 6.0] days) was found to be influenced by several factors resulting in earlier trajectories. Notably, nearly 25% of the sample demonstrated immediate RTL (i.e., 0 days). Among student-athletes who did not immediately RTL, males demonstrated a decreased rate in RTL (rate = 0.79; 95% CI 0.66-0.96) compared to females. Further, student-athletes with a ≥ 21 change in symptom severity score (post-injury baseline) demonstrated a higher rate of RTL (rate = 1.47; 95% CI 1.21-1.79) compared to student-athletes with a symptom severity change score < 21. Lastly, male student-athletes demonstrated two times higher odds (odds ratio = 1.95; 95% CI 1.02-3.73) of immediate RTL compared to female student-athletes. No other covariates were associated with time to RTL.
Collectively, the present findings suggest a rapid return to the classroom following concussion. Specifically, males demonstrated higher odds of time to RTL, whereas those with greater differences in symptom severity resulted in a higher rate of time to RTL among those who did not immediately RTL. Ultimately, these findings support prior work emphasizing an individualized approach to SRC management.
本研究旨在描述影响参加脑震荡评估、研究与教育（CARE）联盟的学生运动员恢复学习时间（RTL）的人口统计学和受伤后因素。
2014年至2020年期间，共有47860名学生运动员参加了美国国家大学体育协会-国防部（NCAA-DoD）CARE联盟研究，本数据集中分析了1485例与运动相关的脑震荡（SRC）。使用描述性统计计算人口统计学和受伤后特征，随后采用Kaplan-Meier估计法，按性别（男、女）、基线精神状况（抑郁、焦虑）和/或学习障碍、NCAA分区（I、II、III）、SRC病史（0、1、2、3+）、NCAA运动类别（接触性、有限接触性、非接触性运动）以及基线/受伤后症状严重程度评分的中位数差异（<21、≥21）来检查恢复正常学业表现的中位时间（即RTL）。此外，使用多变量零膨胀负二项式（ZINB）回归模型来检查它们与RTL的关联。
总体而言，发现RTL时间（均值=4.96±8.24天，中位数=3.0[四分位间距=0.0，6.0]天）受多种因素影响，导致恢复轨迹更早。值得注意的是，近25%的样本显示立即恢复学习（即0天）。在未立即恢复学习的学生运动员中，男性的RTL率（率=0.79；95%CI 0.66-0.96）低于女性。此外，与症状严重程度变化评分<21的学生运动员相比，症状严重程度评分（受伤后与基线相比）变化≥21的学生运动员的RTL率更高（率=1.47；95%CI 1.21-1.79）。最后，与女学生运动员相比，男学生运动员立即恢复学习的几率高出两倍（优势比=1.95；95%CI 1.02-3.73）。没有其他协变量与RTL时间相关。
总体而言，本研究结果表明脑震荡后可迅速重返课堂。具体而言，男性恢复学习时间的几率更高，而症状严重程度差异较大的人在未立即恢复学习的人群中恢复学习时间的比率更高。最终，这些结果支持了之前强调对SRC进行个体化管理的研究工作。
