Spectrum of acute clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets: Clinical article

Ann Christine Duhaime, Jonathan G. Beckwith, Arthur C. Maerlender, Thomas W. Mcallister, Joseph J. Crisco, Stefan M. Duma, P. Gunnar Brolinson, Steven Rowson, Laura A. Flashman, Jeffrey J. Chu, Richard M. Greenwald

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Object. Concussive head injuries have received much attention in the medical and public arenas, as concerns have been raised about the potential short- and long-term consequences of injuries sustained in sports and other activities. While many student athletes have required evaluation after concussion, the exact definition of concussion has varied among disciplines and over time. The authors used data gathered as part of a multiinstitutional longitudinal study of the biomechanics of head impacts in helmeted collegiate athletes to characterize what signs, symptoms, and clinical histories were used to designate players as having sustained concussions. Methods. Players on 3 college football teams and 4 ice hockey teams (male and female) wore helmets instrumented with Head Impact Telemetry (HIT) technology during practices and games over 2-4 seasons of play. Preseason clinical screening batteries assessed baseline cognition and reported symptoms. If a concussion was diagnosed by the team medical staff, basic descriptive information was collected at presentation, and concussed players were reevaluated serially. The specific symptoms or findings associated with the diagnosis of acute concussion, relation to specific impact events, timing of symptom onset and diagnosis, and recorded biomechanical parameters were analyzed. Results. Data were collected from 450 athletes with 486,594 recorded head impacts. Forty-eight separate concussions were diagnosed in 44 individual players. Mental clouding, headache, and dizziness were the most common presenting symptoms. Thirty-one diagnosed cases were associated with an identified impact event; in 17 cases no specific impact event was identified. Onset of symptoms was immediate in 24 players, delayed in 11, and unspecified in 13. In 8 cases the diagnosis was made immediately after a head impact, but in most cases the diagnosis was delayed (median 17 hours). One diagnosed concussion involved a 30-second loss of consciousness; all other players retained alertness. Most diagnoses were based on self-reported symptoms. The mean peak angular and rotational acceleration values for those cases associated with a specific identified impact were 86.1 ±42.6g (range 16.5-177.9g) and 3620 ± 2166 rad/sec2 (range 183-7589 rad/sec2), respectively. Conclusions. Approximately two-thirds of diagnosed concussions were associated with a specific contact event. Half of all players diagnosed with concussions had delayed or unclear timing of onset of symptoms. Most had no externally observed findings. Diagnosis was usually based on a range of self-reported symptoms after a variable delay. Accelerations clustered in the higher percentiles for all impact events, but encompassed a wide range. These data highlight the heterogeneity of criteria for concussion diagnosis, and in this sports context, its heavy reliance on self-reported symptoms. More specific and standardized definitions of clinical and objective correlates of a "concussion spectrum" may be needed in future research efforts, as well as in the clinical diagnostic arena.

Original languageEnglish (US)
Pages (from-to)1092-1099
Number of pages8
JournalJournal of neurosurgery
Volume117
Issue number6
DOIs
StatePublished - Dec 1 2012

Fingerprint

Head Protective Devices
Athletes
Head
Sports
Hockey
Telemetry
Unconsciousness
Football
Delayed Diagnosis
Medical Staff
Dizziness
Craniocerebral Trauma
Biomechanical Phenomena
Cognition
Signs and Symptoms
Headache
Longitudinal Studies
Students
Technology
Wounds and Injuries

Keywords

  • Athletes
  • Biomechanics
  • Concussion
  • Football
  • Hockey
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Spectrum of acute clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets : Clinical article. / Duhaime, Ann Christine; Beckwith, Jonathan G.; Maerlender, Arthur C.; Mcallister, Thomas W.; Crisco, Joseph J.; Duma, Stefan M.; Brolinson, P. Gunnar; Rowson, Steven; Flashman, Laura A.; Chu, Jeffrey J.; Greenwald, Richard M.

In: Journal of neurosurgery, Vol. 117, No. 6, 01.12.2012, p. 1092-1099.

Research output: Contribution to journalArticle

Duhaime, AC, Beckwith, JG, Maerlender, AC, Mcallister, TW, Crisco, JJ, Duma, SM, Brolinson, PG, Rowson, S, Flashman, LA, Chu, JJ & Greenwald, RM 2012, 'Spectrum of acute clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets: Clinical article', Journal of neurosurgery, vol. 117, no. 6, pp. 1092-1099. https://doi.org/10.3171/2012.8.JNS112298
Duhaime, Ann Christine ; Beckwith, Jonathan G. ; Maerlender, Arthur C. ; Mcallister, Thomas W. ; Crisco, Joseph J. ; Duma, Stefan M. ; Brolinson, P. Gunnar ; Rowson, Steven ; Flashman, Laura A. ; Chu, Jeffrey J. ; Greenwald, Richard M. / Spectrum of acute clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets : Clinical article. In: Journal of neurosurgery. 2012 ; Vol. 117, No. 6. pp. 1092-1099.
@article{9f7a73aecbc84e698fd8a85896052a2d,
title = "Spectrum of acute clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets: Clinical article",
abstract = "Object. Concussive head injuries have received much attention in the medical and public arenas, as concerns have been raised about the potential short- and long-term consequences of injuries sustained in sports and other activities. While many student athletes have required evaluation after concussion, the exact definition of concussion has varied among disciplines and over time. The authors used data gathered as part of a multiinstitutional longitudinal study of the biomechanics of head impacts in helmeted collegiate athletes to characterize what signs, symptoms, and clinical histories were used to designate players as having sustained concussions. Methods. Players on 3 college football teams and 4 ice hockey teams (male and female) wore helmets instrumented with Head Impact Telemetry (HIT) technology during practices and games over 2-4 seasons of play. Preseason clinical screening batteries assessed baseline cognition and reported symptoms. If a concussion was diagnosed by the team medical staff, basic descriptive information was collected at presentation, and concussed players were reevaluated serially. The specific symptoms or findings associated with the diagnosis of acute concussion, relation to specific impact events, timing of symptom onset and diagnosis, and recorded biomechanical parameters were analyzed. Results. Data were collected from 450 athletes with 486,594 recorded head impacts. Forty-eight separate concussions were diagnosed in 44 individual players. Mental clouding, headache, and dizziness were the most common presenting symptoms. Thirty-one diagnosed cases were associated with an identified impact event; in 17 cases no specific impact event was identified. Onset of symptoms was immediate in 24 players, delayed in 11, and unspecified in 13. In 8 cases the diagnosis was made immediately after a head impact, but in most cases the diagnosis was delayed (median 17 hours). One diagnosed concussion involved a 30-second loss of consciousness; all other players retained alertness. Most diagnoses were based on self-reported symptoms. The mean peak angular and rotational acceleration values for those cases associated with a specific identified impact were 86.1 ±42.6g (range 16.5-177.9g) and 3620 ± 2166 rad/sec2 (range 183-7589 rad/sec2), respectively. Conclusions. Approximately two-thirds of diagnosed concussions were associated with a specific contact event. Half of all players diagnosed with concussions had delayed or unclear timing of onset of symptoms. Most had no externally observed findings. Diagnosis was usually based on a range of self-reported symptoms after a variable delay. Accelerations clustered in the higher percentiles for all impact events, but encompassed a wide range. These data highlight the heterogeneity of criteria for concussion diagnosis, and in this sports context, its heavy reliance on self-reported symptoms. More specific and standardized definitions of clinical and objective correlates of a {"}concussion spectrum{"} may be needed in future research efforts, as well as in the clinical diagnostic arena.",
keywords = "Athletes, Biomechanics, Concussion, Football, Hockey, Traumatic brain injury",
author = "Duhaime, {Ann Christine} and Beckwith, {Jonathan G.} and Maerlender, {Arthur C.} and Mcallister, {Thomas W.} and Crisco, {Joseph J.} and Duma, {Stefan M.} and Brolinson, {P. Gunnar} and Steven Rowson and Flashman, {Laura A.} and Chu, {Jeffrey J.} and Greenwald, {Richard M.}",
year = "2012",
month = "12",
day = "1",
doi = "10.3171/2012.8.JNS112298",
language = "English (US)",
volume = "117",
pages = "1092--1099",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "6",

}

TY - JOUR

T1 - Spectrum of acute clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets

T2 - Clinical article

AU - Duhaime, Ann Christine

AU - Beckwith, Jonathan G.

AU - Maerlender, Arthur C.

AU - Mcallister, Thomas W.

AU - Crisco, Joseph J.

AU - Duma, Stefan M.

AU - Brolinson, P. Gunnar

AU - Rowson, Steven

AU - Flashman, Laura A.

AU - Chu, Jeffrey J.

AU - Greenwald, Richard M.

PY - 2012/12/1

Y1 - 2012/12/1

N2 - Object. Concussive head injuries have received much attention in the medical and public arenas, as concerns have been raised about the potential short- and long-term consequences of injuries sustained in sports and other activities. While many student athletes have required evaluation after concussion, the exact definition of concussion has varied among disciplines and over time. The authors used data gathered as part of a multiinstitutional longitudinal study of the biomechanics of head impacts in helmeted collegiate athletes to characterize what signs, symptoms, and clinical histories were used to designate players as having sustained concussions. Methods. Players on 3 college football teams and 4 ice hockey teams (male and female) wore helmets instrumented with Head Impact Telemetry (HIT) technology during practices and games over 2-4 seasons of play. Preseason clinical screening batteries assessed baseline cognition and reported symptoms. If a concussion was diagnosed by the team medical staff, basic descriptive information was collected at presentation, and concussed players were reevaluated serially. The specific symptoms or findings associated with the diagnosis of acute concussion, relation to specific impact events, timing of symptom onset and diagnosis, and recorded biomechanical parameters were analyzed. Results. Data were collected from 450 athletes with 486,594 recorded head impacts. Forty-eight separate concussions were diagnosed in 44 individual players. Mental clouding, headache, and dizziness were the most common presenting symptoms. Thirty-one diagnosed cases were associated with an identified impact event; in 17 cases no specific impact event was identified. Onset of symptoms was immediate in 24 players, delayed in 11, and unspecified in 13. In 8 cases the diagnosis was made immediately after a head impact, but in most cases the diagnosis was delayed (median 17 hours). One diagnosed concussion involved a 30-second loss of consciousness; all other players retained alertness. Most diagnoses were based on self-reported symptoms. The mean peak angular and rotational acceleration values for those cases associated with a specific identified impact were 86.1 ±42.6g (range 16.5-177.9g) and 3620 ± 2166 rad/sec2 (range 183-7589 rad/sec2), respectively. Conclusions. Approximately two-thirds of diagnosed concussions were associated with a specific contact event. Half of all players diagnosed with concussions had delayed or unclear timing of onset of symptoms. Most had no externally observed findings. Diagnosis was usually based on a range of self-reported symptoms after a variable delay. Accelerations clustered in the higher percentiles for all impact events, but encompassed a wide range. These data highlight the heterogeneity of criteria for concussion diagnosis, and in this sports context, its heavy reliance on self-reported symptoms. More specific and standardized definitions of clinical and objective correlates of a "concussion spectrum" may be needed in future research efforts, as well as in the clinical diagnostic arena.

AB - Object. Concussive head injuries have received much attention in the medical and public arenas, as concerns have been raised about the potential short- and long-term consequences of injuries sustained in sports and other activities. While many student athletes have required evaluation after concussion, the exact definition of concussion has varied among disciplines and over time. The authors used data gathered as part of a multiinstitutional longitudinal study of the biomechanics of head impacts in helmeted collegiate athletes to characterize what signs, symptoms, and clinical histories were used to designate players as having sustained concussions. Methods. Players on 3 college football teams and 4 ice hockey teams (male and female) wore helmets instrumented with Head Impact Telemetry (HIT) technology during practices and games over 2-4 seasons of play. Preseason clinical screening batteries assessed baseline cognition and reported symptoms. If a concussion was diagnosed by the team medical staff, basic descriptive information was collected at presentation, and concussed players were reevaluated serially. The specific symptoms or findings associated with the diagnosis of acute concussion, relation to specific impact events, timing of symptom onset and diagnosis, and recorded biomechanical parameters were analyzed. Results. Data were collected from 450 athletes with 486,594 recorded head impacts. Forty-eight separate concussions were diagnosed in 44 individual players. Mental clouding, headache, and dizziness were the most common presenting symptoms. Thirty-one diagnosed cases were associated with an identified impact event; in 17 cases no specific impact event was identified. Onset of symptoms was immediate in 24 players, delayed in 11, and unspecified in 13. In 8 cases the diagnosis was made immediately after a head impact, but in most cases the diagnosis was delayed (median 17 hours). One diagnosed concussion involved a 30-second loss of consciousness; all other players retained alertness. Most diagnoses were based on self-reported symptoms. The mean peak angular and rotational acceleration values for those cases associated with a specific identified impact were 86.1 ±42.6g (range 16.5-177.9g) and 3620 ± 2166 rad/sec2 (range 183-7589 rad/sec2), respectively. Conclusions. Approximately two-thirds of diagnosed concussions were associated with a specific contact event. Half of all players diagnosed with concussions had delayed or unclear timing of onset of symptoms. Most had no externally observed findings. Diagnosis was usually based on a range of self-reported symptoms after a variable delay. Accelerations clustered in the higher percentiles for all impact events, but encompassed a wide range. These data highlight the heterogeneity of criteria for concussion diagnosis, and in this sports context, its heavy reliance on self-reported symptoms. More specific and standardized definitions of clinical and objective correlates of a "concussion spectrum" may be needed in future research efforts, as well as in the clinical diagnostic arena.

KW - Athletes

KW - Biomechanics

KW - Concussion

KW - Football

KW - Hockey

KW - Traumatic brain injury

UR - http://www.scopus.com/inward/record.url?scp=84870943815&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84870943815&partnerID=8YFLogxK

U2 - 10.3171/2012.8.JNS112298

DO - 10.3171/2012.8.JNS112298

M3 - Article

C2 - 23030057

AN - SCOPUS:84870943815

VL - 117

SP - 1092

EP - 1099

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 6

ER -