Mild Traumatic Brain Injury in Major and Minor League Baseball Players

Green, Gary A.; Pollack, Keshia M.; D’Angelo, John; Schickendantz, Mark S.; Caplinger, Roger; Weber, Kathleen M.; Valadka, Alex B.; McAllister, Thomas W.; Dick, Randall W.; Mandelbaum, Bert R.; Curriero, Frank C.

doi:10.1177/0363546514568089

Cited by 46 publications

(77 citation statements)

References 13 publications

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“…During the first year of this electronic system, 161 concussions were recorded in the minor league and 29 in the major league, pointing to the need for improved concussion management. 18 MLB responded to this growing concern regarding concussions and the impact on player performance by implementing a standard concussion protocol at the start of the 2011-2012 season. 21,28,36,39 The protocol requires preseason neurocognitive baseline testing in the form of the SCAT5, use of the SCAT5 as a standardized concussion screening tool during play, the addition of a 7-day DL exclusively for concussed players, neurological evaluation demonstrating a return to baseline before returning to play, and prohibition of same-day return to play.…”

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confidence: 99%

Concussion Incidence and Impact on Player Performance in Major League Baseball Players Before and After a Standardized Concussion Protocol

Peterson

Tjong

Terry

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Sports-related concussions have garnered significant attention in recent years because of the negative effects they can have on a player’s cognitive health and performance. In response to this growing concern, Major League Baseball (MLB) introduced a standardized concussion protocol during the 2011-2012 season. Purpose/Hypothesis: The purpose of this study was to compare the reported incidence of concussions and the subsequent performance of MLB players before and after the introduction of the standardized concussion protocol. We hypothesized that the introduction of the standardized concussion protocol would not have an impact on player performance postconcussion. Study Design: Cohort study; Level of evidence, 3. Methods: Players who suffered a concussion between 2001 and 2018 were identified from the MLB transactions page. Incidence and player performance were compared before and after the introduction of the standardized concussion protocol. Player performance was evaluated using traditional data and sabermetric data, which are advanced statistics used in conjunction with standard statistics to better compare players and teams. Player averages were calculated and compared using paired t tests for 30 days before and after concussion, 1 year before and after concussion, and career before and after concussion. Averages were also compared before and after the institution of the standardized concussion protocol using independent-measures t tests. Results: There were a total of 114 players who suffered 142 concussions, with 77% of those occurring after the introduction of the concussion protocol (32 before, 110 after). The average time missed because of concussion significantly decreased from 33.7 days (range, 10-122 days) to 18.9 days (range, 6-111 days) after the concussion protocol ( P = .0005). There was no difference in player performance (including batting average, on-base percentage, and slugging for batters; earned run average, fielding-independent pitching, and walks plus hits per inning pitched for pitchers) after concussion at any time point (30 days, 1 year, or career) when comparing these statistics before versus after the MLB concussion protocol. However, batter performance was significantly poorer 1 year after concussion and over the remainder of the players' careers ( P < .05). Conclusion: The number of reported concussions increased after the introduction of the MLB concussion protocol. However, players spent significantly less time on the disabled list without any adverse effect on player performance. Despite these changes, long-term batting performance was significantly poorer after concussion.

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confidence: 99%

Concussion Incidence and Impact on Player Performance in Major League Baseball Players Before and After a Standardized Concussion Protocol

Peterson

Tjong

Terry

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…14 The risk of traumatic brain injury is not new to the sport, with long-term outcomes increasingly investigated. 7 Although full-contact sports with repetitive neurotrauma have been linked to neurocognitive changes, the study of the short-term considerations after a player sustains SRC in limited-contact sports is also clinically relevant. 25 Performance and financial changes have relevance to individual players as well as franchises in strategic decision making regarding contract negotiations, trades, and acquisitions.…”

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Short-Term Outcomes of Concussions in Major League Baseball: A Historical Cohort Study of Return to Play, Performance, Longevity, and Financial Impact

Ramkumar

Navarro

Haeberle

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:The short-term outcomes of concussions within Major League Baseball (MLB) warrant further consideration beyond a medical standpoint given that performance, career, and financial data remain unknown. The perception of this injury directly affects decision making from the perspective of both player and franchise.Purpose:To evaluate the effect of concussion on MLB players by (1) establishing return-to-play (RTP) time after concussion; (2) comparing the career length and performance of players with concussion versus those who took nonmedical leave; and (3) analyzing player financial impact after concussion.Study Design:Cohort study; Level of evidence, 3.Methods:Contracts, transactions, injury reports, and performance statistics from 2005 to 2017 were analyzed by comparing matched players who sustained a concussion versus those who took nonmedical leave. Of the 4186 eligible MLB players, 145 sustained concussions resulting in the activation of concussion protocol and 538 took nonmedical leave. RTP time was recorded. Career length was analyzed in reference to an experience-based stratification of full seasons remaining after the concussion. Changes in player performance and salary before and after concussion were compared with the same parameters for players who took nonmedical leave.Results:The mean RTP time was 26 days (95% CI, 20-32 days) for athletes with concussion and 8 days (95% CI, 6-10 days) for those who took nonmedical leave. Athletes with concussion had a mean of 2.8 full seasons remaining, whereas athletes who took nonmedical leave had 3.1 seasons remaining (P = .493). The probability of playing in the MLB after concussion compared with the nonmedical leave pool was not significantly lower (P = .534, log-rank test; hazard ratio, 1.108). Postconcussion performance decreased significantly in position players, including a lower batting average and decreased on-base percentage in the players with concussion compared with those returning from nonmedical leave. Players who sustained a concussion lost a mean of US$654,990 annually compared with players who took nonmedical leave.Conclusion:This study of the short-term outcomes after concussion in limited-contact MLB athletes demonstrates that concussions may not decrease career spans but may result in decreased performance in addition to financial loss when compared with matched controls who took nonmedical leave. In sports such as baseball that are not subject to repetitive head trauma, career spans may not decrease after a single concussive event. However, sentinel concussions have deleterious short-term effects on performance and compensation among MLB players.

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“…Although a consistent definition of TBI was not found among the included studies, concussion was the most commonly identified outcome of interest (Table 3 ). Further, TBI rates varied according to sex ( 22 ), level of play ( 19 , 20 ) (high school, collegiate, major, and minor leagues) and whether it was a game or practice ( 18 , 28 ). The average injury rate (Table 4 ) per 1,000 athletic exposures (AE) was 0.13 (range 0.03–0.46) ( 20 , 33 ).…”

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confidence: 99%

“…Further, TBI rates varied according to sex ( 22 ), level of play ( 19 , 20 ) (high school, collegiate, major, and minor leagues) and whether it was a game or practice ( 18 , 28 ). The average injury rate (Table 4 ) per 1,000 athletic exposures (AE) was 0.13 (range 0.03–0.46) ( 20 , 33 ). The most common mechanisms of injury (Table 5 ) included being struck (by a ball or bat) ( 17 ) and colliding with another player ( 31 ).…”

Section: Resultsmentioning

confidence: 99%

“…The most common mechanisms of injury (Table 5 ) included being struck (by a ball or bat) ( 17 ) and colliding with another player ( 31 ). The distributions across these common mechanisms, however, varied according to age ( 17 ), gender ( 27 ), and level of play ( 20 , 31 ). Finally, an increase in baseball- and softball-related TBIs was observed over time ( 26 ).…”

Section: Resultsmentioning

confidence: 99%

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Systematic Review of Traumatic Brain Injuries in Baseball and Softball: A Framework for Prevention

Cusimano

Zhu

2017

Front. Neurol.

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BackgroundTraumatic brain injuries (TBIs) are an important public health challenge. The classification of baseball and softball as low contact sports and their association with extremity injuries cause individuals to overlook the risk of TBI in baseball and softball.PurposeTo summarize our knowledge of the epidemiology and risk factors of TBIs associated with baseball and softball with an aim to better design and implement preventive strategies.MethodsA search algorithm containing keywords that were synonymous to the terms “TBI,” “baseball” was applied to the following nine databases: MEDLINE, Scopus, PubMed, EMBASE, CINAHL, Healthstar, PsychINFO, AMED, Cochrane library. Cited reference lists of identified articles were also consulted yielding a total of eighty-eight articles for full review. The search was concluded on November 14, 2016. The level of evidence was evaluated according to the guidelines from Strengthening the Reporting of Observational Studies in Epidemiology statement.ResultsTwenty-nine articles published between 2000 and 2016 met the criteria for analysis. Collectively, they examined the years 1982–2015 and identified 242,731 baseball-and softball-related TBIs. The most explored outcome of TBI was concussion. The average injury rate per 1,000 athletic exposures was 0.13 (range 0.03–0.46). The most common mechanism of injury was being struck by bat for younger players and being struck by ball for older athletes (adolescent and beyond). Rates of TBI were on average 4.17 times greater in games compared to practices. Females were on average 2.04 times more likely to sustain a TBI than males. Severity of TBIs varied considerably from mild and returning to the field on the same day, to immediate death. Generally, there is poor compliance with helmet use and return-to-play post-concussion guidelines. An increase TBI rates was observed over time. Multifaceted preventive strategies must be implemented to reduce the frequency and burden of these injuries.ConclusionIt is difficult to compare the epidemiologic trends of TBI in baseball and softball due critical differences in the methods employed across the studies. Additional research is needed to provide a greater understanding of baseball- and softball-related TBI and to aid in the development of prevention and management modules.

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Mild Traumatic Brain Injury in Major and Minor League Baseball Players

Abstract: Mild traumatic brain injury is an important problem in professional baseball players, especially for catchers. This study provides a foundation for future inquiry to reduce the incidence of MTBI in those positions at greatest risk and to provide a baseline as rules and equipment evolve.

Cited by 46 publications

References 13 publications

Concussion Incidence and Impact on Player Performance in Major League Baseball Players Before and After a Standardized Concussion Protocol

Concussion Incidence and Impact on Player Performance in Major League Baseball Players Before and After a Standardized Concussion Protocol

Short-Term Outcomes of Concussions in Major League Baseball: A Historical Cohort Study of Return to Play, Performance, Longevity, and Financial Impact

Systematic Review of Traumatic Brain Injuries in Baseball and Softball: A Framework for Prevention

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