Multiple Past Concussions in High School Football Players

Abstract

Background There is increasing concern about the possible long-term effects of multiple concussions, particularly on the developing adolescent brain. Whether the effect of multiple concussions is detectable in high school football players has not been well studied, although the public health implications are great in this population. Purpose To determine if there are measureable differences in cognitive functioning or symptom reporting in high school football players with a history of multiple concussions. Study Design Cross-sectional study; Level of evidence, 3. Methods Participants included 5232 male adolescent football players (mean [±SD] age, 15.5 ± 1.2 years) who completed baseline testing between 2009 and 2014. On the basis of injury history, athletes were grouped into 0 (n = 4183), 1 (n = 733), 2 (n = 216), 3 (n = 67), or ≥4 (n = 33) prior concussions. Cognitive functioning was measured by the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery, and symptom ratings were obtained from the Post-Concussion Symptom Scale. Results There were no statistically significant differences between groups (based on the number of reported concussions) regarding cognitive functioning. Athletes with ≥3 prior concussions reported more symptoms than did athletes with 0 or 1 prior injury. In multivariate analyses, concussion history was independently related to symptom reporting but less so than developmental problems (eg, attention or learning problems) or other health problems (eg, past treatment for psychiatric problems, headaches, or migraines). Conclusion In the largest study to date, high school football players with multiple past concussions performed the same on cognitive testing as those with no prior concussions. Concussion history was one of several factors that were independently related to symptom reporting.

Investigating Effects of Sex Differences and Prior Concussions on Symptom Reporting and Cognition Among Adolescent Soccer Players

“…This association was considerably attenuated but remained significant after controlling for other factors that more likely contributed to current postconcussion-like symptom reporting, including demographics (being an older adolescent, being female), developmental history (ADHD, learning disabilities), and psychological history (aim 2). In fact, prior mental health treatment was the strongest predictor for greater symptom reporting among these youth soccer players and is consistent with the findings from mixed-sport youth samples 33,37 and a large youth football sample 5 recruited from this same statewide cohort.…”

“…Based on previous work with youth who have a history of concussions, 5,6,37,47,61 the following was hypothesized:…”

“…Based on previous work with youth who have a history of concussions, 5,6,37,47,61 the following was hypothesized: (1) there would be no differences in cognitive test performance between those with and without prior concussions, but those with prior concussions would report more baseline preseason symptoms, and (2) factors other than prior concussions would predict cognition and symptoms. Based on prior work comparing cognition and symptoms between boys and girls with prior concussions, 7,61 the following was hypothesized: (3) girls with prior concussions would not have worse cognitive functioning and would not report more symptoms than boys with prior concussions when accounting for sex differences on tests and symptom questionnaires among noninjured youth.…”

Predictors of clinical recovery from concussion: a systematic review

“…Prior to injury, girls and young women report more symptoms than boys and young men in most studies. 10 60 People with pre-existing developmental or health problems, such as ADHD, 60 133–135 learning problems, 60 134 135 a history of mental health 60 or substance abuse problems, 60 a history of treatment for headaches 61 or migraines, 60 or multiple prior concussions 60 61 129 report more symptoms than people who do not have these conditions.…”

Acute Sport Concussion Assessment Optimization: A Prospective Assessment from the CARE Consortium

“…Developmental status and trajectories at the younger ages may find different points of interpretation for any number of measures, but particularly where symptoms and motorcontrol measures are concerned [21,22]. In addition, a number of pre-morbid conditions (e.g., concussion history) may influence baseline and/or post-injury performance [23].…”