Sport-related concussion return-to-play practices of medical team staff in elite football in the United Kingdom

Rosenbloom, Craig; Chatterjee, Robin; Chu, Wing; Broman, Daniel; Kryger, Katrine Okholm

doi:10.1080/24733938.2021.1983921

Cited by 7 publications

(4 citation statements)

References 28 publications

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“…Symptom burden (severity and number) symptom evaluation list [15]. Participants rated their symptoms for 22 items on a 7-point scale, consisting of none (0), mild (1-2), moderate (3)(4), or severe (5)(6). Measures consisted of the total number of symptoms (out of 22) and the symptom severity, which was a total sum of all symptoms (out of 132).…”

Section: Resultsmentioning

confidence: 99%

“…Although the subjective symptom checklists are widely used, the American Medical Society for Sports Medicine notes that current methods of evaluation and monitoring may not reflect physiologic recovery [4]. Additionally, while many clinicians feel confident about managing SRC, there is concern about the accuracy of player-reported symptoms as players may underreport to return earlier to sport [5]. Tracking physiologic recovery quantitatively may offer a less subjective and more personalized method of evaluation and management of SRC.…”

Section: Introductionmentioning

confidence: 99%

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Investigation on the Relationship between Metabolic Changes and Symptom Burden in Sport-Related Concussion Recovery

Allyn,

José R,

Ryan N

2024

Int J Brain Disord Treat

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Background: A sport-related concussion (SRC) is a mild traumatic brain injury resulting from impulsive forces in sports, often presenting various symptoms. Clinicians lack objective measures and rely on subjective patient reports (via symptom checklists or inventories) to guide return-toplay decisions. These methods, however, may not reflect physiologic recovery, with concern over the under-reporting of symptoms to return to activity quicker. Quantitative tracking of physiologic recovery could offer a more personalized approach to treating concussion. Following concussion, neurometabolic events unfold impacting neuronic membranes and disrupting ionic balance. Sodiumpotassium pumps increase, boosting ATP production but depleting glucose as well leading to an inability to utilize glucose effectively. During this period alternative energy substrates may be used potentially including ketone bodies. Acetone, a ketone body that is produced when the main ketone body is broken down to be used for energy, is small and able to be exhaled in the breath and measured non-invasively. Tracking the altered metabolism and understanding how those changes affect symptomology could offer a quantitative measure useful for clinicians. This study, part of the BrACKS initiative, aims to explore breath acetone as a marker for concussion recovery, assessing its association with symptom severity and number. Methods:In this cross-sectional study six collegiate athletes from a single Division I university including (N = 5) football players, and (N = 1) soccer player diagnosed with a SRC during their competitive season were recruited for the study. Breath acetone was measured in parts per million by portable breathalyzer and symptoms measured by the Sport Concussion Assessment Tool (SCAT-5) daily until participants were 14 days post-concussion or cleared to return to activity. Statistical assessments evaluating the dependency of breath acetone on symptom measures, exploring the relationship between daily changes in breath acetone and symptom measures, and determining how larger or smaller changes in symptoms affect breath acetone.Results: Breath acetone exhibited individualized patterns like symptom severity and number. No significant association was found between breath acetone and symptom severity or number, but a significant associative relationship was observed in daily changes between breath acetone and symptom number. Conclusion:While breath acetone did not show a direct association with symptom burden, the study suggests potential for quantitative biomarkers to complement traditional symptom tracking. Further longitudinal research with larger cohorts is essential for understanding this relationship and making recommendations.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Investigation on the Relationship between Metabolic Changes and Symptom Burden in Sport-Related Concussion Recovery

Allyn,

José R,

Ryan N

2024

Int J Brain Disord Treat

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“…Due to a discrepancy in the understanding of the mechanism and severity of concussion, it has been reported that many players and coaches did not believe that concussion can impair performance [ 30 ]. As has been recorded in the literature, coaches can pressure medical staff to clear players to play and manipulate the RTP process [ 32 , 33 ]. Where medical staff and clinicians are reported to have pressured players to return prematurely, this type of practice will only further compromise the long-term health of the players in many facets.…”

Section: Discussionmentioning

confidence: 99%

Protect the Player, Protect the Game: Reflections from Ex-Professional Rugby Union Players on Law Changes, Protective Equipment, and Duty of Care in the Professional Game

Daly

Blackett

Pearce

et al. 2022

JFMK

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The emphasis of this study was to interview ex-professional male rugby union players (n = 23, mean age 35.5 ± 4.7 years) and discuss concussion management during their careers. In this study, two major themes were identified: (1) the duty of care to professional rugby union players by medical personnel, coaching staff, and owners of professional clubs and (2) the use of protective equipment and law changes to enhance player safety. In total, twenty-three ex-professional rugby union players were interviewed, and the majority (61%) had represented their countries at international test-level rugby. These interviews highlighted the belief that medical teams should be objective, independent entities within a professional rugby club. Furthermore, medical teams should not be in a position of being pressurised by head coaches, members of the coaching team, or club owners regarding return-to-play (RTP) protocols specific to concussion. The interviewees believed that they were pressured by coaches or members of the coaching team to play with concussion or concussive symptoms and other physical injuries. The results indicated that they had manipulated concussion testing themselves or with assistance to pass standard concussion testing protocols. The interviewees indicated that club owners have a duty of care to players even in retirement due to the high incidence of physical and mental injuries endured as a professional rugby player. Most participants indicated that a reduction in match playing time and reducing the amount of time engaged in contact training (workload volume) may assist in reducing concussion incidence. The participants suggested that changes to the current laws of the game or the use of protective equipment did not mitigate against concussion risk in the game of rugby union. The main limitation to the study is that participants had retired in the past ten years, and conditions for players may have changed. This study has highlighted that additional efforts are required by professional clubs to ensure the highest duty of care is delivered to current players and recently retired players.

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“…If an activity provokes a symptom, athletes are moved back one stage of the protocol [ 1 ]. Yet, this assessment has also been criticized by clinicians for the possible underreporting of symptoms due to the subjective nature of the tool [ 6 ]. Attempts have been made to strengthen diagnosis of concussion via the addition of objective markers of the physiologic consequences post-concussion rather than relying solely on signs and symptoms.…”

Section: Introductionmentioning

confidence: 99%

Differences in Volatile Organic Compounds Between Concussed and Non-concussed Division I Athletes

Abadie,

McKeag,

Springer

et al. 2024

Cureus

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IntroductionDiagnosing a concussion is challenging because of complex and variable symptoms. Establishing a viable biomarker of injury may rely on physiologic measurements rather than symptomology. Volatile organic compounds (VOCs) such as breath acetone have been identified as potential physiological markers that can capture changes in the utilization of energy substrates post-concussion. Here, we aimed to explore whether differences in VOCs exist between concussed and non-concussed athletes at the initial and later stages of injury recovery. MethodsSix (N=6) non-concussed athletes were enrolled as control participants prior to the competitive season. Control participants' breath acetone, heart rate, and anthropometric measures were obtained at rest and throughout a single exercise challenge by breathalyzer. Six (N=6) athletes diagnosed with concussion during the competitive season had breath acetone measured daily until cleared to return to activity or approximately four weeks following enrollment where they participated in an exit exercise challenge having breath acetone, heart rate, and anthropometric measures obtained. Comparisons were made between at-rest measures of concussed and non-concussed participants at multiple time points during the recovery period. Paired t-test comparisons with individuals serving as their own control were used to determine individual differences in recovery. Visual graphs were used to demonstrate differences in obtained measures amongst individuals and between groups during the exercise challenges. ResultsResults demonstrated statistically significant differences in breath acetone between concussed and control participants when the highest day measured during the first week of concussion was compared to the control participant's resting values (P=0.017). Additionally, when the concussed participants served as their own control and their highest measured day of the first week post-concussion was compared to values when cleared to return to activity or at 26 days post-concussion, there was a significant difference in breath acetone (P=0.028). Comparing breath acetone during exercise between non-concussed and cleared concussed participants or four weeks post-injury, demonstrated no significant differences throughout the challenge or at rest prior. Visual graph comparisons in a single participant before and after concussion suggest differences may appear following exercise during the recovery period. DiscussionThese results suggest VOCs, particularly breath acetone, have the potential to serve as diagnostic markers of concussion. However, longitudinal research within larger cohorts and with equipment able to expel VOCs other than acetone from measures are needed to make informed recommendations.

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Sport-related concussion return-to-play practices of medical team staff in elite football in the United Kingdom

Cited by 7 publications

References 28 publications

Investigation on the Relationship between Metabolic Changes and Symptom Burden in Sport-Related Concussion Recovery

Investigation on the Relationship between Metabolic Changes and Symptom Burden in Sport-Related Concussion Recovery

Protect the Player, Protect the Game: Reflections from Ex-Professional Rugby Union Players on Law Changes, Protective Equipment, and Duty of Care in the Professional Game

Differences in Volatile Organic Compounds Between Concussed and Non-concussed Division I Athletes

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