Browsing by Author "Marshall, Stephen W."

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    Association between concussion and mental health in former collegiate athletes
    (Springer, 2014-12) Kerr, Zachary Y.; Evenson, Kelly R.; Rosamond, Wayne D.; Mihalik, Jason P.; Guskiewicz, Kevin M.; Marshall, Stephen W.; Department of Social and Behavioral Sciences, Richard M. Fairbanks School of Public Health
    BACKGROUND: The existing research on the association between concussion and mental health outcomes is largely limited to former professional athletes. This cross-sectional study estimated the association between recurrent concussion and depression, impulsivity, and aggression in former collegiate athletes. METHODS: Former collegiate athletes who played between 1987-2012 at a Division I university completed an online questionnaire. The main exposure, total number of self-recalled concussions (sport-related and non-sport-related), were categorized as: zero (referent), one, two, or three or more concussions. The main outcomes were the depression module of The Patient Health Questionnaire (PHQ-9), the Short Form of the Barratt Impulsiveness scale (BIS15); and the 12-item Short Form of the Buss-Perry Aggression Questionnaire (BPAQ-SF). Depression was categorized into a binomial severity classification that differentiated between no or mild depression (PHQ-9 scores <10) and moderate to severe depression (PHQ-9 scores ≥10). Impulsivity and aggression were kept as continuous outcomes. Binomial regression estimated adjusted prevalence ratios (PR). Linear regression estimated adjusted mean differences (MD). RESULTS: Of the 797 respondents with complete data (21.9% completion rate), 38.8% reported at least one concussion. Controlling for alcohol dependence and family history of depression, the prevalence of moderate to severe depression among former collegiate athletes reporting three or more concussions in total was 2.4 times that of those reporting zero concussions [95% Confidence Interval (CI): 1.0, 5.7]. Controlling for alcohol dependence, family history of anxiety, relationship status, obtaining a post-graduate degree, and playing primary college sport professionally, former collegiate athletes reporting two or more concussions in total had higher mean scores for impulsivity, compared to those reporting no concussions (2 concussions MD = 2.7; 95% CI: 1.2, 4.1; 3+ concussions MD = 1.9; 95% CI: 0.6, 3.2). Controlling for alcohol dependence, sex, and relationship status, former collegiate athletes reporting three or more concussions in total had a higher mean score for aggression, compared to those reporting no concussions (MD = 3.0; 95% CI: 1.4, 4.7). CONCLUSIONS: Our study found an association between former concussion and greater risk of severe depression and higher levels of impulsivity and aggression among former collegiate athletes. Additional prospective studies better addressing causality and ascertaining valid lifetime concussion histories and medical histories are needed.
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    Injury Rates in Age-Only Versus Age-and-Weight Playing Standard Conditions in American Youth Football
    (SAGE Publications, 2015-09) Kerr, Zachary Y.; Marshall, Stephen W.; Simon, Janet E.; Hayden, Ross; Snook, Erin M.; Dodge, Thomas; Gallo, Joseph A.; Valovich McLeod, Tamara C.; Mensch, James; Murphy, Joseph M.; Nittoli, Vincent C.; Dompier, Thomas P.; Ragan, Brian; Yeargin, Susan W.; Parsons, John T.; School of Health and Rehabilitation Sciences
    BACKGROUND: American youth football leagues are typically structured using either age-only (AO) or age-and-weight (AW) playing standard conditions. These playing standard conditions group players by age in the former condition and by a combination of age and weight in the latter condition. However, no study has systematically compared injury risk between these 2 playing standards. PURPOSE: To compare injury rates between youth tackle football players in the AO and AW playing standard conditions. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Athletic trainers evaluated and recorded injuries at each practice and game during the 2012 and 2013 football seasons. Players (age, 5-14 years) were drawn from 13 recreational leagues across 6 states. The sample included 4092 athlete-seasons (AW, 2065; AO, 2027) from 210 teams (AW, 106; O, 104). Injury rate ratios (RRs) with 95% CIs were used to compare the playing standard conditions. Multivariate Poisson regression was used to estimate RRs adjusted for residual effects of age and clustering by team and league. There were 4 endpoints of interest: (1) any injury, (2) non-time loss (NTL) injuries only, (3) time loss (TL) injuries only, and (4) concussions only. RESULTS: Over 2 seasons, the cohort accumulated 1475 injuries and 142,536 athlete-exposures (AEs). The most common injuries were contusions (34.4%), ligament sprains (16.3%), concussions (9.6%), and muscle strains (7.8%). The overall injury rate for both playing standard conditions combined was 10.3 per 1000 AEs (95% CI, 9.8-10.9). The TL injury, NTL injury, and concussion rates in both playing standard conditions combined were 3.1, 7.2, and 1.0 per 1000 AEs, respectively. In multivariate Poisson regression models controlling for age, team, and league, no differences were found between playing standard conditions in the overall injury rate (RRoverall, 1.1; 95% CI, 0.4-2.6). Rates for the other 3 endpoints were also similar (RRNTL, 1.1 [95% CI, 0.4-3.0]; RRTL, 0.9 [95% CI, 0.4-1.9]; RRconcussion, 0.6 [95% CI, 0.3-1.4]). CONCLUSION: For the injury endpoints examined in this study, the injury rates were similar in the AO and AW playing standards. Future research should examine other policies, rules, and behavioral factors that may affect injury risk within youth football.
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    Methods and Descriptive Epidemiology of Services Provided by Athletic Trainers in High Schools: The National Athletic Treatment, Injury and Outcomes Network Study
    (National Athletic Trainers' Association, 2015-12) Kerr, Zachary Y.; Dompier, Thomas P.; Dalton, Sara L.; Miller, Sayers John; Hayden, Ross; Marshall, Stephen W.; Department of Social and Behavioral Sciences, Richard M. Fairbanks School of Public Health
    CONTEXT: Research is limited on the extent and nature of the care provided by athletic trainers (ATs) to student-athletes in the high school setting. OBJECTIVE: To describe the methods of the National Athletic Treatment, Injury and Outcomes Network (NATION) project and provide the descriptive epidemiology of AT services for injury care in 27 high school sports. DESIGN: Descriptive epidemiology study. SETTING: Athletic training room (ATR) visits and AT services data collected in 147 high schools from 26 states. PATIENTS OR OTHER PARTICIPANTS: High school student-athletes participating in 13 boys' sports and 14 girls' sports during the 2011-2012 through 2013-2014 academic years. MAIN OUTCOME MEASURE(S): The number of ATR visits and individual AT services, as well as the mean number of ATR visits (per injury) and AT services (per injury and ATR visit) were calculated by sport and for time-loss (TL) and non-time-loss (NTL) injuries. RESULTS: Over the 3-year period, 210 773 ATR visits and 557 381 AT services were reported for 50 604 injuries. Most ATR visits (70%) were for NTL injuries. Common AT services were therapeutic activities or exercise (45.4%), modalities (18.6%), and AT evaluation and reevaluation (15.9%), with an average of 4.17 ± 6.52 ATR visits and 11.01 ± 22.86 AT services per injury. Compared with NTL injuries, patients with TL injuries accrued more ATR visits (7.76 versus 3.47; P < .001) and AT services (18.60 versus 9.56; P < .001) per injury. An average of 2.24 ± 1.33 AT services were reported per ATR visit. Compared with TL injuries, NTL injuries had a larger average number of AT services per ATR visit (2.28 versus 2.05; P < .001). CONCLUSIONS: These findings highlight the broad spectrum of care provided by ATs to high school student-athletes and demonstrate that patients with NTL injuries require substantial amounts of AT services.
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    The National Athletic Treatment, Injury and Outcomes Network (NATION): Methods of the Surveillance Program, 2011-2012 Through 2013-2014
    (National Athletic Trainers' Association, 2015-08) Dompier, Thomas P.; Marshall, Stephen W.; Kerr, Zachary Y.; Hayden, Ross; Department of Epidemiology, Richard M. Fairbanks School of Public Health
    CONTEXT: Previous epidemiologic researchers have examined time-loss (TL) injuries in high school student-athletes, but little is known about the frequency of non-time-loss (NTL) injuries in these athletes. OBJECTIVE: To describe the methods of the National Athletic Treatment, Injury and Outcomes Network (NATION) Surveillance Program and provide descriptive epidemiology of TL and NTL injuries across athletes in 27 high school sports. DESIGN: Descriptive epidemiology study. SETTING: Aggregate injury and exposure data collected from 147 high schools in 26 states. PATIENTS OR OTHER PARTICIPANTS: High school student-athletes participating in 13 boys' sports and 14 girls' sports during the 2011-2012 through 2013-2014 academic years. MAIN OUTCOME MEASURE(S): Athletic trainers documented injuries and exposures using commercially available injury-tracking software packages. Standard injury-tracking software was modified by the software vendors to conform to the surveillance needs of this project. The modified software exported a set of common data elements, stripped of personally identifiable information, to a centralized automated verification and validation system before they were included in the centralized research database. Dependent measures were injury and exposure frequencies and injury rates with 95% confidence intervals stratified by sport, sex, and injury type (TL or NTL). RESULTS: Over the 3-year period, a total of 2337 team seasons across 27 sports resulted in 47 014 injuries and 5 146 355 athlete-exposures. The NTL injuries accounted for 38 765 (82.45%) and TL injuries for 8249 (17.55%) of the total. CONCLUSIONS: The NTL injuries accounted for a substantial amount of the total number of injuries sustained by high school student-athletes. This project demonstrates the feasibility of creating large-scale injury surveillance systems using commercially available injury-tracking software.
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    National collegiate athletic association injury surveillance system: review of methods for 2004-2005 through 2013-2014 data collection
    (National Athletic Trainers’ Association, 2014-07) Kerr, Zachary Y.; Dompier, Thomas P.; Snook, Erin M.; Marshall, Stephen W.; Klossner, David; Hainline, Brian; Corlette, Jill; Department of Health Sciences, School of Health and Rehabilitation Sciences
    BACKGROUND: Since 1982, the National Collegiate Athletic Association has used the Injury Surveillance System (ISS) to collect injury and athlete-exposure data from a representative sample of collegiate institutions and sports. At the start of the 2004-2005 academic year, a Web-based ISS replaced the paper-based platform previously used for reporting injuries and exposures. OBJECTIVE: To describe the methods of the Web-based National Collegiate Athletic Association ISS for data collection as implemented from the 2004-2005 to 2013-2014 academic years. DESCRIPTION: The Web-based ISS monitored National Collegiate Athletic Association-sanctioned practices and competitions, the number of participating student-athletes, and time-loss injuries during the preseason, regular season, and postseason in 25 collegiate sports. Starting in the 2009-2010 academic year, non-time-loss injuries were also tracked. Efforts were made to better integrate ISS data collection into the workflow of collegiate athletic trainers. Data for the 2004-2005 to 2013-2014 academic years are available to researchers through a standardized application process available at the Datalys Center Web site. CONCLUSIONS: As of February 2014, more than 1 dozen data sets have been provided to researchers. The Datalys Center encourages applications for access to the data.
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    Return to play and risk of repeat concussion in collegiate football players: comparative analysis from the NCAA Concussion Study (1999–2001) and CARE Consortium (2014–2017)
    (BMJ, 2020) McCrea, Michael; Broglio, Steven P.; McAllister, Thomas; Zhou, Wenxian; Zhao, Shi; Katz, Barry P.; Kudela, Maria; Harezlak, Jaroslaw; Nelson, Lindsay D.; Meier, Timothy B.; Marshall, Stephen W.; Guskiewicz, Kevin; Psychiatry, School of Medicine
    Objective We compared data from the National Collegiate Athletic Association (NCAA) Concussion Study (1999–2001) and the NCAA-Department of Defense Concussion Assessment, Research and Education (CARE) Consortium (2014–2017) to examine how clinical management, return to play (RTP) and risk of repeat concussion in collegiate football players have changed over the past 15 years. Methods We analysed data on reported duration of symptoms, symptom-free waiting period (SFWP), RTP and occurrence of within-season repeat concussion in collegiate football players with diagnosed concussion from the NCAA Study (n=184) and CARE (n=701). Results CARE athletes had significantly longer symptom duration (CARE median=5.92 days, IQR=3.02–9.98 days; NCAA median=2.00 days, IQR=1.00–4.00 days), SFWP (CARE median=6.00 days, IQR=3.49–9.00 days; NCAA median=0.98 days, IQR=0.00–4.00 days) and RTP (CARE median=12.23 days, IQR=8.04–18.92 days; NCAA median=3.00 days, IQR=1.00–8.00 days) than NCAA Study athletes (all p<0.0001). In CARE, there was only one case of repeat concussion within 10 days of initial injury (3.7% of within-season repeat concussions), whereas 92% of repeat concussions occurred within 10 days in the NCAA Study (p<0.001). The average interval between first and repeat concussion in CARE was 56.41 days, compared with 5.59 days in the NCAA Study (M difference=50.82 days; 95% CI 38.37 to 63.27; p<0.0001). Conclusion Our findings indicate that concussion in collegiate football is managed more conservatively than 15 years ago. These changes in clinical management appear to have reduced the risk of repetitive concussion during the critical period of cerebral vulnerability after sport-related concussion (SRC). These data support international guidelines recommending additional time for brain recovery before athletes RTP after SRC.
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    School-level determinants of incidence of sports-related concussion: Findings from the CARE Consortium
    (Public Library of Science, 2023-04-10) Singichetti, Bhavna; Marshall, Stephen W.; Breedlove, Katherine M.; Cameron, Kenneth L.; McCrea, Michael A.; McAllister, Thomas W.; Broglio, Steven P.; CARE Consortium Investigators; Psychiatry, School of Medicine
    Objective: Epidemiologic research on sports-related concussion (SRC) has focused on individual risk factors, with limited research on institutional risk factors and variability in concussion rates. Methods: This study used data from 53,822 athletes-seasons collected at 30 United States sites (26 civilian institutions and 4 military service academies), from 2014/15 to 2018/19 academic years, by the Concussion Assessment, Research, and Education Consortium. School-level risk factors included competitive division (DI, DII, DIII), school type (military/civilian) and a Sport Risk Index (SRI; Low, Medium, High). For comparability between civilian institutions and military academies, only NCAA athletes and concussions in sports games and practices were included. Random intercepts log-binomial regression was used to estimate Risk Ratios (RRs) and model variability in SRC risk. Results: A total of 2,503 SRCs were observed during the study period, including 829 competition SRCs (33%) and 1,674 practice SRCs (67%). Most variability in SRC risk was at the level of athlete or team (within-school), rather than at the school-level. Specifically, across the three SRC outcomes (all [competition and practice combined], competition-only, and practice-only), within-school variability was 5 to 7 times greater than between-school variability. Three school-level risk factors (Division, School Type, and SRI) accounted for over one-third (36%) of between-school variability. SRI was the strongest school-level predictor of SRC risk (RR = 5.7; 95%CI: 4.2, 7.6 for High vs. Low). SRC risk was higher for Division I compared to Divisions II/III (RR = 1.6; 95%CI: 0.9, 2.9 for DI vs. DIII), and military academies had a moderately elevated risk of SRC (RR = 1.4; 95%CI: 0.7, 2.7). Conclusion: A large portion of the apparent variability between schools was attributable to structural factors (sport risk and competitive level), suggesting that there were minimal systemic differences in concussion identification between schools. While most variability is within-school, understanding school-level determinants of concussion risk may still be important in providing the implementation science context for individual-level interventions.