Browsing by Author "Ortega, Justus D."

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    Association of Premorbid Anxiety and Depression Symptoms in Concussion Recovery in Collegiate Student-Athletes
    (Sage, 2024-06-04) Sawlani, Sabrina P.; Goldman, Joshua T.; Babikian, Talin; McArthur, David L.; Polster, Douglas; McCrea, Michael; McAllister, Thomas; Giza, Christopher C.; CARE Consortium; CARE Consortium Investigators; Ortega, Justus D.; Port, Nicholas; Putukian, Margot; McDevitt, Jane; Giza, Christopher C.; Goldman, Joshua T.; Benjamin, Holly J.; Buckley, Thomas; Kaminski, Thomas W.; Clugston, James R.; Feigenbaum, Luis A.; Eckner, James T.; Mihalik, Jason P.; Anderson, Scott; Master, Christina L.; Kontos, Anthony P.; Chrisman, Sara P. O.; Cameron, Kenneth; Duma, Stefan; Miles, Christopher M.; Psychiatry, School of Medicine
    Background: Mental health disorders are linked to prolonged concussion symptoms. However, the association of premorbid anxiety/depression symptoms with postconcussion return-to-play timelines and total symptom burden is unclear. Objective: To examine the association of self-reported premorbid anxiety/depression symptoms in collegiate student-athletes with (1) recovery times until asymptomatic, (2) return-to-play, and (3) postconcussion symptom burden. Study design: Athletes in the Concussion Assessment, Research and Education Consortium completed baseline concussion assessments (Sport Concussion Assessment Tool [SCAT3] and Brief Symptom Inventory-18 [BSI-18]). Athletes were tested postinjury at <6 hours, 24 to 48 hours, time of asymptomatic and start of return-to-play protocol, unrestricted return-to-play, and 6 months after injury. Injured athletes were categorized into 4 groups based on BSI-18 scores: (1) B-ANX, elevated anxiety symptoms only; (2) B-DEP, elevated depression symptoms only; (3) B-ANX&DEP, elevated anxiety and depression symptoms; and (4) B-NEITHER, no elevated anxiety or depression symptoms. Relationship between age, sex, BSI-18 group, SCAT3 total symptom and severity scores, and time to asymptomatic status and return-to-play was assessed with Pearson's chi-squared test and robust analysis of variance. Level of evidence: Level 3. Results: Among 1329 athletes with 1352 concussions, no respondents had a self-reported premorbid diagnosis of anxiety/depression. There was no difference in time until asymptomatic or time until return-to-play between BSI-18 groups (P = 0.15 and P = 0.11, respectively). B-ANX, B-DEP, and B-ANX&DEP groups did not have higher total symptom or severity scores postinjury compared with the B-NEITHER group. Conclusion: Baseline anxiety/depression symptoms in collegiate student-athletes without a mental health diagnosis are not associated with longer recovery times until asymptomatic, longer time to return-to-play, or higher postconcussion total symptom and severity scores compared with athletes without baseline symptoms. Clinical relevance: Anxiety and depression symptoms without a clear mental health diagnosis should be considered differently from other comorbidities when discussing prolonged recovery in collegiate student-athletes.
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    Estimated age of first exposure to American football and outcome from concussion
    (Wolters Kluwer, 2020-11-24) Caccese, Jaclyn B.; Houck, Zac; Kaminski, Thomas W.; Clugston, James R.; Iverson, Grant L.; Bryk, Kelsey N.; Oldham, Jessie R.; Pasquina, Paul F.; Broglio, Steven P.; McAllister, Thomas W.; McCrea, Michael; Reed Hoy, April Marie; Hazzard, Joseph B., Jr.; Kelly, Louise A.; Ortega, Justus D.; Port, Nicholas; Putukian, Margot; Langford, T. Dianne; Giza, Christopher C.; Goldman, Joshua T.; Benjamin, Holly J.; Schmidt, Julianne D.; Feigenbaum, Luis A.; Eckner, James T.; Mihalik, Jason P.; Dysart Miles, Jessica; Anderson, Scott; Master, Christina L.; Collins, Micky W.; Kontos, Anthony P.; Chrisman, Sara P.D.; Brooks, Alison; Jackson, Jonathan C.; McGinty, Gerald; Cameron, Kenneth L.; Susmarski, Adam; O'Donnell, Patrick G.; Duma, Stefan; Rowson, Steve; Miles, Christopher M.; Bullers, Christopher T.; Dykhuizen, Brian H.; Lintner, Laura; Buckley, Thomas A.; Psychiatry, School of Medicine
    Objective: To examine the association between estimated age at first exposure (eAFE) to American football and clinical measures throughout recovery following concussion. Methods: Participants were recruited across 30 colleges and universities as part of the National Collegiate Athletic Association (NCAA)-Department of Defense Concussion Assessment, Research and Education Consortium. There were 294 NCAA American football players (age 19 ± 1 years) evaluated 24-48 hours following concussion with valid baseline data and 327 (age 19 ± 1 years) evaluated at the time they were asymptomatic with valid baseline data. Participants sustained a medically diagnosed concussion between baseline testing and postconcussion assessments. Outcome measures included the number of days until asymptomatic, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) composite scores, Balance Error Scoring System (BESS) total score, and Brief Symptom Inventory 18 (BSI-18) subscores. The eAFE was defined as participant's age at the time of assessment minus self-reported number of years playing football. Results: In unadjusted regression models, younger eAFE was associated with lower (worse) ImPACT Visual Motor Speed (R 2 = 0.031, p = 0.012) at 24-48 hours following injury and lower (better) BSI-18 Somatization subscores (R 2 = 0.014, p = 0.038) when the athletes were asymptomatic. The effect sizes were very small. The eAFE was not associated with the number of days until asymptomatic, other ImPACT composite scores, BESS total score, or other BSI-18 subscores. Conclusion: Earlier eAFE to American football was not associated with longer symptom recovery, worse balance, worse cognitive performance, or greater psychological distress following concussion. In these NCAA football players, longer duration of exposure to football during childhood and adolescence appears to be unrelated to clinical recovery following concussion.
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    King-Devick testing and concussion recovery time in collegiate athletes
    (Elsevier, 2022) Whelan, Bridget M.; Gause, Emma L.; Ortega, Justus D.; Mills, Brianna M.; Schmidt, Julianne D.; Kaminski, Thomas W.; Buckley, Thomas A.; Breedlove, Katherine M.; Kontos, Anthony P.; Clugston, James R.; Goldman, Joshua T.; Harmon, Kimberly G.; McCrea, Michael A.; McAllister, Thomas W.; Broglio, Steven P.; Chrisman, Sara P. D.; Psychiatry, School of Medicine
    Objectives: To assess whether the King-Devick (KD) test is useful as a prognostic test for prolonged concussion symptoms by examining the relationship between a) change in performance on KD test from baseline to within two days post-injury and b) the absolute KD time at post-concussion testing, with an outcome of time to return to play (RTP). Design: Prospective Cohort Study. Methods: Collegiate varsity athletes in the Concussion Assessment, Research, and Education (CARE) Consortium completed baseline and post-injury King-Devick tests from 2014 to 2018. Two exposures were evaluated: 1) change in KD score from baseline to within two days post-injury and 2) absolute KD score within two days post-injury, adjusted for baseline KD. We used Cox proportional hazards models to analyze the relationships between these exposures and time to RTP post-concussion. Results: A total of 309 concussion injuries were included. Median baseline KD score was 40.0 s (IQR: 35.8, 45.2). Median post-injury KD score was 45.8 s (IQR: 39.8, 57.1). Median number of days until RTP in this cohort was 11 (IQR: 8, 17). Post-injury KD score adjusted for baseline KD had a stronger association with time to RTP duration (HR: 0.99 (0.98, 1.00), p = 0.03) than the difference in KD score from baseline to post-injury (HR: 0.99 (0.99, 1.00), p = 0.07). Conclusions: Higher post-injury KD scores are associated with longer RTP. The association between KD post-concussion test and longer RTP warrants further investigation to assess the utility of the KD for prognostication in a clinical setting.
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    Relationship Between the King-Devick Test and Commonly Used Concussion Tests at Baseline
    (Allen Press, 2019-12) Clugston, James R.; Houck, Zachary M.; Asken, Breton M.; Boone, Jonathan K.; Kontos, Anthony P.; Buckley, Thomas A.; Schmidt, Julianne D.; Chrisman, Sara P.D.; Hoffman, Nicole L.; Harmon, Kimberly G.; Kaminski, Thomas W.; Collins, Michael W.; McAllister, Thomas W.; McCrea, Michael A.; Broglio, Steven P.; Ortega, Justus D.; Psychiatry, School of Medicine
    Context: Comprehensive assessments are recommended to evaluate sport-related concussion (SRC). The degree to which the King-Devick (KD) test adds novel information to an SRC evaluation is unknown. Objective: To describe relationships at baseline among the KD and other SRC assessments and explore whether the KD provides unique information to a multimodal baseline concussion assessment. Design: Cross-sectional study. Setting: Five National Collegiate Athletic Association institutions participating in the Concussion Assessment, Research and Education (CARE) Consortium. Patients or other participants: National Collegiate Athletic Association student-athletes (N = 2258, age = 20 ± 1.5 years, 53.0% male, 68.9% white) in 11 men's and 13 women's sports. Main outcome measure(s): Participants completed baseline assessments on the KD and (1) the Symptom Inventory of the Sport Concussion Assessment Tool-3rd edition, (2) the Brief Symptom Inventory-18, (3) the Balance Error Scoring System, (4) the Standardized Assessment of Concussion (SAC), (5) the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test battery, and (6) the Vestibular/Ocular Motor Screening tool during their first year in CARE. Correlation coefficients between the KD and the 6 other concussion assessments in isolation were determined. Assessments with ρ magnitude >0.1 were included in a multivariate linear regression analysis to evaluate their relative association with the KD. Results: Scores for SAC concentration, ImPACT visual motor speed, and ImPACT reaction time were correlated with the KD (ρ = -0.216, -0.276, and 0.164, respectively) and were thus included in the regression model, which explained 16.8% of the variance in baseline KD time (P < .001, Cohen f2 = 0.20). Better SAC concentration score (β = -.174, P < .001), ImPACT visual motor speed (β = -.205, P < .001), and ImPACT reaction time (β = .056, P = .020) were associated with faster baseline KD performance, but the effect sizes were small. Conclusions: Better performance on cognitive measures involving concentration, visual motor speed, and reaction time was weakly associated with better baseline KD performance. Symptoms, psychological distress, balance, and vestibular-oculomotor provocation were unrelated to KD performance at baseline. The findings indicate limited overlap at baseline among the CARE SRC assessments and the KD.