Optimizing Concussion Care Seeking: The Influence of Previous Concussion Diagnosis Status on Baseline Assessment Outcomes,The American Journal of Sports Medicine

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Optimizing Concussion Care Seeking: The Influence of Previous Concussion Diagnosis Status on Baseline Assessment Outcomes
The American Journal of Sports Medicine ( IF 4.8 ) Pub Date : 2022-08-23 , DOI: 10.1177/03635465221118089
Robert C Lynall _{1,

2} , Christopher D'Lauro _{2,

3} , Zachary Y Kerr _{2,

4} , Kristen Knight _{2,

5} , Emily Kroshus _{2,

6} , Daniel D Leeds _{2,

7} , Johna K Register-Mihalik _{2,

8} , Michael McCrea _{2,

9} , Steven P Broglio _{2,

10} , Thomas McAllister _{2,

11} , Julianne D Schmidt _{1,

2} , ₂ , Joseph Hazzard _{2,

12} , Louise Kelly _{2,

13} , Christina Master _{2,

14} , Justus Ortega _{2,

15} , Nicholas Port _{2,

16} , Darren Campbell _{2,

17} , Steven J Svoboda _{2,

18} , Margot Putukian _{2,

19} , Sara P D Chrisman _{2,

20} , James R Clugston _{2,

21} , Dianne Langford _{2,

22} , Gerald McGinty _{2,

23} , Kenneth L Cameron _{2,

24} , Megan N Houston _{2,

24} , Adam James Susmarski _{2,

25} , Joshua T Goldman _{2,

26} , Christopher Giza _{2,

27} , Holly Benjamin _{2,

28} , Thomas Buckley _{2,

29} , Thomas Kaminski _{2,

29} , Luis Feigenbaum _{2,

30} , James T Eckner _{2,

31} , Jason P Mihalik _{2,

32} , Scott Anderson _{2,

33} , Jane McDevitt _{2,

34} , Anthony Kontos _{2,

35} , M Alison Brooks _{2,

36} , Steve Rowson _{2,

37} , Christopher Miles _{2,

38} , Laura Lintner _{2,

39} , Patrick G O'Donnell _{2,

40}

Affiliation

UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia, USA.
Investigation performed at multiple sites.
Department of Behavioral Sciences and Leadership, United States Air Force Academy, Colorado Springs, Colorado, USA.
Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.
University of Washington, Department of Pediatrics & Seattle Children's Research Institute, Center for Child, Development and Health, Seattle, Washington, USA.
Computer and Information Sciences Department, Fordham University, New York, New York, USA.
Matthew Gfeller Sport-Related TBI Research Center & STAR Heel Performance Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
University of Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan.
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Exercise Science, Bloomsburg University.
Department of Exercise Science, California Lutheran University.
Division of Orthopedics, Children's Hospital of Philadelphia.
Department of Kinesiology & Recreation Administration, Humboldt State University.
School of Optometry, Indiana University.
Intermountain Sports Medicine.
MedStar Orthopaedic Institute.
Athletic Medicine, Princeton University.
Center for Child Health, Behavior and Development, Seattle Children's Research Institute.
Department of Community Health and Family Medicine, University of Florida.
Lewis Katz School of Medicine, Temple University.
United States Air Force Academy.
Keller Army Hospital, United States Military Academy.
Department Head Brigade Orthopaedics and Sports Medicine, United States Naval Academy.
Departments of Family Medicine & Orthopaedic Surgery, University of California, Los Angeles.
Department of Pediatrics, University of California, Los Angeles.
Department of Rehabilitation Medicine and Pediatrics, University of Chicago.
Department of Kinesiology & Applied Physiology, University of Delaware.
Department of Physical Therapy, Miller School of Medicine, University of Miami.
Department of PM&R, University of Michigan.
Department of Exercise and Sport Science, University of North Carolina at Chapel Hill.
University of Oklahoma.
Department of Health and Rehabilitation Sciences, Temple University.
Department of Orthopaedic Surgery, University of Pittsburgh.
Department of Orthopedics, University of Wisconsin, Madison.
Department of Biomedical Engineering and Mechanics, Virginia Tech.
Department of Family and Community Medicine, Wake Forest University.
Wake Forest School of Medicine Family Medicine, Winston Salem State University.
Department of Urology, UMass Memorial Health.

Background:

The prevalence of unreported concussions is high, and undiagnosed concussions can lead to worse postconcussion outcomes. It is not clear how those with a history of undiagnosed concussion perform on subsequent standard concussion baseline assessments.

Purpose:

To determine if previous concussion diagnosis status was associated with outcomes on the standard baseline concussion assessment battery.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Concussion Assessment, Research, and Education (CARE) Consortium participants (N = 29,934) self-reported concussion history with diagnosis status and completed standard baseline concussion assessments, including assessments for symptoms, mental status, balance, and neurocognition. Multiple linear regression models were used to estimate mean differences and 95% CIs among concussion history groups (no concussion history [n = 23,037; 77.0%], all previous concussions diagnosed [n = 5315; 17.8%], ≥1 previous concussions undiagnosed [n = 1582; 5.3%]) at baseline for all outcomes except symptom severity and Brief Symptom Inventory–18 (BSI-18) score, in which negative binomial models were used to calculate incidence rate ratios (IRRs). All models were adjusted for sex, race, ethnicity, sport contact level, and concussion count. Mean differences with 95% CIs excluding 0.00 and at least a small effect size (≥0.20), and those IRRs with 95% CIs excluding 1.00 and at least a small association (IRR, ≥1.10) were considered significant.

Results:

The ≥1 previous concussions undiagnosed group reported significantly greater symptom severity scores (IRR, ≥1.38) and BSI-18 (IRR, ≥1.31) scores relative to the no concussion history and all previous concussions diagnosed groups. The ≥1 previous concussions undiagnosed group performed significantly worse on 6 neurocognitive assessments while performing better on only 2 compared with the no concussion history and all previous concussions diagnosed groups. There were no between-group differences on mental status or balance assessments.

Conclusion:

An undiagnosed concussion history was associated with worse clinical indicators at future baseline assessments. Individuals reporting ≥1 previous undiagnosed concussions exhibited worse baseline clinical indicators. This may suggest that concussion-related harm may be exacerbated when injuries are not diagnosed.

中文翻译：

优化脑震荡寻求治疗：先前脑震荡诊断状态对基线评估结果的影响

背景：

未报告的脑震荡的患病率很高，未确诊的脑震荡会导致更糟糕的脑震荡后结果。目前尚不清楚那些有未确诊脑震荡病史的人在随后的标准脑震荡基线评估中的表现如何。

目的：

确定以前的脑震荡诊断状态是否与标准基线脑震荡评估组的结果相关。

学习规划：

横断面研究；证据水平，3。

方法：

脑震荡评估、研究和教育 (CARE) 联盟参与者 (N = 29,934) 自我报告了脑震荡病史和诊断状态，并完成了标准基线脑震荡评估，包括对症状、精神状态、平衡和神经认知的评估。多元线性回归模型用于估计脑震荡史组之间的平均差异和 95% CI（无脑震荡史 [n = 23,037; 77.0%]，所有既往脑震荡诊断 [n = 5315; 17.8%]，≥1 次脑震荡未确诊 [ n = 1582；5.3%]）除症状严重程度和Brief Symptom Inventory-18 (BSI-18) 评分之外的所有结局，其中负二项式模型用于计算发病率比（IRR）。所有模型都针对性别、种族、民族、运动接触水平和脑震荡计数进行了调整。

结果：

与无脑震荡史和所有既往脑震荡诊断组相比，≥1 次未确诊脑震荡组的症状严重程度评分（IRR，≥1.38）和 BSI-18（IRR，≥1.31）评分显着增加。与无脑震荡史和所有既往脑震荡诊断组相比，≥1 次脑震荡未确诊组在 6 项神经认知评估中表现明显较差，而仅在 2 项评估中表现更好。在精神状态或平衡评估方面没有组间差异。