Researchers shared preliminary findings from the largest-ever study of concussion in sport last week at an event hosted by the Pac-12 Conference at the University of California, Los Angeles.
The principal investigators overseeing the NCAA-Department of Defense CARE Consortium study that launched in 2014 — Steve Broglio, director of the University of Michigan NeuroTrauma Research Laboratory; Michael McCrea, director of brain injury research at the Medical College of Wisconsin; and Tom McAllister, chair of the Indiana University School of Medicine Department of Psychiatry — called attention to a handful of trends from their early data analysis, being careful to note that their findings had yet to be peer reviewed and published.
During presentations to leading experts in sport-related concussion, the researchers pointed to data that indicate student-athletes who are removed from play immediately after suffering a concussion return to play roughly two days faster than their counterparts who continue to play after the injury. The findings hint that student-athletes hesitant to report concussions are not only doing more potential harm to themselves, but also to their teams because they are more likely to miss additional playing time.
“By holding off and not reporting your concussion, you’re actually going to cost yourself more time in return to play,” McCrea said. “Evidence like that can convince athletes, who are metric-driven people, that, ‘OK, I get all that health-and-safety campaigning, but I also understand if I report my injury and get a proper assessment, adequate care and management by my athletic training and medical staff, I will have a competitive advantage.’ And that’s important.”
Additionally, study data indicate that the attitudes regarding concussion among student-athletes, medical providers and athletics programs alike have shifted significantly in recent years. In a 2001 study — then the largest of its kind — NCAA football players returned to play an average of 6.7 days after their initial injury. In the CARE study, however, student-athletes are returning to play an average of 14.3 days after suffering a concussion. In the 2001 study, 92 percent of repeat concussions occurred within 10 days of the first injury, but there have been zero repeat concussions within 10 days in the CARE study despite its significantly larger scope. The data seem to show that ensuring adequate time for recovery is being emphasized on campuses across the country.
But what, truly, is adequate recovery time? And how does it differ across an array of athletes from different sports with varying medical histories, activity levels and genetic predispositions, among other factors? Data from the study should be able to answer those questions in the coming years. For now, though, McCrea said preliminary imaging data appear to indicate that the brain continues to recover even after symptoms have abated and after student-athletes can pass cognitive and balance tests. How long that period of brain vulnerability lasts and how it differs among various strata of student-athletes remain to be seen.
“I’m confident that the science will inform that question,” McCrea said, “but it doesn’t yet.”
In all, the study has enrolled more than 28,000 participants, including student-athletes at 26 campuses and students at four military academies. More than 1,600 concussions have been recorded, nearly 300 in football alone. Of those 1,600 injuries, almost 150 have taken place at schools that are part of the study’s advanced research core, where student-athletes take part in neuroimaging, genetic testing and blood draws at predetermined intervals following an injury. The advanced research core also is testing uninjured student-athletes from contact and noncontact sports to serve as control groups to determine the effects of exposure to lower-level impacts. Early data suggest these lower-intensity hits — like those routinely experienced by football linemen — could have a cumulative effect that can lead to injury, though the subject requires more analysis.
In NCAA contact sports, the CARE study has found that two-thirds of concussions occur in practice or training, while only about 30 percent happen in competition. The preponderance of brain injuries in practice suggests that guidelines geared toward regulating contact in practice — such as the newly updated year-round football practice contact recommendations — could have a meaningful impact on concussion rates.
Studies relevant to CARE Consortium data will begin to be published within the year, and the lead researchers hope to convene with top minds in the field annually to review the most important findings and discuss their clinical implications.
The findings will be used to influence recommendations and rules pertaining to student-athlete health and safety, and the researchers hope the study lays the groundwork for a decades long examination of the long-term effects of concussion and exposure to contact.
“The CARE Consortium is providing compelling data that have already begun to influence policy and recommendations that improve student-athlete health and safety,” NCAA Chief Medical Officer Brian Hainline said. “Science is informing decisions.”