Citation

Sanders GD, Cullum CM. JAMA Netw. Open 2024; 7(1): e2353292.

Copyright

(Copyright © 2024, American Medical Association)

DOI

10.1001/jamanetworkopen.2023.53292

PMID

38265803

Abstract

Traumatic brain injury (TBI) is a public health concern, and there are multiple myths, debates, and unresolved questions about concussion and potential lingering symptoms or long-term effects. Mild TBI (mTBI), or concussion, occurs as a result of many causes, and most cases recover within days to weeks and are not typically associated with long-term effects.1 The article by Ntikas et al2 is timely and addresses an important topic, because a subgroup of those who experience mTBI continue to report lingering symptoms beyond the typical recovery window, yet this subgroup and their symptoms remain poorly understood. In their study, Ntikas and colleagues took a novel approach by using an international sample to examine clinical outcomes in individuals presenting to emergency departments in various countries following a sport-related TBI (SR-TBI) and compared them at 3- and 6-month follow-up with a group of adults with TBI who sustained their injury due to other causes. Along with analyzing the entire sample, the authors focused on subgroups most relevant to sport—that is, mTBI with and without intracranial findings on imaging. Clinical outcomes included ratings of functional ability, quality of life, posttraumatic stress, depression, anxiety, and postconcussion symptoms, with outcomes dichotomized to reflect impairment or no impairment. Using functional ratings from the Glasgow Outcome Scale-Extended3 (GOSE) at 3-month follow-up, more than one-half of the SR-TBI group reported incomplete functional recovery (42% for those with mTBI overall, and 33% for mTBI and negative imaging findings), with elevated rates of postconcussion symptoms and impaired health-related quality of life. At 6-month follow-up, despite improvement in psychological indices, nearly one-half of individuals with SR-TBI reported incomplete functional recovery based on GOSE ratings, with subgroups of mTBI reporting negligible changes from the initial 3-month follow-up. Interestingly, there were no significant differences in functional status ratings between groups with and without SR-TBI, although the SR-TBI group did show lower anxiety, depression and other symptom scores compared with the nonsports sample. Related research in adolescents comparing sport-related concussion (SRC) vs concussion due to motor vehicle accidents found that those in the latter group reported higher symptom burden and longer recovery times than those with SRC.4

The present study builds upon the research literature in 2 substantive ways. First, by leveraging samples from 18 countries, Ntikas et al2 were able to compare gross recovery outcomes between individuals with sport-related and non–sport-related brain injuries. Few studies have compared directly sport-related and non–sport-related TBI, and such a large and internationally diverse sample theoretically should enhance power to detect meaningful differences and generalize to broader populations. In addition, the authors tracked recovery outcomes over a longer interval than some similar investigations, which is important because recovery trajectories are not uniformly linear and may vary depending on a host of factors, including severity, cause, preexisting conditions, and timing of injury. That said, the finding of such high rates of incomplete recovery ratings among their SR-TBI cases was somewhat surprising, given that most studies of SRC tend to show better outcomes and less frequent lingering symptoms. ...

Language: en

Keywords

Humans; Brain; *Sports; *Athletic Injuries; *Brain Injuries