Abstract
Concussion has been described in the United States (US) collegiate student–athlete population, but female-specific findings are often underrepresented and underreported. Our study aimed to describe female collegiate student–athletes’ initial injury characteristics and return to activity outcomes following concussion. Female collegiate student–athletes (n = 1393) from 30-US institutions experienced a concussion and completed standardized, multimodal concussion assessments from pre-injury through unrestricted return to play (uRTP) in this prospective, longitudinal cohort study. Initial injury presentation characteristics, assessment, and return to activity outcomes [<48-h (acute), return to learn, initiate return to play (iRTP), uRTP] were collected. We used descriptive statistics to report injury characteristics, return to activity outcomes, and post-injury assessment performance change categorization (worsened, unchanged, improved) based on change score confidence rank criteria across sport contact classifications [contact (n = 661), limited (n = 446), non-contact (n = 286)]. The median (25th to 75th percentile) days to return to learn was 6.0 (3.0–10.0), iRTP was 8.1 (4.8–13.8), and uRTP was 14.8 (9.9–24.0), but varied by contact classification. Across contact levels, the majority experienced worse SCAT total symptom severity (72.8–82.6%), ImPACT reaction time (91.2–92.6%), and BSI-18 total score (45.2–51.8%) acutely relative to baseline, but unchanged BESS total errors (58.0–60.9%), SAC total score (71.5–76.1%), and remaining ImPACT domains (50.6–66.5%). Our findings provide robust estimates of the typical female collegiate student–athlete presentation and recovery trajectory following concussion, with overall similar findings to the limited female collegiate student–athlete literature. Overall varying confidence rank classification was observed acutely. Our findings provide clinically-relevant insights for athletes, clinicians, researchers, and policymakers to inform efforts specific to females experiencing concussion.
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Data Availability
The CARE Consortium datasets generated and analyzed during the current study are available in the FITBIR Repository (https://fitbir.nih.gov/).
Code Availability
Not applicable.
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Acknowledgements
The authors would also like to thank Jody Harland, Janetta Matesan, Michael Menser (Indiana University School of Medicine); Ashley Rettmann, Nicole L’Heureux (University of Michigan); Melissa McEachern (Medical College of Wisconsin); Michael Jarrett, Vibeke Brinck, and Bianca Byrne, (Quesgen); Melissa Baker, Christy Collins, Will Felix, Bethany Morath (Datalys Center for Sports Injury Research and Prevention); and the research and medical staff at each of the CARE participation sites. We are grateful for the participation of the student–athletes without whom this research would not be possible.
The authors would also like to thank non-authorship members of the CARE Working Group consisting of the following individuals for their help and support: Kristy Arbogast, PhD and Patricia R. Roby, PhD, ATC (Children’s Hospital of Philadelphia); Stacey Harcum, DrPH, Kalyn C. Jannace, PhD, MPH, and Franseca Scott (Uniformed Services University); Tamerah N. Hunt, PhD, ATC (Georgia Southern University); Dianne Langford, PhD and Jane McDevitt, PhD, ATC (Temple University); Susan Perkins, PhD (Indiana University), and Jessica Wallace (University of Alabama).
Contributing manuscript individuals under the CARE Consortium Investigators title include: Scott A. Anderson, ATC (Retired; formerly University of Oklahoma); M. Allison Brooks, MD, MPH (University of Wisconsin-Madison); Thomas W. Kaminski, PhD, ATC (University of Delaware); Kenneth L. Cameron, PhD, MPH, ATC (United States Military Academy); Christopher D’Lauro, PhD (United States Air Force Academy); Anthony P. Kontos, PhD (University of Pittsburgh); Stefan Duma, PhD (Virginia Tech); Luis A. Feigenbaum, PT, DPT, ATC (University of Miami); Christopher C. Giza, MD and Joshua T. Goldman, MD, MBA (University of California-Los Angeles); April Hoy, MS, ATC (Azusa Pacific University); and Justus Ortega, PhD (California State Polytechnic University, Humboldt).
Funding
This study was made possible, in part, with support from the Grand Alliance Concussion Assessment, Research, and Education Consortium, funded by the National Collegiate Athletic Association and the Department of Defense. The US Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702-5014, USA is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under Award No. W81XWH-14-2-0151. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).
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LBL conceived this specific plan for this report, carried out the statistical analyses and drafted the manuscript; EE and JC participated in the statistical analysis; PFP, MAM, TWM, and SPB participated in the study design and coordination, and conceived the original overarching study. All authors have read, provided feedback, and approved the final version of the manuscript.
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All disclosures below are not directly related to the current project, but are reported for full transparency to readers. Dr. Landon Lempke has current or prior funding unrelated to the current project from the National Athletic Trainers’ Association (NATA), American College of Sports Medicine (ACSM), Eastern Athletic Trainers’ Association, VALD, internally from university affiliations, and has received various speaker honorarium and travel reimbursement for talks given. Dr. Thomas Buckley reports current or prior funding from NIH, Henry F. Jackson Foundation for the Advancement of Military Medicine, and State Space, Inc. Dr. James Clugston reports current or prior funding from the NFL, and a stipend for serving on an institutional Data Safety Monitoring Board. Dr. James Eckner reports current or prior funding from NIH, NSF, and internal university funding. Dr. Eckner also reports being a co-author (stipend received) for a book chapter in “Concussion Management for Wheelchair Athletes”, on the editorial board (unpaid) for the journal Physical Medicine and Rehabilitation, and a co-inventor on US Patent #8657295, and a Data and Safety Monitoring Board Member for an unrelated NIH Project. Dr. Margot Putukian reports the following committee and position roles: CMO for MLS, Senior Advisor NFL HN&S Committee, FA Research Task Force, CISG Expert Group, NOCSAE SAC. Dr. Putukian also receives royalties from Netters Sports Medicine textbook, and UpToDate chapter. Dr. Michael McCrea has received research funding from the NIH, CDC, DoD, NCAA, NFL, and Abbott Laboratories. Dr. Thomas McAllister reports current or prior grant support from NIH, DoD, and NCAA, as well as textbook royalties from the “Textbook of Traumatic Brain Injury” from the American Psychiatric Association Publishing, Inc., and is an unpaid member for the concussion Scientific Advisory Committee for the Australian-Rules Football Conference. Dr. Steven Broglio has current or past research funding from the NIH, CDC, DoD, NCAA, NATA, NFL/Under Armour/GE; Simbex; and ElmindA. Dr. Broglio has consulted for US Soccer (paid), US Cycling (unpaid), University of Calgary SHRed Concussions external advisory board (unpaid), medico-legal litigation, and received speaker honorarium and travel reimbursements for talks given. Dr. Broglio is also a co-author of “Biomechanics of Injury (3rd edition)” and has a patent pending on “Brain Metabolism Monitoring Through CCO Measurements Using All-Fiber-Integrated Super-Continuum Source” (U.S. Application No. 17/164490). Lastly, Dr. Broglio is on the and is/was on the editorial boards (all unpaid) for Journal of Athletic Training (2015 to present), Concussion (2014 to present), Athletic Training and Sports Health Care (2008 to present), and British Journal of Sports Medicine (2008 to 2019).
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The study was performed in accordance with the standards of ethics outlined in the Declaration of Helsinki. All study procedures were reviewed and approved by the University of Michigan IRB, the US Army Medical Research and Materiel Command Human Research Protection Office (HRPO), as well the local IRB at each of the performance sites.
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Lempke, L.B., Caccese, J.B., Syrydiuk, R.A. et al. Female Collegiate Athletes’ Concussion Characteristics and Recovery Patterns: A Report from the NCAA-DoD CARE Consortium. Ann Biomed Eng 52, 2741–2755 (2024). https://doi.org/10.1007/s10439-023-03367-y
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DOI: https://doi.org/10.1007/s10439-023-03367-y