Attribution of Concussion-Like Symptoms and History of Collision Sports Exposure—Reply
Attribution of Concussion-Like Symptoms and History of Collision Sports Exposure—Reply
Silverberg, Noah D.;Mannix, Rebekah;Iverson, Grant L.
2016-04-01 00:00:00
In Reply In a study published in the December 2015 issue of JAMA Pediatrics,1 we aimed to document concussion-like symptoms in high school athletes with no recent concussion during their preseason baseline evaluation and identify health history variables associated with symptom reporting. We reported that concussion history was associated with concussion-like symptoms in high school athletes, but its effect was small relative to certain preexisting learning, psychiatric, and headache disorders. In a letter to the editor,2 Mr Comrie proposed that prior concussion(s) and/or repetitive head trauma through participation in collision sports may be responsible for both the symptoms and the preexisting conditions themselves, suggesting that the effect of prior (documented or undocumented) neurotrauma may be much larger than represented in our study. We appreciate Mr Comrie’s thoughtful commentary. Our cross-sectional study cannot fully evaluate his hypotheses. However, several findings reported in the original article and from supplementary descriptive statistics are relevant to Mr Comrie’s hypothesis. First, girls played fewer collision sports and reported fewer prior concussions, but reported more concussion-like symptoms than boys. Second, multivariable modeling revealed that concussion history and several pre-existing conditions were independently associated with concussion-like symptoms. Third, the majority of high school athletes with no prior concussions or preexisting conditions reported at least one symptom. Taken together, the findings from our study do not support (or strongly refute) Mr Comrie’s hypothesis that the learning, psychiatric, headache disorders, and concussion-like symptoms in our sample are attributable to neurotrauma. We agree with Mr Comrie’s assertion that the link between collision sport participation in childhood and later life health outcomes requires further research. The 2 studies that Mr Comrie cites provide little insight. Both report on the risk of psychiatric problems following a single physician-diagnosed traumatic brain injury in childhood, not repetitive subconconcussive blows. Our study suggests that concussion-like symptoms are very common and that clinicians should consider an athlete’s concussion history and preexisting learning, psychiatric, and headache disorders, as well as situational factors such as life stress3 and poor sleep,4 when evaluating athletes who have persistent symptoms following concussion. We agree with Mr Comrie that extra caution is needed in return-to-play decision making for athletes with a history of multiple concussions and/or extensive neurotrauma exposure. However, attributing any concussion-like symptom to brain damage and potentially benching athletes with nonspecific symptoms goes too far. Balancing the risk of neurotrauma with the benefits of athletic endeavors, including contact sports, requires careful consideration at both the individual and societal level, well beyond the scope of our study. Back to top Article Information Corresponding Author: Noah D. Silverberg, PhD, G. F. Strong Rehabilitation Centre, 4255 Laurel St, Vancouver, BC V5Z 2G9, Canada (noah.silverberg@vch.ca). Published Online: February 15, 2016. doi:10.1001/jamapediatrics.2015.4649. Conflict of Interest Disclosures: Dr Iverson has been reimbursed by the government, professional scientific bodies, and commercial organizations for discussing or presenting research relating to mild traumatic brain injury and sport-related concussion at meetings, scientific conferences, and symposiums. He has a clinical practice in forensic neuropsychology involving individuals who have sustained mild traumatic brain injuries (including athletes). He has received honorariums for serving on research panels that provide scientific peer review of programs. He is a co-investigator, collaborator, or consultant on grants relating to mild traumatic brain injuries funded by several organizations. He has received research support from test publishing companies in the past, including ImPACT Applications Systems (not in the past 5 years). References 1. Iverson GL, Silverberg ND, Mannix R, et al. Factors associated with concussion-like symptom reporting in high school athletes. JAMA Pediatr. 2015;169(12):1132-1140. PubMedGoogle ScholarCrossref 2. Comrie D. Attribution of concussion-like symptoms and a history of collision sports exposure [published online February 15, 2016]. JAMA Pediatr. 2016. doi: 10.1001/jamapediatrics.2015.4649.Google Scholar 3. Gouvier WD, Cubic B, Jones G, Brantley P, Cutlip Q. Postconcussion symptoms and daily stress in normal and head-injured college populations. Arch Clin Neuropsychol. 1992;7(3):193-211.PubMedGoogle ScholarCrossref 4. Silverberg ND, Berkner PD, Atkins JE, Zafonte R, Iverson GL. Relationship between short sleep duration and preseason concussion testing [published online August 4, 2015]. Clin J Sport Med. doi:10.1097/JSM.0000000000000241. PubMedGoogle Scholar
http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.pngJAMA PediatricsAmerican Medical Associationhttp://www.deepdyve.com/lp/american-medical-association/attribution-of-concussion-like-symptoms-and-history-of-collision-TL20RgC8Me
Attribution of Concussion-Like Symptoms and History of Collision Sports Exposure—Reply
Attribution of Concussion-Like Symptoms and History of Collision Sports Exposure—Reply
Abstract
In Reply In a study published in the December 2015 issue of JAMA Pediatrics,1 we aimed to document concussion-like symptoms in high school athletes with no recent concussion during their preseason baseline evaluation and identify health history variables associated with symptom reporting. We reported that concussion history was associated with concussion-like symptoms in high school athletes, but its effect was small relative to certain preexisting learning, psychiatric, and headache...
In Reply In a study published in the December 2015 issue of JAMA Pediatrics,1 we aimed to document concussion-like symptoms in high school athletes with no recent concussion during their preseason baseline evaluation and identify health history variables associated with symptom reporting. We reported that concussion history was associated with concussion-like symptoms in high school athletes, but its effect was small relative to certain preexisting learning, psychiatric, and headache disorders. In a letter to the editor,2 Mr Comrie proposed that prior concussion(s) and/or repetitive head trauma through participation in collision sports may be responsible for both the symptoms and the preexisting conditions themselves, suggesting that the effect of prior (documented or undocumented) neurotrauma may be much larger than represented in our study. We appreciate Mr Comrie’s thoughtful commentary. Our cross-sectional study cannot fully evaluate his hypotheses. However, several findings reported in the original article and from supplementary descriptive statistics are relevant to Mr Comrie’s hypothesis. First, girls played fewer collision sports and reported fewer prior concussions, but reported more concussion-like symptoms than boys. Second, multivariable modeling revealed that concussion history and several pre-existing conditions were independently associated with concussion-like symptoms. Third, the majority of high school athletes with no prior concussions or preexisting conditions reported at least one symptom. Taken together, the findings from our study do not support (or strongly refute) Mr Comrie’s hypothesis that the learning, psychiatric, headache disorders, and concussion-like symptoms in our sample are attributable to neurotrauma. We agree with Mr Comrie’s assertion that the link between collision sport participation in childhood and later life health outcomes requires further research. The 2 studies that Mr Comrie cites provide little insight. Both report on the risk of psychiatric problems following a single physician-diagnosed traumatic brain injury in childhood, not repetitive subconconcussive blows. Our study suggests that concussion-like symptoms are very common and that clinicians should consider an athlete’s concussion history and preexisting learning, psychiatric, and headache disorders, as well as situational factors such as life stress3 and poor sleep,4 when evaluating athletes who have persistent symptoms following concussion. We agree with Mr Comrie that extra caution is needed in return-to-play decision making for athletes with a history of multiple concussions and/or extensive neurotrauma exposure. However, attributing any concussion-like symptom to brain damage and potentially benching athletes with nonspecific symptoms goes too far. Balancing the risk of neurotrauma with the benefits of athletic endeavors, including contact sports, requires careful consideration at both the individual and societal level, well beyond the scope of our study. Back to top Article Information Corresponding Author: Noah D. Silverberg, PhD, G. F. Strong Rehabilitation Centre, 4255 Laurel St, Vancouver, BC V5Z 2G9, Canada (noah.silverberg@vch.ca). Published Online: February 15, 2016. doi:10.1001/jamapediatrics.2015.4649. Conflict of Interest Disclosures: Dr Iverson has been reimbursed by the government, professional scientific bodies, and commercial organizations for discussing or presenting research relating to mild traumatic brain injury and sport-related concussion at meetings, scientific conferences, and symposiums. He has a clinical practice in forensic neuropsychology involving individuals who have sustained mild traumatic brain injuries (including athletes). He has received honorariums for serving on research panels that provide scientific peer review of programs. He is a co-investigator, collaborator, or consultant on grants relating to mild traumatic brain injuries funded by several organizations. He has received research support from test publishing companies in the past, including ImPACT Applications Systems (not in the past 5 years). References 1. Iverson GL, Silverberg ND, Mannix R, et al. Factors associated with concussion-like symptom reporting in high school athletes. JAMA Pediatr. 2015;169(12):1132-1140. PubMedGoogle ScholarCrossref 2. Comrie D. Attribution of concussion-like symptoms and a history of collision sports exposure [published online February 15, 2016]. JAMA Pediatr. 2016. doi: 10.1001/jamapediatrics.2015.4649.Google Scholar 3. Gouvier WD, Cubic B, Jones G, Brantley P, Cutlip Q. Postconcussion symptoms and daily stress in normal and head-injured college populations. Arch Clin Neuropsychol. 1992;7(3):193-211.PubMedGoogle ScholarCrossref 4. Silverberg ND, Berkner PD, Atkins JE, Zafonte R, Iverson GL. Relationship between short sleep duration and preseason concussion testing [published online August 4, 2015]. Clin J Sport Med. doi:10.1097/JSM.0000000000000241. PubMedGoogle Scholar
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