Search

Importance The major North American professional sports leagues were among the first to return to full-scale sport activity during the coronavirus disease 2019 (COVID-19) pandemic. Given the unknown incidence of adverse cardiac sequelae after COVID-19 infection in athletes, these leagues implemented a conservative return-to-play (RTP) cardiac testing program aligned with American College of Cardiology recommendations for all athletes testing positive for COVID-19. Objective To assess the prevalence of detectable inflammatory heart disease in professional athletes with prior COVID-19 infection, using current RTP screening recommendations. Design, Setting, and Participants This cross-sectional study reviewed RTP cardiac testing performed between May and October 2020 on professional athletes who had tested positive for COVID-19. The professional sports leagues (Major League Soccer, Major League Baseball, National Hockey League, National Football League, and the men’s and women’s National Basketball Association) implemented mandatory cardiac screening requirements for all players who had tested positive for COVID-19 prior to resumption of team-organized sports activities. Exposures Troponin testing, electrocardiography (ECG), and resting echocardiography were performed after a positive COVID-19 test result. Interleague, deidentified cardiac data were pooled for collective analysis. Those with abnormal screening test results were referred for additional testing, including cardiac magnetic resonance imaging and/or stress echocardiography. Main Outcomes and Measures The prevalence of abnormal RTP test results potentially representing COVID-19–associated cardiac injury, and results and outcomes of additional testing generated by the initial screening process. Results The study included 789 professional athletes (mean [SD] age, 25 [3] years; 777 men [98.5%]). A total of 460 athletes (58.3%) had prior symptomatic COVID-19 illness, and 329 (41.7%) were asymptomatic or paucisymptomatic (minimally symptomatic). Testing was performed a mean (SD) of 19 (17) days (range, 3-156 days) after a positive test result. Abnormal screening results were identified in 30 athletes (3.8%; troponin, 6 athletes [0.8%]; ECG, 10 athletes [1.3%]; echocardiography, 20 athletes [2.5%]), necessitating additional testing; 5 athletes (0.6%) ultimately had cardiac magnetic resonance imaging findings suggesting inflammatory heart disease (myocarditis, 3; pericarditis, 2) that resulted in restriction from play. No adverse cardiac events occurred in athletes who underwent cardiac screening and resumed professional sport participation. Conclusions and Relevance This study provides large-scale data assessing the prevalence of relevant COVID-19–associated cardiac pathology with implementation of current RTP screening recommendations. While long-term follow-up is ongoing, few cases of inflammatory heart disease have been detected, and a safe return to professional sports activity has thus far been achieved.

Aim: Postconcussion symptom-rating scales are frequently used concussion assessment tools that do not align directly with new expert, consensus-based concussion subtype classification systems. This may result in delays in concussion diagnosis, subspecialty referral and rehabilitative strategies. Objective: To determine the representation of subtype-directed symptomatology in common postconcussion symptom-rating scales. Methods: Literature review and expert consensus were used to compile commonly used concussion symptom-rating scales. Statistics were generated to describe the degree of representation of the consensus symptom set. Results: The percentage of symptoms representing each subtype/associated condition is low overall (15–26%). The ocular-motor (11%) and vestibular subtypes (19%) and cervical strain (5%)-associated condition were the most under-represented and also had the greatest unmet needs. Conclusion: Concussion subtypes do not have equal representation on commonly used concussion symptom-rating scales. There is a need for a subtype-directed symptom assessment to allow for increased accuracy of diagnosis and to guide management.

BACKGROUND Concussion is a heterogeneous mild traumatic brain injury (mTBI) characterized by a variety of symptoms, clinical presentations, and recovery trajectories. By thematically classifying the most common concussive clinical presentations into concussion subtypes (cognitive, ocular-motor, headache/migraine, vestibular, and anxiety/mood) and associated conditions (cervical strain and sleep disturbance), we derive useful definitions amenable to future targeted treatments. OBJECTIVE To use evidence-based methodology to characterize the 5 concussion subtypes and 2 associated conditions and report their prevalence in acute concussion patients as compared to baseline or controls within 3 d of injury. METHODS A multidisciplinary expert workgroup was established to define the most common concussion subtypes and their associated conditions and select clinical questions related to prevalence and recovery. A literature search was conducted from January 1, 1990 to November 1, 2017. Two experts abstracted study characteristics and results independently for each article selected for inclusion. A third expert adjudicated disagreements. Separate meta-analyses were conducted to do the following: 1) examine the prevalence of each subtype/associated condition in concussion patients using a proportion, 2) assess subtype/associated conditions in concussion compared to baseline/uninjured controls using a prevalence ratio, and 3) compare the differences in symptom scores between concussion subtypes and uninjured/baseline controls using a standardized mean difference (SMD). RESULTS The most prevalent concussion subtypes for pediatric and adult populations were headache/migraine (0.52; 95% CI = 0.37, 0.67) and cognitive (0.40; 95% CI = 0.25, 0.55), respectively. In pediatric patients, the prevalence of the vestibular subtype was also high (0.50; 95% CI = 0.40, 0.60). Adult patients were 4.4, 2.9, and 1.7 times more likely to demonstrate cognitive, vestibular, and anxiety/mood subtypes, respectively, as compared with their controls (P

Background Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment. Objective To describe the current landscape of treatment for concussion and to provide summary agreements related to treatment to assist clinicians in the treatment of concussion. Methods On October 14 to 16, 2015, the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion meeting was convened in Pittsburgh, Pennsylvania. Thirty-seven concussion experts from neuropsychology, neurology, neurosurgery, sports medicine, physical medicine and rehabilitation, physical therapy, athletic training, and research and 12 individuals representing sport, military, and public health organizations attended the meeting. The 37 experts indicated their agreement on a series of statements using an audience response system clicker device. Results A total of 16 statements of agreement were supported covering (1) Summary of the Current Approach to Treating Concussion, (2) Heterogeneity and Evolving Clinical Profiles of Concussion, (3) TEAM Approach to Concussion Treatment: Specific Strategies, and (4) Future Directions: A Call to Research. Support (ie, response of agree or somewhat agree) for the statements ranged from to 97% to 100%. Conclusion Concussions are characterized by diverse symptoms and impairments and evolving clinical profiles; recovery varies on the basis of modifying factors, injury severity, and treatments. Active and targeted treatments may enhance recovery after concussion. Research is needed on concussion clinical profiles, biomarkers, and the effectiveness and timing of treatments. Abbreviations ARS, audience response systemCDC, Centers for Disease Control and PreventionDoD, Department of DefensemTBI, mild traumatic brain injuryNCAA, National Collegiate Athletic AssociationNFL, National Football LeagueNIH, National Institutes of HealthRCT, randomized controlled trialRTP, return to playSRC, sport- and recreation-related concussionTBI, traumatic brain injuryTEAM, Targeted Evaluation and Active Management.

This article describes common principles of biomechanics for running, jumping, and kicking. These activities form the basis for much of sports activity. Understanding human movement allows the physician to prescribe appropriate prevention, treatment, and rehabilitation to patients.

Objective To evaluate characteristics of paediatric concussion patients utilising the emergency department (ED) prior to initial concussion clinic evaluation. Design Prospective cohort. Setting Clinics of an American urban/suburban family practice (12/2014–04/2015). Subjects Consented concussion patients 8–18 years presenting to clinic within 3 days of injury (n=195; age=14.3, SD=2.1 years; female=42.3%). Intervention Participants completed a systematic evaluation at initial clinic visit and survey at 4-6 weeks (73.8% follow-up). Criterion variables included demographics, prior head injury, time of injury (TOI) factors, total symptom severity, Immediate Postconcussion Assessment and Cognitive Test (ImPACT) composites, one-month persistent symptoms, one-month Paediatric Quality of Life (PedsQL). Outcome measures ED visit before clinic evaluation (yes/no) served as the dependent variable. Results ED visits were reported for 12.8% (n=25) of participants. Amnesia (36.0% vs. 10.1%; p Conclusions Paediatric patients presenting to concussion clinic with 72 hours of injury who first visited an ED, have more dramatic symptoms at the TOI, yet do not appear to have any worse initial symptom severity, ImPACT scores, or one-month persistent symptoms or PedsQL than those who presented first to clinic. Future study should evaluate these relationships in larger samples. Competing interests The current study is funded in part by the National Operating Committee on Standards for Athletic Equipment. Ms. Fonseca is employed at the study setting. Ms. Phillips is employed at the study setting. Dr. Bloom is employed at the study setting.

Objective To examine associations between acute post-concussion measures and 1-month persistent symptom presence among paediatric concussion patients. Design Prospective cohort. Setting Three family medicine clinics, from the same practice, in an urban/suburban area of the USA. Subjects Paediatric concussion patients (n=179); ages 8-18 years (median age=15; IQR: 13-16) presenting within three days of injury. Intervention Participants completed a systematic evaluation during their initial visit and a 4-6 week follow-up survey (80% follow-up; n=144). The initial visit variables included age, gender, previous head injury, total symptom severity, Immediate Postconcussion Assessment and Cognitive Test (ImPACTTM) composite scores, and near point convergence (NPC). Outcome measures The primary outcome was 1-month follow-up persistent symptom presence, determined using the Rivermead Postconcussion Symptoms Questionnaire. We assessed univariate relationships for each variable with persistent symptoms. Variables significant in univariable analyses (p Results Persistent symptoms were reported for 27.1% (n=39) of participants. Females were more likely to have persistent symptoms (OR=1.9; 95% CI: 0.9, 4.0; p=0.086). Initial visit total symptom severity (Z=4.2; p Conclusions Gender, acute symptom burden and post-concussion neurocognitive deficits have significant relationships with persistent symptom presence. Clinicians should be mindful of these factors when considering treatment. Competing interests The current study was funded in part by the National Operating Committee on Standards for Athletic Equipment. Dr. Bloom is employed at the study setting. Ms. Fonseca is employed at the study setting. Ms. Phillips is employed at the study setting.