Faculty Collaboration Database

Medical Disqualification Following Concussion in Collegiate Student-Athletes: Findings from the CARE Consortium. Sports Med 2020 Oct;50(10):1843-1855

Date

06/20/2020

Pubmed ID

32557231

DOI

10.1007/s40279-020-01302-y

Scopus ID

2-s2.0-85086735106 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

BACKGROUND: The absence of evidence-based guidelines make medical disqualification (MDQ) following concussion one of the most challenging decision-making processes faced by sports medicine professionals.

OBJECTIVE: We aimed to compare premorbid and postmorbid factors between student-athletes that were and were not medically disqualified from sport following a concussion.

METHODS: Among 1832 student-athletes diagnosed with concussion within the CARE Consortium, 53 (2.9%) were medically disqualified (MDQ +) and 1779 (97.1%) were not medically disqualified (MDQ-). We used contingency tables and descriptive statistics for an initial evaluation of a broad list of premorbid and postmorbid factors. For those factors showing association with MDQ status, we calculated odds ratios and 95% confidence intervals for the odds of being MDQ + in the presence of the identified factor.

RESULTS: History of 2 (OR: 3.2, 95% CI 1.5, 6.9) or 3 + (OR: 7.4, 95% CI 3.4, 15.9) previous concussions; 1 + headaches in past 3 months (OR: 1.8, 95% CI 1.0, 3.2); immediate removal from play (OR: 2.4, 95% CI 1.2, 4.9); alcohol (OR: 2.6, 95% CI 1.2, 5.4), tobacco (OR: 3.3, 95% CI 1.1, 9.5), or marijuana use since injury (OR: 5.4, 95% CI 1.5, 19.0); as well as prolonged recovery due to mental health alterations (OR: 5.3, 95% CI 2.0, 14.1) or motivation/malingering (OR: 7.5, 95% CI 3.3, 17.0) increased odds of being MDQ + . The MDQ + group took longer to become asymptomatic relative to the MDQ- group (MDQ + : 23.5 days, 95% CI 15.8, 31.2; MDQ-: 10.6 days, 95% CI 9.5, 11.6; p < 0.001).

CONCLUSIONS: MDQ following concussion was relatively rare. We identified three patterns related to MDQ following concussion: (1) concussion and headache history were the only premorbid factors that differed (2) initial concussion presentation was more severe and more immediate in the MDQ + group, and (3) post-concussion recovery outcomes expressed the greatest differences between groups.

Author List

Schmidt JD, Rawlins MLW, Lynall RC, D'Lauro C, Clugston JR, McAllister TW, McCrea M, Broglio SP, CARE Consortium Investigators

Author

Michael McCrea PhD Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Athletic Injuries
Brain Concussion
Clinical Decision-Making
Female
Humans
Male
Return to Sport
Risk Factors
Universities