High altitude modulates concussion incidence, severity, and recovery in young athletes

ABSTRACT

Background

High altitude may affect concussion, but prior studies are limited . We tested whether high altitude affects sport-related concussion (SRC) incidence, severity, and recovery.

Methods

Twenty-five thousand eight hundred fifteen baseline and post-injury Immediate Post-Concussion Assessment and Cognitive Testing results were compiled from Florida and Colorado, low (27 m or 62 m) and high (1,640 m or 1,991 m) altitude locations, respectively. Incidence, severity, and recovery of injury were compared between altitudes.

Results

High altitude was associated with increased suspected concussion incidence (adjusted OR, 2.04 [95% CI, 1.86 to 2.24];P < .0001). However, high altitude was associated with lower concussion severity measured by Severity Index (SI) (adjusted OR, 0.42 [95% CI, 0.37 to 0.49];P < .0001). High altitude was associated with decreased recovery from post-concussive symptoms in the migraine (β, −2.72 [95% CI, −3.31 to −2.13]; P < .0001), cognitive (β, −1.88 [95% CI, −2.40 to −1.36]; P < .0001), and sleep symptom clusters (β, −0.30 [95% CI, −0.52 to −0.08]; P = .007). Athletes with initial SI≥8 showed prolonged neurocognitive dysfunction at high altitude (HR, 1.38 [95% CI, 1.06 to 1.81]; P = .02).

Conclusions

High altitude was associated with increased suspected concussions and prolonged recovery but less severe initial injury.

KEYWORDS:

• Sports related concussion
• mild traumatic brain injury
• high altitude
• severity index

Acknowledgments

None

Disclosure statement

No potential conflict of interest was reported by the author(s).

Previous publications/presentations

A previous version of this project was submitted as a poster to the 2020 AANS Annual Scientific Meeting.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.